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Sample records for single-incision sling system

  1. Minimally invasive treatment of female stress urinary incontinence with the adjustable single-incision sling system (AJUST ™ in an elderly and overweight population

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    Ralf Anding

    Full Text Available ABSTRACT Introduction The prevalence of urinary incontinence is increasing. Two major risk factors are overweight and age. We present objective and subjective cure rates of elderly and overweight patients treated with an adjustable single-incision sling system (AJUST™, C.R. BARD, Inc.. Materials and Methods Between 04/2009 and 02/2012 we treated 100 female patients with the single incision sling. Patients were retrospectively evaluated by Stamey degree of incontinence, cough test, pad use, and overall satisfaction. The primary outcomes of the study were objective and subjective cure rates, secondary outcomes were the safety profile of the sling and complications. Results The overall success rate in this population was 84.6% with a mean follow-up of 9.3 months. The average usage of pads per day decreased from 4.9 to 1.6 and was significantly lower in patients with a BMI <30 (p=0.004. Postoperative residual SUI was also lower in patients with a BMI <30 (p=0.006. Postoperative satisfaction was better in patients with a lower BMI, but this difference did not reach a level of significance (p=0.055. There were no complications such as bleeding, bladder injury, or tape infection. Conclusions In elderly and obese patients a considerable success rate is achievable with this quick and minimal invasive procedure. However, the success rate shows a clear trend in favor of a lower body-mass-index. The cut-off point has been identified at a BMI of 30. The AJUST™ system can be regarded as safe and beneficial for elderly and obese patients.

  2. Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients

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    Omer Bayrak

    2015-08-01

    Full Text Available ABSTRACTPurpose:To compare transobturator midurethral sling (TOS and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2 female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL.Materials and Methods:In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL.Results:There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05. ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively. In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190.Conclusions:The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.

  3. A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence

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    Schellart, René P.; Zwolsman, Sandra E.; Lucot, Jean-Philippe; de Ridder, Dirk J. M. K.; Dijkgraaf, Marcel G. W.; Roovers, Jan-Paul W. R.

    2018-01-01

    Midurethral sling procedures are the first surgical option in women undergoing surgery for stress urinary incontinence (SUI). Single-incision midurethral-slings (SIMS) were designed to provide similar efficacy to traditional midurethral slings but with reduced morbidity. In this international trial

  4. Comparison of the clinical outcomes of transobturator and single-incision slings for stress urinary incontinence

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    Ling-Ying Wu

    2016-07-01

    Full Text Available The aim of this study was to compare the clinical outcomes of anti-incontinence surgeries employing the transobturator sling and single-incision sling (SIS. Our hypothesis is that the outcome of the SIS is not inferior to the obturator sling. This retrospective study reviewed the medical records of patients who underwent anti-incontinence surgery with the transobturator sling or SIS from July 2005 to November 2014. Patients who underwent concomitant pelvic organ reconstruction with an artificial mesh were excluded. Assessments included preoperative and postoperative urodynamic examinations, perioperative complications, and postoperative urogenital symptoms. A total of 122 women were recruited according to the inclusion and exclusion criteria. Among them, 68 patients underwent transobturator sling procedures while 54 patients underwent SIS procedures. The subjective failure rate of the transobturator sling and SIS were 10.2% and 18.5%, respectively (p = 0.292. The objective failure rate, defined as a pad test showing more than 2 g of urine, was 10.2% for the transobturator sling and 12.9% for the SIS (p = 0.777. SIS resulted in less blood loss, operative time, length of hospital stay, and transient voiding dysfunction after the operation. No major complication occurred after either surgical intervention. In conclusion, SIS and transobturator slings might have similar efficacy, safety, and effects on new-onset urogenital symptoms.

  5. A randomized, controlled trial comparing an innovative single incision sling with an established transobturator sling to treat female stress urinary incontinence

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    Hinoul, Piet; Vervest, Harry A. M.; den Boon, Jan; Venema, Pieter L.; Lakeman, Marielle M.; Milani, Alfredo L.; Roovers, Jan-Paul W. R.

    2011-01-01

    Mid urethral sling procedures have become the surgical treatment of choice for female stress urinary incontinence. Innovative modifications of mid urethral sling procedures were recently introduced with the claim of offering similar efficacy and decreased morbidity. We compared the efficacy and

  6. Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study.

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    Naumann, Gert; Steetskamp, Joscha; Meyer, Mira; Laterza, Rosa; Skala, Christine; Albrich, Stefan; Koelbl, Heinz

    2013-05-01

    The objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI). Retropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients. From January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc(®) and Ajust(®) SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively). The SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.

  7. Contasure-Needleless® single incision sling compared with transobturator TVT-O® for the treatment of stress urinary incontinence: long-term results.

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    Martinez Franco, Eva; Amat Tardiu, Lluís

    2015-02-01

    This study compared transobturator tension-free vaginal tape (TVT-O®) and Contasure-Needleless (C-NDL®) at long-term follow-up . Non-inferiority, prospective, single-centre , quasi-randomised trial started in September 2006 and finished in April 2011 to compare C-NDL® with transobturator vaginal tape (TVT-O®) mesh in the treatment of stress urinary incontinence (SUI) . Epidemiological information, intraoperative and postoperative complications, subjective estimates of blood loss and pain levels were recorded. We also analysed the postoperative stress test, the subjective impression of improvement using the Sandvik Severity Index and the quality of life during follow-up using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) . Two hundred and fifty-seven women with primary SUI were scheduled to receive TVT-O® or C-NDL® and were followed up at least 3 years after the procedure . One hundred and eleven women in the C-NDL® group (84.7%) had a negative stress test, compared with 54 women (88.9%) in the TVT-O® group (p = 0.0065 for the non-inferiority test). The postoperative Sandvik Severity Index was 0 or better than the preoperative score in 90.7% of patients in the C-NDL® group and 95.4% of patients in the TVT-O® group (p = 0.0022). The complication rate was similar in both groups. There were significant differences (p = 0.02) in postoperative pain within the TVT-O® group. The degree of satisfaction was not statistically significant between the two groups. The outcomes for the C-NDL® group were similar to those of the TVT-O® group, adding the concept of "single incision tape" to the tension-free sling option.

  8. Comparison of single-incision mini-slings (Ajust) and standard transobturator midurethral slings (Align) in the management of female stress urinary incontinence: A 1-year follow-up.

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    Chang, Chia-Pei; Chang, Wen-Hsun; Hsu, Yen-Mei; Chen, Yi-Jen; Wen, Kuo-Chang; Chao, Kuan-Chong; Yen, Ming-Shyen; Horng, Huann-Cheng; Wang, Peng-Hui

    2015-12-01

    To investigate the effectiveness and safety of a new single-incision mini-sling (SIMS)-Ajust-compared with the standard transobturator midurethral sling (SMUS)-Align-for the treatment of female stress urinary incontinence (SUI). A retrospective cohort study was conducted between January 1, 2010 and August 31, 2012. Women with SUI who underwent either SMUS-Align or SIMS-Ajust were recruited. The primary outcomes included operation time, estimated operative blood loss, postoperative pain, and complications. The secondary outcomes included subjective and objective success, defined as an International Consultation on Incontinence Questionnaire (ICIQ) score of 0 or improvement as felt by the patient and a long-term complication, such as dyspareunia and mesh erosion after 6 months and 12 months of follow-up. A total of 136 patients were enrolled, including 76 receiving SMUS-Align and 60 receiving SIMS-Ajust. Baseline characteristics of the patients in both groups were similar, without a statistically significant difference. Primary outcomes between both groups were similar, except that women treated with SIMS-Ajust had statistically significantly shorter operation time (p = 0.003), less intent to treat (p < 0.05), and earlier postoperative discharge (p = 0.001) than women treated with SMUS-Align. Secondary outcomes were similar without a significant difference between the two groups (93% vs. 88% success rate in each group). Our results showed that SIMS-Ajust was not inferior to SMUS-Align with respect to success rate, and might have a slight advantage in early discharge. A long-term follow-up or prospective study is needed to confirm the above findings. Copyright © 2015. Published by Elsevier B.V.

  9. The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence. A study protocol for a pragmatic, multicentre, non-inferiority randomised controlled trial.

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    Abdel-Fattah, Mohamed; MacLennan, Graeme; Kilonzo, Mary; Assassa, R Phil; McCormick, Kirsty; Davidson, Tracey; McDonald, Alison; N'Dow, James; Wardle, Judith; Norrie, John

    2017-08-11

    Single-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence (SUI) with reduced morbidity and earlier recovery while maintaining similar efficacy to standard midurethral slings (SMUS). The aim of this study is to determine the clinical and cost-effectiveness of adjustable anchored SIMS compared with tension-free SMUS in the surgical management of female SUI, with 3-year follow-up. A pragmatic, multicentre, non-inferiority randomised controlled trial. The primary outcome measure is the patient-reported success rate measured by the Patient Global Impression of Improvement at 12 months. The primary economic outcome will be incremental cost per quality-adjusted life year gained at 12 months. The secondary outcomes measures include adverse events, objective success rates, impact on other lower urinary tract symptoms, health-related quality of life profile and sexual function, and reoperation rates for SUI. Secondary economic outcomes include National Health Service and patient primary and secondary care resource use and costs, incremental cost-effectiveness and incremental net benefit. The statistical analysis of the primary outcome will be by intention-to-treat and also a per-protocol analysis. Results will be displayed as estimates and 95% CIs. CIs around observed differences will then be compared with the prespecified non-inferiority margin. Secondary outcomes will be analysed similarly. The North of Scotland Research Ethics Committee has approved this study (13/NS/0143). The dissemination plans include HTA monograph, presentation at international scientific meetings and publications in high-impact, open-access journals. The results will be included in the updates of the National Institute for Health and Care Excellence and the European Association of Urology guidelines; these two specific guidelines directly

  10. Single-incision laparoscopic surgery in a survival animal model using a transabdominal magnetic anchoring system.

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    Cho, Yong Beom; Park, Chan Ho; Kim, Hee Cheol; Yun, Seong Hyeon; Lee, Woo Yong; Chun, Ho-Kyung

    2011-12-01

    Though single-incision laparoscopic surgery (SILS) can reduce operative scarring and facilitates postoperative recovery, it does have some limitations, such as reduction in instrument working, difficulty in triangulation, and collision of instruments. To overcome these limitations, development of new instruments is needed. The aim of this study is to evaluate the feasibility and safety of a magnetic anchoring system in performing SILS ileocecectomy. Experiments were performed in a living dog model. Five dogs (26.3-29.2 kg) underwent ileocecectomy using a multichannel single port (OCTO port; Darim, Seoul, Korea). The port was inserted at the umbilicus and maintained a CO(2) pneumoperitoneum. Two magnet-fixated vascular clips were attached to the colon using an endoclip applicator, and it was held together across the abdominal wall by using an external handheld magnet. The cecum was then retracted in an upward direction by moving the external handheld magnet, and the mesocolon was dissected with Ultracision(®). Extracorporeal functional end-to-end anastomosis was done using a linear stapler. All animals survived during the observational period of 2 weeks, and then re-exploration was performed under general anesthesia for evaluation of intra-abdominal healing and complications. Mean operation time was 70 min (range 55-100 min), with each subsequent case taking less time. The magnetic anchoring system was effective in achieving adequate exposure in all cases. All animals survived and convalesced normally without evidence of clinical complication during the observation period. At re-exploration, all anastomoses were completely healed and there were no complications such as abscess, bleeding or organ injury. SILS ileocecectomy using a magnetic anchoring system was safe and effective in a dog model. The development of magnetic anchoring systems may be beneficial for overcoming the limitations of SILS.

  11. Surgeon-tailored polypropylene mesh as a needleless single-incision sling versus TVT-O for the treatment of female stress urinary incontinence: a comparative study.

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    ElSheemy, Mohammed S; Fathy, Hesham; Hussein, Hussein A; Hussein, Eman A; Hassan, Sarah Mohamed

    2015-06-01

    To compare safety and efficacy of surgeon-tailored polypropylene mesh through needleless single-incision technique (STM) versus tension-free vaginal tape-obturator (TVT-O) aiming to decrease cost of treatment of stress urinary incontinence (SUI). This is important in developing countries due to limited healthcare resources. A retrospective cohort study was done at Urology and Gynecology Departments (dual-center), Cairo University, from January 2011 to August 2013. STM was inserted in 72 females, while TVT-O was inserted in 48 females. Females evaluated by cough stress test, stress and urge incontinence quality of life questionnaire (SUIQQ), Q max and abdominal leak point pressure (ALPP) were included. Different factors were compared between both groups using paired t, Wilcoxon's signed rank, McNemar, Chi-square, Fisher's exact, independent t or Mann-Whitney tests. Age, parity, previous surgeries, ALPP, intrinsic sphincter deficiency (ISD), associated prolapse and associated prolapse repair were comparable in both groups. No significant difference was found between both groups in postoperative complications (except groin pain), cure, SUIQQ indices improvement and Q max decline. In total, 65 (90 %) cured, 6 (8 %) improved while failure was detected in one (1 %) patient in STM group, while 42 (87 %) cured, 4 (8 %) improved and failure was detected in two (4 %) patients in TVT-O group. Presence of ISD (p = 0.565), urgency (p = 0.496), UUI (p = 0.531), previous surgeries (p = 0.345), associated urogenital prolapse (p = 0.218) or associated prolapse repair (p = 0.592) did not lead to any significant difference in outcome between both groups. Cost of mesh decreased from US$500 (TVT-O) to US$10 (STM). Outcome of STM is comparable to TVT-O. Furthermore, STM is more economic.

  12. A multicentre prospective randomised study of single-incision mini-sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the management of female stress urinary incontinence: pain profile and short-term outcomes.

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    Mostafa, Alyaa; Agur, Wael; Abdel-All, Mohamed; Guerrero, Karen; Lim, Chi; Allam, Mohamed; Yousef, Mohamed; N'Dow, James; Abdel-fattah, Mohamed

    2012-11-01

    To compare the postoperative pain profile, peri-operative details, and short-term patient-reported and objective success rates of single-incision mini-slings (SIMS) versus standard mid-urethral slings (SMUS). In a multicentre prospective randomised trial in six UK centres in the period between October 2009 and October 2010, 137 women were randomised to either adjustable SIMS (Ajust®, C. R. Bard Inc., NJ, USA), performed under local anaesthesia as an opt-out policy (n=69), or SMUS (TVT-O™, Ethicon Inc., Somerville, USA) performed under general anaesthesia (n=68). Randomisation was done through number-allocation software and using telephone randomisation. Postoperative pain profile (primary outcome) was assessed on a ten-point visual analogue scale at fixed time-points. Pre- and post operatively (4-6 months) women completed symptom severity, urgency perception scale (UPS), quality of life and sexual function questionnaires. In addition, women completed a Patient Global Impression of Improvement Questionnaire and underwent a cough stress test at 4-6 months follow up. Sample size calculation was performed and data were analysed using SPSS 18. Descriptive analyses are given and between-group comparisons were performed using chi-square, Fischer exact test and Mann-Whitney test as appropriate. Significance level was set at 5%. Women in the SIMS Ajust® group had a significantly lower postoperative pain profile up to 4 weeks (p=TVT-O™ groups respectively. There was a trend towards higher rates of de novo urgency or worsening of pre-existing urgency in the SIMS Ajust® group (21.7% versus 8.8%) but this did not reach statistical significance (p=0.063). Women in the SIMS Ajust® group had shorter hospital stay (median (IQR) 3.65 (2.49, 4.96)) compared to (4.42 (3.16, 5.56)) the TVT-O™ group 95% CI (-0.026, 1.326), with significantly earlier return to normal activities (p=0.025) and to work (p=0.006). The adjustable single-incision mini-sling (Ajust®) is associated

  13. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

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    Palanivelu, Praveenraj; Patil, Kedar Pratap; Parthasarathi, Ramakrishnan; Viswambharan, Jaiganesh K; Senthilnathan, Palanisami; Palanivelu, Chinnusamy

    2015-01-01

    The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  14. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

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    Praveenraj Palanivelu

    2015-01-01

    Full Text Available Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. Material and Methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11 and with corrugated drain (2.09 needlescopic method (1.2, Umbilical tape sling (1.95, crural stitch method (2.5. Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  15. Single Incision Laparoscopic Splenectomy: Our First Experiences

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    Umut Barbaros

    2011-06-01

    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  16. A single incision transaxillary thoracoscopic sympathectomy

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    Marić Nebojša

    2014-01-01

    Full Text Available Background/Aim. Primary hyperhidrosis causes are unknown. The disorder begins in early childhood. It intensifies in puberty and maturity. It is equally present in both sexes. The symptoms exacerbate when the body temperature rises and due to emotional stimuli affecting the sympathetic nerve system. The aim of this study was to demonstrate that videoassisted thoracoscopic surgery (VATS sympathectomy is a method for primary focal hyperhidrosis permanent treatment. The single incision method in properly selected patients maximizes the intervention effectiveness and minimizes aesthetic side effects. Methods. This prospective study analysed the findings in patients who had been operated on due to primary focal hyperhidrosis (face, palms, and armpits using a single small transaxilarry incision in the third inter-rib space at the level of the anterior axillary line with two 5 mm flexible ports. All the patients, with T2-T5 thoracoscopic sympathectomy of the sympathetic chain using a single small incision in the third inter-rib space in the anterior axillary line, were analysed in the period from September 2009 to November 2010 regarding the postoperative morbidity and outcomes of the operation (clinical evaluation and visual analogue scale with a view to assessing the effectiveness of the surgery conducted in this manner. Results. A total of 47 patients (18 men, 29 women, 18 to 48 years old (29 on average had underwent 94 bilateral video-assisted thoracoscopic sympathectomies. The sympathectomy was indicated in cases of facial blushing and sweating (6.38%, palmary sweating (34.04%, axillary sweating (14.89% or both palmary and axillary sweating (44.68%. The largest percentage of patients (98.6% had left the hospital the following day. The postoperative 30 day’s mortality was 0 and the conversion into open surgery was not necessary. As for complications, there had been an occurrence of partial pneumothorax in two patients treated by means of

  17. Single-incision total laparoscopic hysterectomy

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    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  18. Single incision laparoscopic colorectal resection: Our experience

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    Chinnusamy Palanivelu

    2012-01-01

    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  19. Transvaginal retropubic sling systems: efficacy and patient acceptability

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    Moldovan CP

    2015-02-01

    Full Text Available Christina P Moldovan,1 Michelle E Marinone,2 Andrea Staack3 1Department of Psychology, Loma Linda University, Loma Linda, California, United States of America; 2School of Medicine, Loma Linda University, Loma Linda, California, United States of America; 3Department of Urology, Loma Linda University Medical Center, Loma Linda, California, United States of America Abstract: Stress urinary incontinence is a common, disabling, and costly medical problem that affects approximately 50% of women with urinary incontinence. Suburethral retropubic slings have been developed as a minimally invasive and effective surgical option, and they have been used as a first-line treatment for stress urinary incontinence since 1995. However, complications including vaginal extrusion, erosion, pain, bleeding, infections, lower urinary tract symptoms, urinary retention, and incontinence have been reported with use of the slings. Several companies manufacture sling kits, and the sling kits vary with regard to the composition of the mesh and introducer needle. The aim of this review was to determine which sling kit was most effective for patients, had minimal reported side effects, and was best accepted by patients and surgeons. In a review of the literature, it was found that a total of 38 studies were published between 1995 and 2014 that reported on eight tension-free retropubic sling kits: SPARC, RetroArc, Align, Advantage, Lynx, Desara, Supris, and Gynecare TVT. The Gynecare TVT was the most cited sling kit; the second most cited was the SPARC. This review provides a summary of the studies that have examined positive and negative outcomes of the retropubic tension-free suburethral sling procedure using various sling kits. Overall, the results of the literature review indicated that data from comparisons of the available sling kits are insufficient to make an evidenced-based recommendation. Therefore, the decision regarding which sling kit is appropriate to use in

  20. Single-incision laparoscopic bariatric surgery

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    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  1. Current Status of Single-incision Laparoscopic Surgery

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    Ahmed, Irfan; Ciancio, Fabio; Ferrara, Vincenzo

    2012-01-01

    Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future...

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

    Science.gov (United States)

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

    2013-06-01

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

  3. Cost assessment of instruments for single-incision laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Al-Tayar, Haytham; Rosenberg, Jacob

    2012-01-01

    Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed...

  4. Modification of the Nuss Procedure: The Single-incision Technique

    Directory of Open Access Journals (Sweden)

    Tetsushi Aizawa, MD

    2014-11-01

    Full Text Available Summary: The Nuss procedure is a prevalent minimally invasive surgery for pectus excavatum. Although the Nuss procedure has the advantage of leaving less obtrusive scars, the standard technique requires at least 3 skin incisions to insert several instruments. We experienced 7 cases of the modified Nuss procedure using a single incision during a 7-year period. To facilitate passing of the bar, a traction guide was created according to our unique method. There was no need for a bar stabilizer, and no severe intraoperative complications occurred. All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation. Two patients underwent bar removal via the same single incision without any difficulties.

  5. Randomized trial of a comparison of the efficacy of TVT-O and single-incision tape TVT SECUR systems in the treatment of stress urinary incontinent women--2-year follow-up.

    Science.gov (United States)

    Masata, Jaromir; Svabik, Kamil; Zvara, Karel; Drahoradova, Petra; El Haddad, Rachid; Hubka, Petr; Martan, Alois

    2012-10-01

    The aim of this study was to compare the efficacy of the use of tension-free vaginal tape obturator (TVT-O) and single-incision TVT SECUR, hammock and U approach (TVT-S, H and U), in the treatment of urodynamic stress urinary incontinence (SUI). This single-center randomized three-arm trial compared the objective and subjective efficacy and early failure rate of the TVT-O and TVT-S H and U approach by objective criteria (cough test) and subjective criteria using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-UI SF). The objective efficacy rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined by no stress leakage of urine after surgery based on the evaluation of ICIQ-UI SH (when patients ticked "Never"/"Urine does not leak" in answer to question 6: When does urine leak?). Objective and subjective efficacy were evaluated using Last Failure Carried Forward analysis, i.e., final analysis also included patients with early failure. To describe outcome at different time points, the Last Observation Carried Forward method was also implemented. One hundred ninety-seven women with proven SUI were randomized into three groups--TVT-O (n = 68), TVT-S H (n = 64), and TVT-S U (n = 65). Each patient allocated to a treatment group received the planned surgery. There were no differences in each group in preoperative characteristics. Median follow-up after surgery was 2 years (SD, 0.8; range, 0.1 to 3.8 years). Of the subjects, 92.6% in the TVT-O group, 68.8% in the TVT-S H group, and 69.2% in the TVT-S U group had negative stress test (p TVT-O group, 68.8% in the TVT-S H group, and 61.5% in the TVT-S U group were subjectively continent (p = 0.02). Our study demonstrated a significantly lower subjective and objective cure rate in the single-incision TVT group compared to the TVT-O group.

  6. The TVT Worldwide Observational Registry for Long-Term Data: safety and efficacy of suburethral sling insertion approaches for stress urinary incontinence in women.

    Science.gov (United States)

    Tincello, Douglas G; Botha, Theunis; Grier, Douglas; Jones, Peter; Subramanian, Dhinagar; Urquhart, Colin; Kirkemo, Aaron; Khandwala, Salil

    2011-12-01

    We examined the clinical effectiveness of a single incision sling in women with stress urinary incontinence and obtained comparative perioperative and postoperative data on retropubic and transobturator slings. Women who underwent a cough stress test were treated with surgery using a single incision, retropubic or obturator sling (Gynecare® TVT SECUR™, TVT™ or TVT Obturator System, respectively) with the choice of sling based on surgeon preference. Objective cure was assessed by the standing cough stress test at 1 year. Subjective outcomes were assessed by the Incontinence Quality of Life Questionnaire and EQ-5D™. Perioperative data and return to normal activity were recorded. Of the 1,398 women who underwent surgery there were postoperative data on 1,334, including 32.8%, 17.8% and 49.4% who received a tension free vaginal tape, obturator tension free vaginal tape and SECUR, respectively. After obturator tension free vaginal tape surgery fewer women had a positive cough stress test than after TVT and SECUR surgery (4 of 110 or 3.6% vs 24 of 187 or 12.8% and 59 of 374 or 15.8%, respectively). Incontinence Quality of Life Questionnaire effect size was 1.87, 1.42 and 1.56, respectively, indicating a large treatment effect. Using our Incontinence Quality of Life Questionnaire response definition 85.4%, 79.0% and 85.2% of the TVT, TVT outside-in obturator system and SECUR cohorts, respectively, were treatment responders (p = 0.11).The SECUR cohort had the shortest operative time, the lowest proportion of women who required an overnight stay and the most women who underwent surgery under local anesthesia. Median time to return to employment, housework, sex life and hobbies was most rapid for SECUR. This registry demonstrates the high effectiveness of all 3 approaches. The single incision sling appeared to have objective and subjective efficacy similar to that of the retropubic sling and it can be performed under local anesthesia in an office environment

  7. Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

    Directory of Open Access Journals (Sweden)

    Aram Baram

    2014-02-01

    Full Text Available Background: Primary hyperhidrosis is characterized by excessive sweating beyond physiological needs. It is a common disease (incidence 2.8% that causes intense discomfort for patients. In the last decade, advantages of Single-Incision Thoracoscopic Sympathectomy have become clear, particularly in decreasing morbidity of sympathectomy. Patients and methods: From January 2010 to December 2012, 39 patients (29 females and 10 males with primary palmar or axillary hyperhidrosis were treated by thoracoscopic sympathectomy. The age ranged from 18 to 40 years with a mean of 26.28 years. We used single incision thoracoscopic electrocoagulation through 10 mm incision for thoracic sympathetic chain (T2–T4. Results: The mean follow-up was 23.6 ± 14.2 months (range = 4–24 months. A total of 97.42% of patients were satisfied with the results. A total of 72.5% of patients had cure, one patient (2.5% and another patient (2.5% presented with recurrent axillary hyperhidrosis. The morbidity was 10.2% with no mortality. Percentage of compensatory sweating and gustatory sweating were 5.1% (p = .353 and 2.5% (p = .552, respectively. The result of sympathectomy in patients with both palmar and axillary hyperhidrosis was significantly better (17, 43.58% compared to palmar type (14, 35.89% or axillary type (7, 17.94%. Conclusion: Thoracoscopic sympathectomy is a simple, safe, and cost-effective therapy with good results and low complications.

  8. Single-incision laparoscopic surgery for pyloric stenosis.

    Science.gov (United States)

    Kozlov, Yury; Novogilov, Vladimir; Podkamenev, Alexey; Rasputin, Andrey; Weber, Irina; Solovjev, Alexey; Yurkov, Pavel

    2012-04-01

    Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

  9. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

    Directory of Open Access Journals (Sweden)

    Xin-Lei Xia

    2015-01-01

    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  10. Adjustable mini-sling compared to conventional mid-urethral slings in women with urinary incontinence

    DEFF Research Database (Denmark)

    Rudnicki, Martin; von Bothmer-Ostling, Katarina; Holstad, Anja

    2017-01-01

    INTRODUCTION: The primary aim was to compare the objective and subjective outcomes and short-term complication rates of an adjustable single-incision mini-sling (SIMS) versus standard mid-urethral slings (SMUS). The secondary aim was reporting pain perception and complications at one-year follow......-up. MATERIAL AND METHODS: The study was designed as a multicenter prospective randomized trial where women were included by eight centers in Denmark, Norway and Sweden. The trial was registered at ClinicalTrials. gov: NCT01754558. A total of 305 women less than 60 years old with verified stress urinary...... incontinence were included. All women were randomized to SIMS (Ajust(®) ; N=155) or SMUS (TVT, TVT-O or TOT; N=150) and were evaluated by stress test and bladder diary before and after surgery and symptoms related to incontinence using ICIQ-SF, PISQ-12 and PGI-S and PGI-I. Objective cure was defined...

  11. Single incision laparoscopic liver resection (SILL – a systematic review

    Directory of Open Access Journals (Sweden)

    Benzing, Christian

    2015-12-01

    Full Text Available Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome.Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL. The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good.Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.

  12. Single-incision laparoscopic cholecystectomy with needle graspers.

    Science.gov (United States)

    Sumiyoshi, Kinjiro; Sato, Norihiro; Akagawa, Shin; Hirano, Tatsuya; Koikawa, Kazuhiro; Horioka, Kohei; Ozono, Keigo; Fujiwara, Kenji; Tanaka, Masao; Sada, Masayuki

    2012-01-01

    Single-incision laparoscopic cholecystectomy (SILC) is a promising alternative to standard multi-incision laparoscopic cholecystectomy (LC). However, generalization of SILC is still hampered by technical difficulties mainly associated with the lack of trocars used for retraction of the gallbladder. We therefore developed a modified method of SILC with the use of needle graspers (SILC-N) for optimal retraction and exposure. In addition to two trocars inserted through a single transumbilical incision, two needle ports were placed on the right subcostal and lateral abdominal wall, through which needle graspers were used for retraction of the gallbladder. Since December, 2009, 12 patients with symptomatic cholelithiasis were treated by SILC-N. SILC-N was successfully performed in all but one patient requiring a conversion to the 4-port LC with a mean operative time of 71.5 (48-107) minutes. None of the patients experienced intraoperative or postoperative complications. The transumbilical incision and pinholes for needle graspers were almost invisible on discharge. Our preliminary results suggest that SILC-N is a simple, safe and feasible technique of cholecystectomy offering similar postoperative recovery and better cosmetic outcome as compared to conventional LC.

  13. Single incision pediatric endoscopic surgery: advantages of relatively large incision

    International Nuclear Information System (INIS)

    Yilmaz, E.; Afsarlar, E.; Karaman, I.

    2015-01-01

    To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages. Study Design: An observational case series. Place and Duration of Study: Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. Methodology: A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. Results: SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO/sub 2/ could be ensured. All of the patients/parents were satisfied with the cosmesis. Conclusion: SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO/sub 2/, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision. (author)

  14. Single-Incision Laparoscopic Sterilization of the Cheetah (Acinonyx jubatus).

    Science.gov (United States)

    Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schmidt-Küntzel, Anne; Schulman, Martin L; Stander, Jana A; Stegmann, George F; Schoeman, Johan P

    2015-07-01

    To describe laparoscopic ovariectomy and salpingectomy in the cheetah (Acinonyx jubatus) using single-incision laparoscopic surgery (SILS). Prospective cohort. Female cheetahs (Acinonyx jubatus) (n = 21). Cheetahs were randomly divided to receive either ovariectomy (n = 11) or salpingectomy (n = 10). The use and complications of a SILS port was evaluated in all of cheetahs. Surgery duration and insufflation volumes of carbon dioxide (CO2 ) were recorded and compared across procedures. Laparoscopic ovariectomy and salpingectomy were performed without complications using a SILS port. The poorly-developed mesosalpinx and ovarian bursa facilitated access to the uterine tube for salpingectomy in the cheetah. The median surgery duration for ovariectomy was 24 minutes (interquartile range 3) and for salpingectomy was 19.5 minutes (interquartile range 3) (P = .005). The median volume of CO2 used for ovariectomy was 11.25 L (interquartile range 3.08) and for salpingectomy was 4.90 L (interquartile range 2.52), (P = .001) CONCLUSIONS: Laparoscopic ovariectomy and salpingectomy can be performed in the cheetah using SILS without perioperative complications. Salpingectomy is faster than ovariectomy and requires less total CO2 for insufflation. © Copyright 2015 by The American College of Veterinary Surgeons.

  15. Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

    Science.gov (United States)

    Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

    2012-01-01

    The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

  16. Mid-urethral slings in female incontinence: Current status

    Directory of Open Access Journals (Sweden)

    Ryan M Krlin

    2011-01-01

    Full Text Available The advent of the mid-urethral sling (MUS 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI. Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one′s choice of MUS to the individual patient and her unique clinical parameters remains the best option.

  17. Tension-releasing suture appendage on single-incision sling device: A novel approach to postoperative voiding dysfunctions

    Directory of Open Access Journals (Sweden)

    Tsia-Shu Lo

    2016-08-01

    Conclusion: Tension-releasing suture is effective in the management of immediate postoperative voiding dysfunction in an SIS procedure. SIS operation has good short-term objective and subjective cure rates for female urodynamic stress incontinence.

  18. Predictive factors that influence treatment outcomes of innovative single incision sling: comparing TVT-Secur to an established transobturator sling for female stress urinary incontinence.

    Science.gov (United States)

    Hwang, Eugene; Shin, Ju Hyun; Lim, Jae Sung; Song, Ki Hak; Sul, Chong Koo; Na, Yong Gil

    2012-07-01

    This study aims to identify independent risk factors for treatment failure of tension-free vaginal tape TVT-Secur (TVT-S) compared to that of the well-established transobturator tape. Of a total of 175 consecutive patients with urodynamically confirmed stress urinary incontinence (SUI) identified between July 2007 and March 2010, 89 patients underwent TVT-S, and 86 underwent TOT. Cure was defined using the Urogenital Distress Inventory as no urinary leakage during physical activity, coughing, or sneezing as reported by patients during a telephone survey. To identify predictors of treatment failure, multivariable logistic regression models were used, and odds ratios (ORs) were calculated using variables identified during univariate analysis. There were more patients with cystocele ≥ grade 2 in the TVT-S group (p = 0.031); otherwise the groups were well matched. After a median follow-up of 32 months (range, 12-44 months), the overall cure rate was 80.6%; it was 70.8% for those treated with TVT-S and 90.7% for those treated with TOT (p = 0.001). In a multivariate model, previous incontinence surgery (OR 27.1, p = 0.005) and a cystocele ≥ grade 2 (OR 3.0, p = 0.020) were independent risk factors influencing the outcome of TVT-S procedures. For the TOT procedures, detrusor overactivity was an independent risk factor in a multivariate model (OR 8.6, p = 0.033). TVT-S could be performed for selected patients, but conventional TOT procedures are still superior to the novel TVT-S device.

  19. Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma.

    Science.gov (United States)

    Barbaros, Umut; Sümer, Aziz; Demirel, Tugrul; Karakullukçu, Nazlı; Batman, Burçin; Içscan, Yalın; Sarıçam, Gülay; Serin, Kürçsat; Loh, Wei-Liang; Dinççağ, Ahmet; Mercan, Selçuk

    2010-01-01

    Transumbilical single incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. Herein, we report the first transumbilical single incision laparoscopic pancreatectomy case in a patient who had renal cell cancer metastasis on her pancreatic corpus and tail. A 59-year-old female who had metastatic lesions on her pancreas underwent laparoscopic subtotal pancreatectomy through a 2-cm umbilical incision. Single incision pancreatectomy was performed with a special port (SILS port) and articulated equipment. The procedure lasted 330 minutes. Estimated blood loss was 100mL. No perioperative complications occurred. The patient was discharged on the seventh postoperative day with a low-volume (20mL/day) pancreatic fistula that ceased spontaneously. Pathology result of the specimen was renal cell cancer metastases. This is the first reported SILS pancreatectomy case, demonstrating that even advanced surgical procedures can be performed using the SILS technique in well-experienced centers. Transumbilical single incision laparoscopic pancreatectomy is feasible and can be performed safely in experienced centers. SILS may improve cosmetic results and allow accelerated recovery for patients even with malignancy requiring advanced laparoscopic interventions.

  20. Laparoscopic surgery for esophageal achalasia: Multiport vs single-incision approach.

    Science.gov (United States)

    Fukuda, Shuichi; Nakajima, Kiyokazu; Miyazaki, Yasuhiro; Takahashi, Tsuyoshi; Makino, Tomoki; Kurokawa, Yukinori; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

    2016-02-01

    SILS can potentially improve aesthetic outcomes without adversely affecting treatment outcomes, but these outcomes are uncertain in laparoscopic Heller-Dor surgery. We determined if the degree of patient satisfaction with aesthetic outcomes progressed with the equivalent treatment outcomes after the introduction of a single-incision approach to laparoscopic Heller-Dor surgery. We retrospectively reviewed 20 consecutive esophageal achalasia patients (multiport approach, n = 10; single-incision approach, n = 10) and assessed the treatment outcomes and patient satisfaction with the aesthetic outcomes. In the single-incision approach, thin supportive devices were routinely used to gain exposure to the esophageal hiatus. No statistically significant differences in the operating time (210.2 ± 28.8 vs 223.5 ± 46.3 min; P = 0.4503) or blood loss (14.0 ± 31.7 vs 16.0 ± 17.8 mL; P = 0.8637) were detected between the multiport and single-incision approaches. We experienced no intraoperative complications. Mild dysphagia, which resolved spontaneously, was noted postoperatively in one patient treated with the multiport approach. The reduction rate of the maximum lower esophageal sphincter pressure was 25.1 ± 34.4% for the multiport approach and 21.8 ± 19.2% for the single-incision approach (P = 0.8266). Patient satisfaction with aesthetic outcomes was greater for the single-incision approach than for the multiport approach. When single-incision laparoscopic Heller-Dor surgery was performed adequately and combined with the use of thin supportive devices, patient satisfaction with the aesthetic outcomes was higher and treatment outcomes were equivalent to those of the multiport approach. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  1. Postoperative groin pain and success rates following transobturator midurethral sling placement: TVT ABBREVO® system versus TVT™ obturator system.

    Science.gov (United States)

    Canel, Virginie; Thubert, Thibault; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2015-10-01

    Placement of a transobturator midurethral sling (MUS) is the standard surgical treatment for stress urinary incontinence. Most recent MUS procedures have been poorly evaluated. We compared the results using a "new" device expected to reduce postoperative pain, the TVT ABBREVO® system (TVT-Abb), with those using the TVT™ obturator system (TVT-O). This was a retrospective study comparing the use of the TVT-Abb (in 50 patients) and the TVT-O (in 50 patients). The main outcomes were the amount of postoperative pain, the success rate (no reported urinary leakage and negative cough test) with both MUS procedures, and the prevalence of complications. The mean follow-up time was 12 months. The preoperative characteristics of the two groups were comparable. There was less postoperative pain (VAS, 0 to 100) in the TVT-Abb group than in the TVT-O group (12.2 vs. 24.4, p TVT-Abb group and the TVT-O group (8 % vs. 12 %, p = 0.74). The prevalences of perioperative and postoperative complications (bladder/urethral injury, haemorrhage) in the two groups were equal. The success rates were similar at 12 months after surgery (88 % vs. 78 %, p = 0.29). The success rates with TVT-Abb and TVT-O were equal at 12 months after surgery, but there was less immediate postoperative pain with TVT-Abb.

  2. Single-incision video-assisted anatomical segmentectomy with handsewn bronchial closure for endobronchial lipoma.

    Science.gov (United States)

    Galvez, Carlos; Sesma, Julio; Bolufer, Sergio; Lirio, Francisco; Navarro-Martinez, Jose; Galiana, Maria; Baschwitz, Benno; Rivera, Maria Jesus

    2016-08-01

    Endobronchial lipomas are rare benign tumors whose symptoms are usually confused with recurrent infections or even asthma diagnosis, and mostly caused by endobronquial obstructive component which also conditions severity. We report a case of a 60-year-old man with a right-lower lobe upper-segment endobronchial myxoid tumor with uncertain diagnosis. We performed a single incision video-assisted anatomical segmentectomy and wedge bronchoplasty with handsewn closure to achieve complete resection and definitive diagnosis. During the postoperative air leak was not observed and there was no complication, with low pain scores and complete recovery. Final pathological exam showed endobronchial lipoma. Single-incision (SI) anatomical segmentectomies are lung-sparing resections for benign or low-grade malignancies with diagnostic and therapeutic value, and the need for a wedge bronchoplasty is not a necessary indication for conversion to multiport or open thoracotomy.

  3. Single-incision, laparoscopic-assisted jejunal resection and anastomosis following a gunshot wound.

    Science.gov (United States)

    Rubin, Jacob A; Shigemoto, Reynsen; Reese, David J; Case, J Brad

    2015-01-01

    A 2 yr old castrated male Pomeranian was evaluated for a 6 wk history of chronic vomiting, intermittent anorexia, and lethargy. Physical examination revealed a palpable, nonpainful, soft-tissue mass in the midabdominal area. Abdominal radiographs and ultrasound revealed a focal, eccentric thickening of the jejunal wall with associated jejunal mural foreign body and partial mechanical obstruction. Following diagnosis of a partial intestinal obstruction as the cause of chronic vomiting, the patient underwent general anesthesia for a laparoscopic-assisted, midjejunal resection and anastomosis using a single-incision laparoscopic surgery port. The patient was discharged the day after surgery, and clinical signs abated according to information obtained during a telephone interview conducted 2 and 8 wk postoperatively. The dog described in this report is a unique case of partial intestinal obstruction treated by laparoscopic-assisted resection and anastomosis using a single-incision laparoscopic surgery port.

  4. Risk factors for an additional port in single-incision laparoscopic cholecystectomy in patients with cholecystitis.

    Science.gov (United States)

    Araki, Kenichiro; Shirabe, Ken; Watanabe, Akira; Kubo, Norio; Sasaki, Shigeru; Suzuki, Hideki; Asao, Takayuki; Kuwano, Hiroyuki

    2017-01-01

    Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.

  5. No-Drain Single Incision Liposuction Pull-Through Technique for Gynecomastia.

    Science.gov (United States)

    Khalil, Ashraf A; Ibrahim, Amr; Afifi, Ahmed M

    2017-04-01

    Several different methods have been proposed for treatment of gynecomastia, depending on the amount of breast enlargement and skin redundancy. The liposuction pull-through technique has been proposed as an efficacious treatment for many gynecomastia cases. This work aims to study the outcome of this technique when applied as an outpatient procedure, without the use of drains and through a single incision. Fifty-two patients with bilateral gynecomastia without significant skin excess were included in this study. The liposuction pull-through technique was performed through a single incision just above the inframammary fold and without the use of drains. Patients were followed up for 6 months. The proposed technique was able to treat the gynecomastia in all patients, with a revision rate of 1.9% to remove residual glandular tissues. There were no seromas, hematomas, nipple distortion, permanent affection of nipple sensation or wound healing problems. The liposuction pull-through technique is an effective treatment for gynecomastia without significant skin redundancy. It combines the benefits of the direct excision of glandular tissues, with the minimally invasive nature of liposuction. Performing the procedure through a single incision without the use of drains and without general anesthesia is a safe alternative. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

  6. Eyelid reanimation with gold weight implant and tendon sling suspension: evaluation of excursion and velocity using the FACIAL CLIMA system.

    Science.gov (United States)

    Hontanilla, Bernardo; Marre, Diego

    2013-04-01

    This study aims to analyse the efficacy of static techniques, namely gold weight implant and tendon sling, in the reanimation of the paralytic eyelid. Upper eyelid rehabilitation in terms of excursion and blinking velocity is performed using the automatic motion capture system, FACIAL CLIMA. Seventy-four patients underwent a total of 101 procedures including 58 upper eyelid gold weight implants and 43 lower eyelid tendon suspension with 27 patients undergoing both procedures. The presence of lagophtalmos, eye dryness, corneal ulcer, epiphora and lower lid ptosis/ectropion was assessed preoperatively. The Wilcoxon signed-rank test was used to compare preoperative versus postoperative measurements of upper eyelid excursion and blinking velocity determined with FACIAL CLIMA. Significance was set at p CLIMA revealed significant improvement of eyelid excursion and velocity of blinking (p CLIMA system is a reliable method to quantify upper eyelid excursion and blinking velocity and to detect the exact position of the lower eyelid. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision

    Directory of Open Access Journals (Sweden)

    Noah J. Switzer

    2012-01-01

    Full Text Available Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults. Already in 1894, McBurney advocated for the surgical removal of the inflamed appendix and is credited with the initial description of an Open Appendectomy (OA. With the introduction of minimally invasive surgery, this classic approach evolved into a procedure with multiple, smaller incisions; a technique termed Laparoscopic Appendectomy (LA. There is much literature describing the advantages of this newer approach. To name a few, patients have significantly less wound infections, reduced pain, and a reduction in ileus compared with the OA. In the past few years, Single Incision Laparoscopic Appendectomy (SILA has gained popularity as the next major evolutionary advancement in the removal of the appendix. Described as a pioneer in the era of “scarless surgery,” it involves only one transumbilical incision. Patients are postulated to have reduced post-operative complications such as infection, hernias, and hematomas, as well as a quicker recovery time and less post-operative pain scores, in comparison to its predecessors. In this review, we explore the advancement of the appendectomy from open to laparoscopic to single incision.

  8. [Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case].

    Science.gov (United States)

    Telich-Tarriba, José Eduardo; Parrao-Alcántara, Iris Jocelyn; Montes-Hernández, Jesús Manuel; Vega-Pérez, Jesús

    2015-01-01

    Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  9. Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy.

    Science.gov (United States)

    Kroh, Matthew; Chalikonda, Sricharan; Chand, Bipan; Walsh, R Matthew

    2013-01-01

    Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.

  10. Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

    Science.gov (United States)

    Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

    2013-01-01

    Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.

  11. Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy

    Science.gov (United States)

    Fujino, Shiki; Miyoshi, Norikatsu; Noura, Shingo; Shingai, Tatsushi; Tomita, Yasuhiko; Ohue, Masayuki; Yano, Masahiko

    2014-01-01

    In this case report, we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer. The optimal surgical therapy for low-grade appendiceal neoplasm is controversial; currently, the options include appendectomy, cecectomy, right hemicolectomy, and open or laparoscopic surgery. Due to the risk of pseudomyxoma peritonei, complete resection without rupture is necessary. We have encountered 5 cases of low-grade appendiceal neoplasm and all 5 patients had no lymph node metastasis. We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy. In the present case, we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery (SILS), which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery. We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors, such as low-grade appendiceal neoplasms. PMID:24868331

  12. Single incision device (TVT Secur) versus retropubic tension-free vaginal tape device (TVT) for the management of stress urinary incontinence in women: a randomized clinical trial.

    Science.gov (United States)

    Ross, Sue; Tang, Selphee; Schulz, Jane; Murphy, Magnus; Goncalves, Jose; Kaye, Stephen; Dederer, Lorel; Robert, Magali

    2014-12-22

    In 2006, Ethicon Inc. introduced a new minimally invasive single incision sling device for the surgical treatment of stress urinary incontinence, the Gynecare TVT Secur®. For device licensing, no new evidence of TVT Secur efficacy and safety was needed: rather evidence was provided of the long-term follow-up of patients who had a procedure using a predecate retropubic tension-free vaginal tape device. Before adopting TVT Secur into our routine clinical practice, we decided to evaluate it. The objective of our Canadian multi-centre pragmatic randomized controlled trial was to compare the effectiveness of the new single-incision device, TVT Secur, to the established TVT device, in terms of objective cure of stress urinary incontinence (SUI) at 12 months postoperatively. Other outcomes included: complications, symptoms, and incontinence-related quality of life. The sample size estimate for our trial was 300, but the trial stopped early because of poor recruitment. 74 women participated (40 allocated to TVT Secur, 34 to TVT). At 12 months postoperatively, 27/33(82%) of TVT Secur group were cured, compared with 25/28(89%) of the TVT group (relative risk 0.92, 95% confidence interval 0.75 to 1.13, p=0.49). Most women reported little or no SUI symptoms (35/37(95%) vs 29/30(97%), >0.999). Quality of life improved significantly from baseline for both groups (IIQ-7 mean change -25 for both groups) but did not differ between groups (p=0.880). Our small randomized trial did not find statistically significant differences in outcomes between women allocated to the TVT Secur device versus those allocated to the TVT device for stress urinary incontinence. Despite the discontinuation of TVT Secur in March 2013 for commercial reasons, the importance of our study lies in making evidence available for the many women who had a TVT Secur device implanted and their physicians who may be considering alternative treatments. Our experience illustrates the difficulty of undertaking research

  13. Intraoperative Ultrasound-Guided Removal of Retained Mini Sling Anchor Causing Vaginal Pain: A Case Report.

    Science.gov (United States)

    Almassi, Nima; Goldman, Howard B

    2016-01-01

    Since the introduction of the tension-free vaginal tape, the surgical management of female stress urinary incontinence has undergone a dramatic shift toward synthetic midurethral slings (MUSs). The evolution of the MUS has led to the development of the single incision mini sling (SIMS), a minimally invasive procedure that can be performed under local anesthesia. Complications arising after SIMS placement parallel those of the traditional MUS, including pelvic pain, dyspareunia, and mesh erosion. The patient in this case presented with persistent pelvic pain due to a retained SIMS anchor after having previously undergone SIMS placement and subsequent transvaginal exploration with mesh removal. We report the use of intraoperative ultrasound for identification and removal of the retained SIMS anchor.

  14. The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke

    Science.gov (United States)

    Sohn, Min Kyun; Jee, Sung Ju; Hwang, Pyoungsik; Jeon, Yumi

    2015-01-01

    Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (pBobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position. PMID:26798614

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

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

    2005-10-01

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

  17. Flight Testing and Real-Time System Identification Analysis of a UH-60A Black Hawk Helicopter with an Instrumented External Sling Load

    Science.gov (United States)

    McCoy, Allen H.

    1998-01-01

    Helicopter external air transportation plays an important role in today's world. For both military and civilian helicopters, external sling load operations offer an efficient and expedient method of handling heavy, oversized cargo. With the ability to reach areas otherwise inaccessible by ground transportation, helicopter external load operations are conducted in industries such as logging, construction, and fire fighting, as well as in support of military tactical transport missions. Historically, helicopter and load combinations have been qualified through flight testing, requiring considerable time and cost. With advancements in simulation and flight test techniques there is potential to substantially reduce costs and increase the safety of helicopter sling load certification. Validated simulation tools make possible accurate prediction of operational flight characteristics before initial flight tests. Real time analysis of test data improves the safety and efficiency of the testing programs. To advance these concepts, the U.S. Army and NASA, in cooperation with the Israeli Air Force and Technion, under a Memorandum of Agreement, seek to develop and validate a numerical model of the UH-60 with sling load and demonstrate a method of near real time flight test analysis. This thesis presents results from flight tests of a U.S. Army Black Hawk helicopter with various external loads. Tests were conducted as the U.S. first phase of this MOA task. The primary load was a container express box (CONEX) which contained a compact instrumentation package. The flights covered the airspeed range from hover to 70 knots. Primary maneuvers were pitch and roll frequency sweeps, steps, and doublets. Results of the test determined the effect of the suspended load on both the aircraft's handling qualities and its control system's stability margins. Included were calculations of the stability characteristics of the load's pendular motion. Utilizing CIFER(R) software, a method for near

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

    Science.gov (United States)

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

    2015-02-01

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

  19. Hybrid Single-Incision Laparoscopic Colon Cancer Surgery Using One Additional 5 mm Trocar.

    Science.gov (United States)

    Kim, Hyung Ook; Choi, Dae Jin; Lee, Donghyoun; Lee, Sung Ryol; Jung, Kyung Uk; Kim, Hungdai; Chun, Ho-Kyung

    2018-02-01

    Single-incision laparoscopic surgery (SILS) is a feasible and safe procedure for colorectal cancer. However, SILS has some technical limitations such as collision between instruments and inadequate countertraction. We present a hybrid single-incision laparoscopic surgery (hybrid SILS) technique for colon cancer that involves use of one additional 5 mm trocar. Hybrid SILS for colon cancer was attempted in 70 consecutive patients by a single surgeon between August 2014 and July 2016 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine. Using prospectively collected data, an observational study was performed on an intention-to-treat basis. Hybrid SILS was technically completed in 66 patients, with a failure rate of 5.7% (4/70). One patient was converted to open surgery for para-aortic lymph node dissection. Another was converted to open surgery due to severe peritoneal adhesion. An additional trocar was inserted for adhesiolysis in the other two cases. Median lengths of proximal and distal margins were 12.8 cm (interquartile range [IQR], 10.0-18.6), and 8.2 cm (IQR, 5.5-18.3), respectively. Median total number of lymph nodes harvested was 24 (IQR, 18-33). Overall rate of postoperative morbidity was 12.9%, but there were no Clavien-Dindo grade III or IV complications. There was no postoperative mortality or reoperation. Median postoperative hospital stay was 6 days (IQR, 5-7). Hybrid SILS using one additional 5 mm trocar is a safe and effective minimally invasive surgical technique for colon cancer. Experienced laparoscopic surgeons can perform hybrid SILS without a learning curve based on the formulaic surgical techniques presented in this article.

  20. Solo Single-Incision Laparoscopic Resectional Roux-en-Y Gastric Bypass for Morbid Obesity with Metabolic Syndrome.

    Science.gov (United States)

    Kang, So Hyun; Lee, Yoontaek; Park, Young Suk; Ahn, Sang-Hoon; Park, Do Joong; Kim, Hyung-Ho

    2017-12-01

    With the advancement of laparoscopic devices and surgical technology, the era of minimal invasive surgery has progressed to reduced-port surgery, and finally to single-incision laparoscopic surgery (SILS). Several reports show successful application of SILS to various types of bariatric surgery. Oftentimes, this requires a skilled and experienced scopist to perform the procedure. To overcome the technical difficulties of single-incision Roux-en-Y gastric bypass, a manual scope holder was used instead of an assistant scopist, greatly stabilizing the field of view. This allows the surgery to be performed at any time without being influenced by the need of a highly experienced scopist. In this report, we describe in detail the world's first solo single-incision laparoscopic resectional Roux-en-Y gastric bypass.

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

    Directory of Open Access Journals (Sweden)

    Sanoop K Zachariah

    2013-01-01

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

  2. Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.

    Science.gov (United States)

    Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou

    2015-01-01

    We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

  3. SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Chee Wei Tay

    2013-01-01

    Full Text Available Objectives. We report the single-incision laparoscopic cholecystectomy (SILC learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6 min, P = 0.04 after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004. Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC.

  4. Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8).

    Science.gov (United States)

    Galvez, Carlos; Lirio, Francisco; Sesma, Julio; Baschwitz, Benno; Bolufer, Sergio

    2017-01-01

    Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months.

  5. Single incision vs conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study.

    Science.gov (United States)

    Kwag, Seung-Jin; Kim, Jun-Gi; Oh, Seong-Taek; Kang, Won-Kyung

    2013-09-01

    The purpose of the study was to evaluate the safety and effects of single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer by comparing it with conventional laparoscopic anterior resection (CLAR). Twenty-four patients who underwent SILAR between April 2010 and July 2011 were case matched 1:2 with patients who underwent CLAR, with respect to age, sex, body mass index, tumor location, and history of abdominal surgery. Two patients in the SILAR group and 1 patient in the CLAR group experienced anastomotic leakage. The operative time was longer in the SILAR group than in the CLAR group (251 ± 50 vs 237 ± 49 minutes; P = .253). The number of harvested lymph nodes (19.6 ± 10.7 vs 20.8 ± 7.7; P = .630) was not different. The postoperative hospital stay was shorter in the SILAR group (7.1 ± 3.4 days) than in the CLAR group (8.1 ± 3.5 days) (P = .234). On the basis of the early outcomes, we conclude that SILAR is feasible and safe. Moreover, the adequate lymph node harvest and free margins support the use of this procedure. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Single-Incision Laparoscopic Colectomy for Cancer: Short-Term Outcomes and Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Rodrigo Pedraza

    2013-01-01

    Full Text Available Introduction. Single-incision laparoscopic colectomy (SILC is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies ( and anterior resections (. There were no significant differences in operative time (127.9 versus 126.7 min, conversions (0 versus 1, complications (14% versus 8%, length of stay (4.5 versus 4.0 days, readmissions (2% versus 2%, and reoperations (2% versus 2%. Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques.

  7. Single-incision laparoscopic appendectomy using homemade glove port at low cost

    Directory of Open Access Journals (Sweden)

    Sang Myoung Lee

    2016-01-01

    Full Text Available Purpose: The aim of this study was to report homemade glove port technique for single-incision laparoscopic appendectomy (SILA. Materials and Methods: Our homemade glove port was composed of a size 6 latex sterile surgical glove, a sterilized plastic bangle, and three pieces of silicon tube (5 cm in length that were used as the suction tube. Clinical data were retrospectively collected from those patients who underwent SILA at Bucheon St. Mary's Hospital, Bucheon, Gyeonggi-do, South Korea between February 2014 and June 2014, including patient demographics, and operative and postoperative outcomes. To compare the outcomes, a retrospective review was performed for those patients who underwent conventional laparoscopic appendectomy (CLA between October 2013 and January 2014. Both SILA and CLA were performed by the same surgical team. Results: The SILA and CLA groups included 37 and 57 patients, respectively. The mean age, weight, body mass index (BMI, operation time, and pathologic diagnosis of gangrenous appendicitis were not significantly different between the two groups. However, the mean hospital stay in the CLA group was significantly (P = 0.018 longer than that in the SILA group (4.2 days vs 3.5 days. There was no conversion to open surgery in both the groups. Of the cases who underwent SILA, 10 (27.0% needed insertion of additional port and drain. There was one (3.2% complication of umbilical surgical site infection. Conclusion: In this study, SILA, with homemade glove port, was technically feasible and safe at low cost.

  8. Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

    Science.gov (United States)

    Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim

    2015-06-01

    The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload. © The Author(s) 2014.

  9. Single incision laparoscopic-assisted intestinal surgery (SILAIS) in 7 dogs and 1 cat.

    Science.gov (United States)

    Case, J Brad; Ellison, Gary

    2013-06-01

    To describe the clinical findings and short-term outcome in 7 dogs and 1 cat undergoing single-incision laparoscopic-assisted intestinal surgery (SILAIS) using an SILS™ or EndoCone™ port. Prospective case series. Dogs (n = 7) and cat (n = 1). An SILS™ port using three 5-mm instrument cannulas or EndoCone™ port was used to perform an initial limited laparoscopic abdominal exploration. The stomach and descending duodenum were explored intracorporeally and the jejunum through orad descending colon was explored extracorporeally. All intestinal procedures (enterotomy, biopsy, resection, and anastomosis) were performed extracorporeally. Omentalization of affected bowel was accomplished either intracorporeally or extracorporeally. Short-term outcome was determined. SILAIS was completed successfully in all but 1 dog and all animals had a good short-term outcome. Most (n = 5) animals were discharged the day after surgery. SILAIS was performed in a median of 120 minutes (interquartile range; 82-148 minutes) and was associated with a moderate level of difficulty. No major complications occurred but conversion to celiotomy (n = 1) and enlargement of the incision (n = 3) was required because of inability to exteriorize the affected bowel. SILAIS using an SILS™ or EndoCone™ port in dogs and cats is feasible and appears effective in selected cases. Single portal laparoscopic-assisted intestinal surgery might be an effective method of minimizing morbidity in dogs and cats with uncomplicated intestinal disease. © Copyright 2013 by The American College of Veterinary Surgeons.

  10. A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Hajong, Ranendra; Hajong, Debobratta; Natung, Tanie; Anand, Madhur; Sharma, Girish

    2016-10-01

    Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=post-operative pain, with lesser analgesic requirements (p=operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.

  11. Urinary incontinence - vaginal sling procedures

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007376.htm Urinary incontinence - vaginal sling procedures To use the sharing features ... are types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ...

  12. Single-Incision Versus Three-Port Laparoscopic Appendectomy: Short- and Long-Term Outcomes.

    Science.gov (United States)

    Vellei, Samatha; Borri, Alessandro

    2017-08-01

    To compare the outcome of patients who had undergone single-incision laparoscopic appendectomy (SILA) with others who had undergone three-port laparoscopic appendectomy (3-PORT). Data from all adults with uncomplicated appendicitis treated by laparoscopic appendectomy between June 2012 and December 2015 were prospectively collected. Patients with chronic pain, appendix malignancy, at least two previous laparotomies, and those undergoing concomitant surgery for different condition were excluded from analysis. Postoperative pain was assessed by a visual analog scale (VAS). Patients were reviewed postoperatively at 7 days and 1 month in the outpatient clinic. Late complications were assessed with a telephonic interview. A total of 91 patients were included (46 SILA; 45 3-PORT). There were 16 males and 30 females in the SILA group (mean age = 26.76 ± 10.58 years) and 18 males and 27 females in the 3-PORT group (mean age = 26.84 ± 10.79 years). The mean operative time for SILA was 48.54 ± 12.80 min, for the 3-PORT group the mean operative time was 46.33 ± 15.54 min (P = 0.46). No case required conversion. Mean postoperative hospital length of stay was 1.87 ± 0.69 days for SILA and 2.38 ± 1.11 days for 3-PORT (P = 0.01). VAS value of 3.91 ± 1.96 and mean ketorolac usage of 0.38 ± 0.65 in 3-PORT group and SILA patients reported 3.70 ± 1.58 and 0.39 ± 0.58, respectively (P = 0.91). Our mean follow-up in SILA group was 25.75 ± 10.82 months, for 3-PORT group the mean follow-up was 26.9 ± 11.8 months. Eleven patients missed long-term follow-up. No incisional hernia was found. There is a statistically significant difference in cosmetic evaluation in favor of SILA (P PORT laparoscopic appendectomy, but after SILA procedure discharge was quicker and long-term cosmetic satisfaction was superior.

  13. Autologous pubovaginal slings: back to the future or a lost art?

    Directory of Open Access Journals (Sweden)

    Bang SL

    2016-01-01

    Full Text Available Shieh-Ling Bang, Mohammed Belal Department of Urology, Queen Elizabeth Hospital, Birmingham, UK Abstract: Stress urinary incontinence (SUI is an under-diagnosed problem affecting up to 50% of women worldwide. SUI is a source of psychological distress to the individual and also imposes a financial burden to the individual and the health care system. The role of surgery in the treatment in SUI has evolved steadily in the last two decades. The synthetic mid-urethral sling and its different insertion methods have gained widespread popularity and are now the most frequently used surgical interventions for women with SUI in Europe. As the use of synthetic slings becomes more widespread, an increasing number of complications are being reported. With the recent concerns surrounding the use of synthetic transvaginal meshes in organ prolapse surgery, synthetic slings have been put under further scrutiny. It is imperative for health care providers to be aware of the current issues associated with synthetic slings and the alternative surgical options available. Traditional autologous pubovaginal slings (PVS have re-emerged as a viable alternative to synthetic slings in light of the issues with synthetic slings. The re-adoption of autologous PVS has however, been slow due to the technical difficulty of the surgery and perceived higher morbidity rates. In this article, we will discuss the various aspects of autologous PVS and its indications as an alternative to synthetic slings. We will also touch on the current evidence and controversies for synthetic mesh slings. Keywords: autologous pubovaginal sling, stress urinary incontinence, synthetic sling, erosions 

  14. Synthetic Sling Failure - Evaluations and Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, C. S. [Washington River Protection Solutions, Richland, WA (United States); Mackey, Thomas C. [Washington River Protection Solutions, Richland, WA (United States)

    2009-10-26

    The information and evaluations provided in this report were compiled to address the recurring problem of synthetic sling failure. As safety is the number one priority in all work aspects, a solution must be devised to prevent accidents from occurring. A total of thirteen cases regarding synthetic sling failure were evaluated in order to determine their causes, effects, and preventative measures. From the collected data, it was found that all cases in which the synthetic sling contacted the edge of its load resulted in sling failure. It is required that adequate synthetic sling protection devices be used to protect slings in any lift where the sling comes in direct contact with the edge or corner of its load. However, there are no consensus codes or standards stating the type, material, or purpose of the type of protective device used to protect the sling from being cut. Numerous industry standards and codes provide vague descriptions on how to protect synthetic slings. Without a clear, concise statement of how to protect synthetic slings, it is common for inadequate materials and sling protection devices to be used in an attempt to meet the intent of these requirements. The use of an inadequate sling protection device is the main cause of synthetic sling failure in all researched cases. Commercial sling protection devices come in many shapes and sizes, and have a variety of names, as well as advertised uses. 'Abrasion pads' and 'wear protectors' are two different names for products with the same intended purpose. There is no distinguishable way to determine the extent of sling protection which these devices will provide, or what specific scenarios they are made for. This creates room for error in a field where error is unacceptable. This report provides a recommended action for hoisting and rigging activities which require synthetic slings to contact a load, as well as recommended changes to industry standards which will benefit overall

  15. Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

    Science.gov (United States)

    Stiles, Mandy; Case, J Brad; Coisman, James

    2016-08-01

    OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

  16. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  17. The transverse colon cancer with the reversed rotation of the midgut treated with single incision laparoscopic colectomy.

    Science.gov (United States)

    Hirano, Yasumitsu; Hattori, Masakazu; Fujita, Manami; Nishida, Youji; Douden, Kenji; Hashizume, Yasuo

    2013-06-01

    Reversed rotation of the midgut is a rare type of intestinal malrotation. Moreover, synchronous colon cancer has rarely been reported. Preliminary experience with single-incision laparoscopic colectomy (SILC) for colon cancer with reversed rotation of the midgut is reported. An 82-year-old woman was admitted because of a fecal occult blood. A colonoscopy revealed transverse colon cancer. An air-barium contrast enema showed the right-sided sigmoid colon and the left-sided cecum. A computed tomography revealed that the duodenum and the transverse colon were situated at the ventral side of the superior mesenteric artery, and a preoperative diagnosis of suspicion of reversed rotation of the midgut was made. First, a lap protector was inserted through a 4.0 cm transumbilical incision. Four 5 mm ports were placed in the lap protector. On the observation of laparoscopy, the cecum and the ascending colon were not fixed with the retroperitoneum and situated on the left, and the sigmoid colon was situated on the right. We successfully mobilized the transverse colon using a single-incision laparoscopic approach. Resection was achieved following extracorporealization, and the anastomosis was performed extracorporeally using staplers. The patient was discharged on the thirteenth postoperative day. Postoperative follow-up did not reveal any umbilical wound complications. SILC for colon cancer associated with malrotation of the midgut is feasible and a promising alternative method because of its less invasiveness and its adaptability to the malrotation without extending the skin incision.

  18. How to make a sling

    Science.gov (United States)

    ... reduces the risk of opening a closed injury. First Aid Care for all wounds before applying a splint or sling. If you can see bone in the injured site, call your local emergency number (such as 911) or local hospital for ...

  19. A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

    Science.gov (United States)

    Murase, Naruhiko; Uchida, Hiroo; Seki, Takashi; Hiramatsu, Kiyoshi

    2016-02-01

    The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

  20. Two new mini-slings compared with transobturator tension-free vaginal tape for treatment of stress urinary incontinence: A 1-year follow-up randomized controlled trial.

    Science.gov (United States)

    Gaber, Mohamed E; Borg, Tamer; Samour, Hazem; Nawara, Mai; Reda, Ahmed

    2016-12-01

    The aim of this study was to compare the outcome of two single-incision mini-slings (the Contasure-Needleless [C-NDL] and the endopelvic free anchorage) with the standard midurethral transobturator tension-free vaginal tape (TVT-O) procedure. A double blind randomized controlled study was conducted at Ain Shams University Maternity Hospital from August 2014 until July 2015. A total of 209 patients were randomized into three groups. The first group underwent the TVT-O procedure, the second group underwent the endopelvic free anchorage procedure and the third group underwent the C-NDL procedure. Patients were followed up for 12 months in terms of subjective cure, objective cure, and complications rate. After 12 months of follow-up, there were no differences among the three groups in terms of objective cure rate, subjective cure rate, patient satisfaction, or incidence of complications (de novo urge, hemorrhage, infection, and mesh erosion). The C-NDL was associated with a shorter operative time (P < 0.001) and less blood loss (P = 0.021) than the standard TVT-O. The new single-incision mini-slings showed similar efficacy and patient acceptance to that of the standard TVT-O for up to 12 months postoperatively with no difference in the complications rate. The C-NDL is associated with shorter operative time and less blood loss. © 2016 Japan Society of Obstetrics and Gynecology.

  1. Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

    Institute of Scientific and Technical Information of China (English)

    Hongyi Cui

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world.One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC).Most reported techniques utilize special purpose-made access port and articulating instruments,rendering the procedure costly and difficult to learn.This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port.It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

  2. Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy.

    Science.gov (United States)

    Newman, Richard M; Umer, Affan; Bozzuto, Bethany J; Dilungo, Jennifer L; Ellner, Scott

    2016-03-01

    As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost. The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis. The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05). Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Clitoral Pain Following Retropubic Midurethral Sling Placement

    Directory of Open Access Journals (Sweden)

    Melanie Christofferson, DO

    2015-12-01

    Conclusion: Clitoral pain symptoms following placement of a retropubic midurethral sling should be evaluated and promptly addressed, given the potential negative impact on the patient's sexual function. Christofferson M, Barnard J, and Montoya TI. Clitoral pain following retropubic midurethral sling placement. Sex Med 2015;3:346–348.

  4. 21 CFR 890.3640 - Arm sling.

    Science.gov (United States)

    2010-04-01

    ... arm sling is a device intended for medical purposes to immobilize the arm, by means of a fabric band... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Arm sling. 890.3640 Section 890.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES...

  5. Single-incision laparoscopic surgery for locally advanced colorectal cancer : feasibility, short-term and oncologic outcomes.

    Science.gov (United States)

    Famiglietti, F; Leonard, D; Bachmann, R; Remue, C; Abbes Orabi, N; van Maanen, A; van den Eynde, M; Kartheuser, A

    2018-01-01

    Data about single-incision laparoscopic surgery (SILS) in locally advanced colorectal cancers are scarce. This study aimed to evaluate perioperative and shortterm oncologic outcomes of SILS in pT3-T4 colorectal cancer. From 2011 to 2015 data from 249 SILS performed in our Colorectal Unit were entered into a prospective database. Data regarding patients with a pT3-T4 colorectal adenocarcinoma were compared to those with pTis-pT2. Factors influencing conversion were assessed by multivariate analysis. There were 100 consecutive patients (T3-T4 = 70, Tis-T2 = 30). Demographics were similar. Tumor size was significantly larger in the T3-T4 group [3.9cm vs 2cm; p2) postoperative complication rate was similar between groups (8.6% vs 10% ; p = 0.999), as well as conversion rate (18.6% vs 6.7% ; p = 0.220). Finally, there were no differences in terms of hospital stay and mortality rate. On multivariate analysis, age (OR = 1.06, 95%CI: 1.012-1.113 ; p = 0.015] and stage IV (OR = 5.372, 95%CI: 1.320-21.862, p = 0.019) were independently associated with conversion. SILS for locally advanced colorectal cancer did not affect the short-term outcomes in this series and oncological clearance remained satisfactory. Age and stage IV disease are independent risk factors for conversion. © Acta Gastro-Enterologica Belgica.

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience

    Directory of Open Access Journals (Sweden)

    M.S. El Badry

    2016-06-01

    Conclusions: Our early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.

  8. Primary fixation of mini slings: a comparative biomechanical study in vivo

    Directory of Open Access Journals (Sweden)

    Paulo Palma

    2012-04-01

    Full Text Available INTRODUCTION AND OBJECTIVES: The mini sling concept for stress urinary incontinence is an anatomical approach that involves placing a midurethral low-tension tape anchored to the obturator internus muscles bilaterally. They overcome the blind passage of long needles and all the related complications. There are many different devices available and because these are outpatient procedures, primary fixation plays an important role in the outcome. The objective is to evaluate the primary fixation of the various devices of attachment of the commercially available mini-slings through biomechanical tests. MATERIALS AND METHODS: A total of 45 Wistar rats were divided in 3 groups of 15 rats each. They underwent 5 subcutaneous implantation of different mini slings and one polipropilene mesh (control, as follows: TVT-Secur® (Gynecare, USA, Type 1 polypropylene mesh (control; Ophira Mini Sling System® (Promedon, Argentina, Tissue Fixation System® (TFS PTY, Australia, Zipper Sling® and "T device" (Prosurg, USA. The abdominal wall was removed on bloc at different times after implant for biomechanical evaluation, which consisted in application of unidirectional force to the extremity of the fixation system or mesh, until it was completely removed from the tissue using a tension meter (Nexygen 3.0 Universal Testing Machine - LLOYD Instruments. The force was measured in Newtons (N. RESULTS: There was significant difference in the resistance to extraction among the different fixation systems. At 7 days the Ophira Mini Sling System® presented the best fixation and "T dispositive" the worst. CONCLUSION: Ophira mini sling System® presented the best primary fixation at 7º, 14º and 30º days. The impact of this feature in the clinical setting needs to be verified.

  9. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2014-01-01

    Full Text Available Background: Single-incision laparoscopic surgery (SILS has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V. Patients and Methods: A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V. Results: No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28 in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25. All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V. Conclusion: The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.

  10. TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

    Science.gov (United States)

    Aniuliene, Rosita; Aniulis, Povilas; Skaudickas, Darijus

    2015-01-01

    The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

  11. Transvaginal sling excision: tips and tricks.

    Science.gov (United States)

    Clifton, Marisa M; Goldman, Howard B

    2017-01-01

    Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal. Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision. All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue. Sling excision can be successfully performed with careful surgical technique and dissection.

  12. “U-Method” TVT-Secur Slings: Are they obstructive?

    Science.gov (United States)

    Richard, Patrick; Gagnon, Louis-Olivier; Tu, Le Mai

    2012-01-01

    Introduction: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the “hammock” or the “U-method” technique. With the latter, the sling is tightened to create a “pillowing effect” on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the “U-method” technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery. Methods: In this retrospective study, we reviewed the charts of 33 women who underwent the “U-method” TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery. Results: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30). One patient had a suspected bladder outlet obstruction (BOO) based on PFS. Maximal flow rate (Qmax) was significantly lower 12 months after surgery (26.0 mL/s [range: 19.0–36.5] vs. 21.5 mL/s [range: 16.0–32.3]). However, median voided volume was lower on the postoperative uroflowmetry (446 mL [range: 348–605] vs. 320 mL [range: 243–502]). Furthermore, none of the patients complained of voiding symptoms after surgery. Conclusions: Although one patient had findings compatible with BOO, none complained of voiding symptoms. TVT-Secur may result in a lower Qmax. However, this finding may be due to a lower voiding volume on the postoperative UDS. PMID:22511425

  13. TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months.

    Science.gov (United States)

    Walsh, Colin A

    2011-09-01

    • Synthetic mid-urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single-incision mini-slings. The present paper is a systematic review of studies reporting 12-month outcomes after the TVT-Secur (TVT-S) procedure. • Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled-trials.com online trial registries were searched for English-language articles containing the terms 'TVT-Secur', 'TVT Secur' or 'mini-sling'. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri-operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates. • Among 1178 women undergoing the TVT-S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the 'U-type' approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT-S procedure 5% of women required repeat continence surgery. • Longer-term studies and randomized comparisons with more established MUSs are required before TVT-S should be routinely used in the surgical treatment of stress urinary incontinence. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  14. Review on midurethral sling procedures for stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Nazura Bt Karim

    2015-05-01

    Full Text Available Minimally invasive suburethral slings, namely the retropubic suburethral sling or the tension-free vaginal tape (TVT, has become the mainstay for surgical management of moderate to severe stress urinary incontinence (SUI taking over the place of Burch's colposuspension after its introduction in the 1990s. Following the introduction of retropubic sling procedures are the transobturator (TVT-O procedures and the mini-sling procedures. This review attempts to summarize the current trend of midurethral sling (MUS procedures in the management of SUI.

  15. Repeat surgery after failed midurethral slings

    DEFF Research Database (Denmark)

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: The objective was to describe the choice of subsequent surgery after failure of synthetic midurethral slings (MUS) based on a nationwide background population. METHODS: We used the Danish National Patient Registry to identify women who had undergone first-time synthetic...

  16. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Brandt, Erik; Oehlenschläger, Jacob

    2015-01-01

    and matched 1:2 with patients subjected to CLC using pre-defined criteria. Follow-up data were obtained from the Danish National Patient Registry, mailed patient questionnaires, and clinical examination. A port-site hernia was defined as a repair for a port-site hernia or clinical hernia located at one......BACKGROUND: Conventional laparoscopic cholecystectomy (CLC) is regarded as the gold standard for cholecystectomy. However, single-incision laparoscopic cholecystectomy (SLC) has been suggested to replace CLC. This study aimed at comparing long-term incidences of port-site hernia and chronic pain...... after SLC versus CLC. METHODS: We conducted a matched cohort study based on prospective data (Jan 1, 2009-June 1, 2011) from the Danish Cholecystectomy Database with perioperative information and clinical follow-up. Consecutive patients undergoing elective SLC during the study period were included...

  17. First experience with single incision laparoscopic surgery in Slovakia: concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis.

    Science.gov (United States)

    Cingel, Vladimir; Zabojnikova, Lenka; Kurucova, Patricia; Varga, Ivan

    2014-09-01

    Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. A 2-3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and

  18. Oncologic outcomes of single-incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a propensity-score matching analysis.

    Science.gov (United States)

    Kim, Chang Woo; Cho, Min Soo; Baek, Se Jin; Hur, Hyuk; Min, Byung Soh; Kang, Jeonghyun; Baik, Seung Hyuk; Lee, Kang Young; Kim, Nam Kyu

    2015-03-01

    The aim of this study was to investigate oncologic outcomes, as well as perioperative and pathologic outcomes, of single-incision laparoscopic anterior resection (SILAR) compared with conventional laparoscopic anterior resection (CLAR) for sigmoid colon cancer using propensity-score matching analysis. From July 2009 through April 2012, a total of 407 patients underwent laparoscopic anterior resection for sigmoid colon cancer. Data on short- and long-term outcomes were collected prospectively and reviewed. Propensity-score matching was applied at a ratio of 1:2 comparing the SILAR (n = 60) and CLAR (n = 120) groups. There was no difference in operation time, estimated blood loss, time to soft diet, and length of hospital stay; however, the SILAR group showed less pain on postoperative day 2 (mean 2.6 vs. 3.6; p = 0.000) and shorter length of incision (3.3 vs. 7.7 cm; p = 0.000) compared with the CLAR group. Morbidity, mortality, and pathologic outcomes were similar in both groups. The 3-year overall survival rates were 94.5 versus 97.1% (p = 0.223), and disease-free survival rates were 89.5 versus 87.4% (p = 0.751) in the SILAR and CLAR groups, respectively. The long-term oncologic outcomes, as well as short-term outcomes, of SILAR are comparable with those of CLAR. Although SILAR might have some technical difficulties, it appears to be a safe and feasible option, with better cosmetic results.

  19. The Role of Hand-Assisted Laparoscopic Technique in the Age of Single-Incision Laparoscopy: An Effective Alternative to Avoid Open Conversion in Colorectal Surgery.

    Science.gov (United States)

    Jung, Kyung Uk; Yun, Seong Hyeon; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

    2018-04-01

    Continuous efforts to reduce the numbers and size of incisions led to the emergence of a new technique, single-incision laparoscopic surgery (SILS). It has been rapidly accepted as the preferred surgical approach in the colorectal area. In the age of SILS, what is the role of hand-assisted laparoscopic surgery (HALS)? We introduce the way to take advantage of it, as an effective alternative to avoid open conversion. This is a retrospective review of prospectively collected data of SILS colectomies performed by a single surgeon in Samsung Medical Center between August 2009 and December 2012. Out of 631 cases of SILS colectomy, 47 cases needed some changes from the initial approach. Among these, five cases were converted to HALS. Four of them were completed successfully without the need for open conversion. One patient with rectosigmoid colon cancer invading bladder was finally opened to avoid vesical trigone injury. The mean operation time of the 4 patients was 265.0 minutes. The mean estimated blood loss was 587.5 mL. The postoperative complication rate associated with the operation was 25%. Conversion from SILS to HALS in colorectal surgery was feasible and effective. It seemed to add minimal morbidity while preserving advantages of minimally invasive surgery. It could be considered an alternative to open conversion in cases of SILS, especially when the conversion to conventional laparoscopy does not seem to be helpful.

  20. Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study.

    Science.gov (United States)

    Ellis, Scott Michael; Varley, Martin; Howell, Stuart; Trochsler, Markus; Maddern, Guy; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

    2016-08-01

    Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills. Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion. 92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A-C) (P skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

  1. Midurethral bulbocavernous muscle sling for genuine stress incontinence - an alternative to synthetic slings?

    Directory of Open Access Journals (Sweden)

    N Rajamaheswari

    2003-01-01

    Full Text Available Objectives: To assess the efficacy of midurethral bulbo-cavernous muscle sling (BCMS in the treatment of genu-ine stress incontinence in women. Methods: A prospective study comprising 25 women was carried out at the Govt. Kasturba Gandhi Hospital, Chennai. The women whose age was in the range of 30-65 years had GSI as proved by urodynamic evaluation. The bulbocavernous muscle sling implies the approximation of both the bulbocavernous muscles around the midurethra with prolene sutures. The procedure is done under regional anaesthesia. Results: These patients were followed up for 2 years. Eighteen (72% women reported complete cure, 4 (16% were significantly improved and in 3 the surgery failed. Conclusions: The bulbocavernous muscle sling is a promising new procedure for genuine stress incontinence. There is no need for intraoperative cystoscopy and the chances of bladder injury are nonexistent. Larger sample with long term follow up and randomized controlled trials comparing it with the other surgical techniques may prove its true efficacy.

  2. Percutaneous nephroscopic management of an isolated giant renal hydatid cyst guided by single-incision laparoscopy using conventional instruments: the Santosh-PGI technique.

    Science.gov (United States)

    Kumar, Santosh; Choudhary, Gautam R; Pushkarna, Arawat; Najjapa, Bhuvnesh; Ht, Vatasla

    2013-11-01

    Isolated renal hydatid rarely presents, but when it does occur, it requires surgical treatment. We report our experience with a novel technique involving percutaneous management of a giant renal hydatid cyst with single-incision laparoscopic assistance. First we performed retrograde ureteropyelogram, which did not show any communication between the cyst and the calyceal. A Veress needle was used for pneumoperitoneum. Three conventional laparoscopic trocars used. Under laparoscopic guidance, we punctured the cyst. The scolicidal solution used was 10% povidone-iodine. The endocyst was removed under vision with grasping forceps through the nephroscope. A Portex drain was placed into the cyst cavity. Percutaneous aspiration and instillation of scolicidal agents followed by re-aspiration have been previously reported. This is an attractive procedure because of its acceptable success rates and reduced morbidity. In our case, simple aspiration of the cyst would not have been successful because the cyst was full of daughter cysts. Also, a blind percutaneous puncture of the cyst and dilatation could have perforated the colon or the mesocolon, which is often wrapped over the surface of such giant cysts thereby making laparoscopic guidance and mobilization of the colon imperative. We devised this unique treatment method for this patient involving three conventional ports at a single umbilical site. We believe this is the first reported case of its kind in the world. Not only this technique is minimally invasive, it is also cost-effective, as only conventional laparoscopic ports and instruments are used during the procedure. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  3. The Outcome of Repeated Mid Urethral Sling in SUI Treatment after Vaginal Excisions of Primary Failed Sling: Preliminary Study

    Directory of Open Access Journals (Sweden)

    Jacek Kociszewski

    2016-01-01

    Full Text Available Mid urethral sling is the standard in SUI treatment. Nevertheless, the risk of reoperation reaches 9%. There is no consensus as to the best treatment option for complications. A question is raised: what is the optimal way to achieve the best result in patients after primary failure? The aim of the study was to evaluate the outcomes of repeat MUS surgery in patients after excision of the sling with recurrent SUI. We compared its effectiveness with uncomplicated cases treated with TVT. 27 patients who underwent the repeated MUS and 50 consecutive patients after primary TVT were enrolled in the study. After 6 months, we have found that 24 (88.46% patients from repeat sling group and 48 (96% patients after primary sling were dry (1-hour pad test, 2 g or less. The difference between groups was not significant. We showed statistically significant improvement of quality of life in both groups. In conclusion, we showed that repeated sling after MUS excision is almost as effective as primary MUS. We postulate that sling excision and repeated MUS may be the best option for persistent SUI and/or complications after MUS procedures. Further multicenter observations are ongoing as to provide results on bigger group of cases.

  4. Comparison of TVT, TVT-O/TOT and mini slings for the treatment of female stress urinary incontinence: 30 months follow up in 531 patients.

    Science.gov (United States)

    Stavros, Charalambous; Ioannis, Vouros; Vasileios, Sakalis I; Gkotsi, Anastasia Ch; Georgios, Salpiggidis; Papathanasiou, Athanasios; Rombis, Vasileios

    2012-09-01

    Although mid-urethral slings (MUS), have been extensively used for the treatment of female stress urinary incontinence (SUI), no published data exists for the efficiency and the complications of these methods in large patient series. This is a retrospective analysis on patients who underwent MUS surgery since 1999. 531 patients were studied and the results of preoperative assessment, perioperative, early postoperatively and each follow up were registered. Patients were classified in three groups according to the MUS used. Efficacy of each method was evaluated in terms of early postoperative course, late complications and patient's symptoms improvement based questioners, pad test, uroflowmetry, filling cystometry and ultrasonography. Evaluation took place at 7th and 30th postoperative day, 3rd and 12th month and then annually. Each patient was characterized as cured, improved or failed. Trans Obturator (TO) group prevailed in efficiency with no significant differences between trans obturator route with inside-out (TVT-O) and outside-in (TOT). Success rate at 30th month evaluation, was higher in the TO group than in Tension-free Vaginal Tape (TVT) or Single-Incision Mini Slings (SIMS) group (93.4% vs 89.5%, 93.4% vs. 91.7%). None TVT patient required reoperation for remaining/reoccurring SUI, while 1.04% of TO group and 5.48% of SIMS group did. Patients of TVT group underwent reoperation for tape related complications in 2.25%, while 2.07% of TO group and none of SIMS group did. The potential limitation of the study is its retrospective character. Even though TO tapes and SIMS seem more efficient than TVT, they carry a risk of SUI re-occurrence that must be weighted towards the risk of potential complications after TVT.

  5. 76 FR 27367 - Slings; Extension of the Office of Management and Budget's (OMB) Approval of Information...

    Science.gov (United States)

    2011-05-11

    ..., rated capacity, and reach of the sling. The information, supplied by the manufacturer, is typically...] Slings; Extension of the Office of Management and Budget's (OMB) Approval of Information Collection... handling. Paragraph (e) of the Standard covers alloy steel chain slings. Paragraph (e)(1) requires that...

  6. Coupled Responses of Sewol, Twin Barges and Slings During Salvage

    Science.gov (United States)

    Yao, Zong; Wang, Wei-ping; Jiang, Yan; Chen, Shi-hai

    2018-04-01

    Korean Sewol is successfully lifted up with the strand jack system based on twin barges. During the salvage operation, two barges and Sewol encounter offshore environmental conditions of wave, current and wind. It is inevitable that the relative motions among the three bodies are coupled with the sling tensions, which may cause big dynamic loads for the lifting system. During the project engineering phase and the site operation, it is necessary to build up a simulation model that can precisely generate the coupled responses in order to define a suitable weather window and monitor risks for the salvage operation. A special method for calculating multibody coupled responses is introduced into Sewol salvage project. Each body's hydrodynamic force and moment in multibody configuration is calculated in the way that one body is treated as freely moving in space, while other bodies are set as fixed globally. The hydrodynamic force and moment are then applied into a numerical simulation model with some calibration coefficients being inserted. These coefficients are calibrated with the model test results. The simulation model built up this way can predict coupled responses with the similar accuracy as the model test and full scale measurement, and particularly generate multibody shielding effects. Site measured responses and the responses only resulted from from the simulation keep project management simultaneously to judge risks of each salvage stage, which are important for success of Sewol salvage.

  7. Arterial oxygen tension and pulmonary ventilation in horses placed in the Anderson Sling suspension system after a period of lateral recumbency and anaesthetised with constant rate infusions of romifidine and ketamine.

    Science.gov (United States)

    François, I; Lalèyê, F-X; Micat, M; Benredouane, K; Portier, K

    2014-09-01

    Some controversy exists over whether or not horses' recovery and cardiopulmonary function are affected by suspension in slings. To measure arterial oxygen tension and pulmonary ventilation in anaesthetised horses placed in a standing position in an Anderson Sling (AS) after a period of right lateral recumbency (RLR). Randomised crossover experimental study. Six Standardbred horses were anaesthetised twice. Catheters were inserted into the right jugular vein and the left carotid artery. After premedication with romifidine, anaesthesia was induced with diazepam and ketamine. Following 50 min in RLR, horses were maintained in either RLR or AS for an additional 60 min through to recovery. Anaesthesia was maintained i.v. with a constant rate infusion of romifidine and ketamine. Heart rate, respiratory rate, mean arterial pressure, expiratory tidal volume, minute volumes and end tidal CO2 were monitored continuously. Venous and arterial bloods were sampled for lactate concentration, creatine kinase activity and blood gas analysis before premedication, after induction, every 20 min for 100 min, as soon as the horse was standing (TR), and 24 h later. The data were averaged within 2 anaesthetic periods: P1, 0-20 min; and P2, 40-100 min. During P2, horses in the RLR group had lower arterial oxygen tension (P = 0.001), higher alveolar-arterial oxygen tension gradient (P = 0.005), higher respiratory rate (P = 0.04) and higher minute volumes (P = 0.04) than horses in the AS group. Arterial CO2 tension and mean arterial pressure increased in the AS group during P2 (P = 0.01 and 0.02 respectively). The recoveries were judged better in the AS group than in the RLR group (P = 0.01). During TR, lactate were higher in the RLR group than in the AS group (P = 0.007). Creatine kinase activities were higher in the AS group at 24 h vs. TR (P = 0.02). Anderson Sling suspension after a period of recumbency improves cardiopulmonary function and recovery quality in horses and

  8. [Attachment theory and baby slings/carriers: technological network formation].

    Science.gov (United States)

    Lu, Zxy-Yann Jane; Lin, Wan-Shiuan

    2011-12-01

    Healthcare providers recognize the important role played by attachment theory in explaining the close relationship between mental health and social behavior in mothers and their children. This paper uses attachment theory in a socio-cultural context to ascertain the mechanism by which baby slings/carriers, a new technology, produced and reproduced the scientific motherhood. It further applies a social history of technology perspective to understand how baby carriers and attachment theory are socially constructed and historically contingent on three major transformations. These transformations include the use of attachment theory-based baby carriers to further scientific motherhood; the use of baby slings/carriers to further the medicalization of breastfeeding and enhance mother-infant attachment; and the use of baby slings/carriers to transform woman's identities by integrating scientific motherhood, independence and fashion. Implications for nursing clinical policy are suggested.

  9. [A retrospective controlled clinical study of single-incision plus one port laparoscopic surgery for sigmoid colon and upper rectal cancer].

    Science.gov (United States)

    Li, G X; Li, J M; Wang, Y N; Deng, H J; Mou, T Y; Liu, H

    2017-07-01

    Objective: To evaluate the short-term and oncologic outcomes of single-incision plus one port laparoscopic surgery (SILS+ 1) for sigmoid colon and upper rectal cancer. Methods: The clinic data of 46 patients with sigmoid colon and upper rectal cancer underwent SILS+ 1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from September 2013 to September 2014 were retrospectively reviewed (SILS+ 1 group). After generating 1∶1 ration propensity scores given the covariates of age, gender, body mass index, American Society of Anesthesiologists score, surgeons, tumor location, the distance of tumor from anal, tumor diameter, and pathologic TNM stage, 46 patients with sigmoid colon and upper rectal cancer underwent conventional laparoscopic surgery (CLS) in the same time were matched as CLS group. The baseline characteristics and short-term outcomes were compared using t test, χ(2) test or Wilcoxon signed ranks test. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival. Results: The two study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. As compared to the CLS group, patients in SILS+ 1 group had a smaller incision ((6.9±1.1) cm vs . (8.4±1.2) cm, t =6.502, P =0.000), less estimated blood loss (20(11) ml vs . 50(30) ml, Z =2.414, P =0.016), shorter intracorporeal operating time ((67.0±25.8) minutes vs . (75.5±27.7) minutes, t =2.062, P =0.042) and significantly faster recovery course including shorter time to first ambulation ((46.7±20.3) hours vs . (78.6±28.0) hours, t =6.255, P =0.000), shorter time to first oral diet ((64.7±28.8) hours vs . (77.1±30.0) hours, t =2.026, P =0.047), shorter time of postoperative hospital stay ((7.8±2.2) days vs . (6.5±2.2) days, t =2.680, P =0.009), and lower postoperative visual analogue scale scores ( F =4.721, P =0.032). No significant difference was observed in total operating

  10. Rectus Fascia Sling for the Treatment of Total Urethral Incontinence ...

    African Journals Online (AJOL)

    Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this ...

  11. Sling surgery for stress urinary incontinence; the perfect solution?

    NARCIS (Netherlands)

    Hogewoning, C.R.C.

    2017-01-01

    Stress urinary incontinence (SUI) is the most observed type of urinary incontinence and is defined as the loss of urine following a rise in abdominal pressure. The TVT (Tension-free Vaginal Tape), a mid-urethral sling (MUS), was introduced in 1996 and soon became the gold standard in the surgical

  12. ADJUSTABLE TRANSOBTURATOR SLING FOR TREATING PATIENTS WITH COMPLICATED STRESS URINARY INCONTINENCE

    Directory of Open Access Journals (Sweden)

    D. D. Shkarupa

    2017-01-01

    Full Text Available Introduction. The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary.Aim. To evaluate the results of complicated stress urinary incontinence (SUI surgical treatment using a transobturator adjustable sling Urosling (Lintex.Materials and methods. The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12 and visual analogue scale (VAS.Results. Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89 patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89 patients. In 3.4% (3/89 women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89 patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO. Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84 of the patients were «very» or «very» satisfied.Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the

  13. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

    Science.gov (United States)

    Elliott, Jason E; Maslow, Ken D

    2012-02-01

    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

  14. Arc-to-arc mini-sling 1999: a critical analysis of concept and technology

    Directory of Open Access Journals (Sweden)

    Paulo Palma

    2011-04-01

    Full Text Available PURPOSE: The aim of this study was to critically review the Arc-to-Arc mini-sling (Palma's technique a less invasive mid-urethral sling using bovine pericardium as the sling material. MATERIALS AND METHODS: The Arc-to-Arc mini-sling, using bovine pericardium, was the first published report of a mini-sling, in 1999. The technique was identical to the "tension-free tape" operation, midline incision and dissection of the urethra. The ATFP (white line was identified by blunt dissection, and the mini-sling was sutured to the tendinous arc on both sides with 2 polypropylene 00 sutures. RESULTS: The initial results were encouraging, with 9/10 patients cured at the 6 weeks post-operative visit. However, infection and extrusion of the mini-sling resulted in sling extrusion and removal, with 5 patients remaining cured at 12 months. CONCLUSION: The Arc-to-Arc mini-sling was a good concept, but failed because of the poor technology available at that time. Further research using new materials and better technology has led to new and safer alternatives for the management of stress urinary incontinence.

  15. Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory.

    Science.gov (United States)

    Schoenthaler, Martin; Avcil, Tuba; Sevcenco, Sabina; Nagele, Udo; Hermann, Thomas E W; Kuehhas, Franklin E; Shariat, Shahrokh F; Frankenschmidt, Alexander; Wetterauer, Ulrich; Miernik, Arkadiusz

    2015-01-01

    To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model. Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy. Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.

  16. Postoperative magnetic resonance imaging characterization of slings for female stress urinary incontinence.

    LENUS (Irish Health Repository)

    Giri, Subhasis K

    2012-01-31

    PURPOSE: The aim was to characterize different types of slings such as autologous rectus fascia (ARF), porcine dermis (PD) and tension-free vaginal tape (TVT) in the early postoperative period with regard to its visibility and location by using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Between October 2003 and June 2007, total of 60 patients underwent MRI after a sling procedure. Thirty-six patients had ARF slings. Twelve patients had a PD sling and 12 had a TVT. All patients had pelvic MRI 6-8 hr postoperatively. Six patients in the ARF sling group had both preoperative and postoperative images at 6 hr and 3 months. MRI images were analyzed with regard to visibility and location. All data were collected prospectively. RESULTS: ARF slings were clearly visible in both T1W and T2W images. ARF appeared as low signal intensity area with surrounding high signal intensity due to fat attached to the rectus fascia in the MRI images obtained 6 hr after the procedure. Although the fatty component of the sling was diminished but was still visible on MRI scan 3 months postoperatively. On the other hand PD and TVT sling materials were not visible by MRI. Most of the ARF slings were located just below the bladder neck. CONCLUSIONS: The ARF sling is easily identifiable on MRI in the early postoperative period primarily because of the fat attached to the autologous rectus fascia. However, depiction of the PD and TVT slings in the early postoperative period is very poor.

  17. A cost-effectiveness analysis of retropubic midurethral sling versus transobturator midurethral sling for female stress urinary incontinence.

    Science.gov (United States)

    Seklehner, Stephan; Laudano, Melissa A; Te, Alexis E; Kaplan, Steven A; Chughtai, Bilal; Lee, Richard K

    2014-11-01

    To compare the cost-effectiveness (CE) of retropubic midurethral sling (RMS) versus transobturator midurethral sling (TMS) for the treatment of female stress urinary incontinence (SUI). A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS. Costing data were obtained from the Medicare RBRVS. Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 randomized RCTs with a minimum of 12 months follow-up, as were corresponding utilities for different continence states. Deterministic and probabilistic estimates of cost-effectiveness (CE) for each procedure were calculated and compared, and sensitivity analyses were performed. In the base-case deterministic analysis, the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS. QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention. The average cost for treatment with RMS however was higher at $9,579 versus $9,017 with TMS. TMS was therefore overall more cost-effective than RMS (CE = $1,438/QALY vs. $1,527/QALY). Sensitivity analysis demonstrated that physician and sling characteristics such as device cost, surgeon fee, efficacy of treatment, operative time, and duration of hospitalization could all affect the relative CE of the therapies. Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI. The efficacy of the two treatments could be affected by physician and sling characteristic factors. © 2013 Wiley Periodicals, Inc.

  18. Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling.

    Science.gov (United States)

    Cluver, Catherine Anne; Hofmeyr, G Justus

    2015-06-01

    The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Predictive value of urodynamics on outcome after midurethral sling surgery for female stress urinary incontinence

    NARCIS (Netherlands)

    Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Kil, Paul J. M.; Vervest, Harry A. M.

    OBJECTIVE: The aim of this study was to evaluate the value of urodynamic investigation in the preoperative workup of midurethral sling surgery and to identify risk factors for failure after 3 different midurethral sling procedures. STUDY DESIGN: Retrospective cohort study. 437 women who underwent a

  20. Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial.

    Science.gov (United States)

    Masata, Jaromir; Svabik, Kamil; Zvara, Karel; Hubka, Petr; Toman, Ales; Martan, Alois

    2016-10-01

    The aim of this study was to compare the efficacy of the tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of stress urinary incontinence in a randomized two-arm study with a 1-year follow-up. This single-centre randomized trial compared the objective and subjective cure rates of TVT-O and Ajust using objective criteria (cough test) and subjective criteria (International Consultation on Incontinence Questionnaire short form, ICIQ-UI SF). The objective cure rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined as no stress leakage of urine after surgery based on the ICIQ-UI SF. The primary outcome was to establish differences in objective and subjective cure rates between the TVT-O and Ajust groups. We also compared postoperative pain profiles using a visual analogue scale (VAS), improvement in quality of life using the ICIQ- UI SF and the Incontinence Quality of Life questionnaire, and overall satisfaction with the surgical procedure using a VAS and a five-item Likert scale. Inclusion criteria were age over 18 years, signed informed consent, and urodynamic stress urinary incontinence. Following a power calculation, 50 patients were enrolled into each group (Ajust and TVT-O). The mean follow-up after surgery was 445 days (SD 157.6 days) in the TVT-O group and 451.8 days (SD 127.6 days) in the Ajust group (p = 76.6 %). At 1 year, 47 patients were evaluated in the TVT-O group and 49 in the Ajust group. No differences in subjective cure rates or objective cure rates were observed. In the Ajust and TVT-O groups, the rates for no subjective stress leakage were 89.8 % and 91.5 %, respectively (p = 1.0, OR 1.22, 95 % CI 0.24 - 6.58), and the rates for a negative stress test were 89.8 % and 87.2 %, respectively (p = 0.76, OR 0.77, 95 % CI 0.17 - 3.32). In the Ajust group two patients reported de novo pain during sexual

  1. The effect of arm sling on balance in patients with hemiplegia.

    Science.gov (United States)

    Acar, Merve; Karatas, Gulcin Kaymak

    2010-10-01

    The aim of this study was to investigate the effect of an arm sling on balance in patients with, hemiplegia following a stroke. Twenty-six patients with hemiplegia (11 men, 15 women) who had, shoulder subluxation were enrolled in the study. Balance was evaluated by the Berg Balance Scale, the, Functional Reach test, and a static balance index which was measured by the Kinesthetic Ability, Trainer 3000. Balance tests were performed twice, with arm sling and without arm sling use. Results of, this study show that the Berg Balance Scores and static balance index ameliorated with arm sling use (p=0.005 and p=0.004, respectively). Likewise, the Functional Reach test was better when performed with an arm sling (p=0.039). In conclusion, arm slings have a beneficial effect on balance in patients, with hemiplegia. An arm sling may be applied for its possible beneficial effect on balance especially in, the early phases of stroke rehabilitation while the upper extremity is still flaccid and arm swing is, reduced. Copyright © 2010 Elsevier B.V. All rights reserved.

  2. Use of a sling for shoulder support in early neurorehabilitation programme

    Directory of Open Access Journals (Sweden)

    Nataša Kos

    2012-04-01

    Full Text Available Background: The purpose of our study was to assess the applicability of a specially designed functional sling for the correction of shoulder joint position in the early phase of neurorehabilitation. Patients and methods: Study included patients hospitalized at the Clinical Department of Neurosurgery of the University Medical Centre in Ljubljana, who suffered from severe paresis or paralysis of the upper limb. All patients included in the research were given a specially designed functional sling with the possibility of individual adjustments. By the help of a manipulated scale (transfer with respect to needed assistance we assessed how much help the patients using the sling needed in every-day activities; special attention was given to the evaluation of patients’ ability to stand up from and sit down in a wheelchair. Results: The research included 15 patients. During the rehabilitation programme, which included a specially designed functional sling, seven patients progressed by a grade on a scale (transfer with respect to needed assistance, seven patients progressed by two grades and one patient was bedridden. The average VAS value for shoulder pain without a functional sling was 5.3. With the use of a functional sling, the average VAS value was 2.3. Conclusion: The research has shown that the sling for shoulder joint position correction in early neurorehabilitation phase plays an important role as a device that enables patients more self-dependence in movement, especially when sitting down in and rising up from a wheel-chair. The process of learning how to use the sling was somewhat more difficult because of sensation disorder as well as cognitive and communication difficulties. An additional drawback was short usage time, because the patients were using the sling during hospitalization period only.

  3. Arterial tortuosity syndrome: An extremely rare disease presenting as a mimic of pulmonary sling

    Directory of Open Access Journals (Sweden)

    Amy Farkas, MD

    2018-02-01

    Full Text Available Pulmonary sling is the anatomic variant defined by the aberrant origin of the left pulmonary artery from the right pulmonary artery. This patient presented with a mimic of pulmonary sling as a result of an extremely rare condition, arterial tortuosity syndrome (ATS. The patient was first diagnosed with pulmonary sling on prenatal echocardiogram performed by cardiology. Computed tomography angiography of the chest obtained at birth to evaluate respiratory depression demonstrated ATS. The early detection of ATS has been demonstrated to improve patient outcome. This case provides an overview of the typical imaging features of ATS to aid radiologists in making this uncommon diagnosis.

  4. Single-incision thoracoscopic surgery for spontaneous ...

    African Journals Online (AJOL)

    aDivision of Pediatric Surgery, bDepartment of Surgery, National Defense Medical. College ... Correspondence to Akinari Hinoki, MD, PhD, Department of Surgery, Division of. Pediatric ... (Echelon60; Ethicon Endo-Surgery, Ethicon, NJ, USA).

  5. Dorsal clitoral nerve injury following transobturator midurethral sling

    Directory of Open Access Journals (Sweden)

    Moss CF

    2016-09-01

    Full Text Available Chailee F Moss,1 Lynn A Damitz,2 Richard H Gracely,3 Alice C Mintz,3 Denniz A Zolnoun,2–4 A Lee Dellon5 1Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus, OH, USA; 2Department of Surgery, University of North Carolina at Chapel Hill, NC, USA; 3Department of Endodontics, University of North Carolina at Chapel Hill, NC, USA; 4Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; 5Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: Transobturator slings can be successfully used to treat stress urinary incontinence and improve quality of life through a minimally invasive vaginal approach. Persistent postoperative pain can occur and pose diagnostic and therapeutic dilemmas. Following a sling procedure, a patient complained of pinching clitoral and perineal pain. Her symptoms of localized clitoral pinching and pain became generalized over the ensuing years, eventually encompassing the entire left vulvovaginal region.Aim: The aim of this study was to highlight the clinical utility of conventional pain management techniques used for the evaluation and management of patients with postoperative pain following pelvic surgery. Methods: We described a prototypical patient with persistent pain in and around the clitoral region complicating the clinical course of an otherwise successful sling procedure. We specifically discussed the utility of bedside sensory assessment techniques and selective nerve blocks in the evaluation and management of this prototypical patient. Results: Neurosensory assessments and a selective nerve block enabled us to trace the source of the patient’s pain to nerve entrapment along the dorsal nerve of the clitoris. We then utilized a nerve stimulator-guided hydrodissection technique to release the scar contracture Conclusion: This case

  6. Management of recurrent stress urinary incontinence after burch and sling procedures.

    Science.gov (United States)

    Zimmern, Philippe E; Gormley, E Ann; Stoddard, Anne M; Lukacz, Emily S; Sirls, Larry; Brubaker, Linda; Norton, Peggy; Oliphant, Sallie S; Wilson, Tracey

    2016-03-01

    To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures. We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared. Mean MESA (Medical Epidemiologic and Social Aspects of Aging) stress index was also compared between those retreated for rSUI compared to those not retreated. Half of the women in the SISTEr trial met inclusion criteria for this analysis (329/655, 174 Burch and 155 fascial sling), as did 444/597 (74%) of subjects in ToMUS (221 transobturator midurethral sling (TMUS), and 223 retropubic midurethral sling (RMUS). Types of surgical retreatment included autologous fascial sling (19), synthetic sling (1), and bulking agent (18). Five-year retreatment free survival rates (and standard errors) were 87% (3%), 96% (2%), 97% (1%), and 99% (0.7%) for Burch, autologous fascial sling, TMUS, and RMUS groups respectively (P < 0.0001). For all index surgery groups, the mean MESA stress index at last visit prior to retreatment for those retreated (n = 23) was significantly higher than mean MESA stress index at last visit for those not retreated (n = 645) (P < 0.0001). In these cohorts, 6% of women after standard anti-incontinence procedures were retreated within 5 years, mostly with injection therapy or autologous fascial sling. Not all women with rSUI chose surgical retreatment. © 2015 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  9. Removal of Polypropylene Sling Mesh From the Urethra: An Anatomic Technique.

    Science.gov (United States)

    Freilich, Drew A; Rovner, Eric S

    2015-07-01

    To describe a technique for removal of intraurethral mesh with minimal disruption of the periurethral anatomy. Through a midline transvaginal approach the sling is located lateral to the urethra and divided. The medial portion of the divided sling is carefully dissected back to its entrance laterally into the urethral lumen. A stay suture is placed on the dissected sling. The sling is located on the contralateral side and likewise divided and dissected back to the urethral lumen. The completely dissected sling is pulled through such that the holding stitch is through and through the urethral lumen, allowing easy localization of the urethral defect on lateral walls of the urethra. These defects are closed with an absorbable suture and the vaginal incision is closed. Three patients have undergone a transvaginal removal of their intraurethral mesh using the described technique. At a mean follow-up of 6.0 months, there were no intraoperative or postoperative complications. All patients were obstructed preoperatively and all developed stress urinary incontinence postoperatively requiring 0-1 pads per day. Current approaches to the surgical repair of chronic intraurethral mesh have significant limitations that are minimized by the described technique. This anatomic removal of mesh from the urethra has several advantages including no disruption of the ventral wall of the urethra, complete removal of foreign body from the urethra, and simplified localization of the urethral wall defect to allow for anatomic closure. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. CT demonstration of chicken trachea resulting from complete cartilaginous rings of the trachea in ring-sling complex

    International Nuclear Information System (INIS)

    Calcagni, Giulio; Bonnet, Damien; Sidi, Daniel; Brunelle, Francis; Vouhe, Pascal; Ou, Phalla

    2008-01-01

    We report a 10-month-old infant who presented with tetralogy of Fallot and respiratory disease in whom the suspicion of a ring-sling complex was confirmed by high-resolution CT. CT demonstrated the typical association of left pulmonary artery sling and the ''chicken trachea'' resulting from complete cartilaginous rings of the trachea. (orig.)

  11. CT demonstration of chicken trachea resulting from complete cartilaginous rings of the trachea in ring-sling complex

    Energy Technology Data Exchange (ETDEWEB)

    Calcagni, Giulio; Bonnet, Damien; Sidi, Daniel [University Paris Descartes, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, AP-HP, Paris (France); Brunelle, Francis [University Paris Descartes, Department of Paediatric Radiology, Hopital Necker-Enfants Malades, AP-HP, Paris Cedex 15 (France); Vouhe, Pascal [University Paris Descartes, Department of Paediatric Cardiovascular Surgery, Hopital Necker-Enfants Malades, AP-HP, Paris (France); Ou, Phalla [University Paris Descartes, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, AP-HP, Paris (France); University Paris Descartes, Department of Paediatric Radiology, Hopital Necker-Enfants Malades, AP-HP, Paris Cedex 15 (France)

    2008-07-15

    We report a 10-month-old infant who presented with tetralogy of Fallot and respiratory disease in whom the suspicion of a ring-sling complex was confirmed by high-resolution CT. CT demonstrated the typical association of left pulmonary artery sling and the ''chicken trachea'' resulting from complete cartilaginous rings of the trachea. (orig.)

  12. CT assessment of tracheobronchial anomaly in left pulmonary artery sling

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Yu-Min M.; Zhu, Ming; Sun, Ai-Min M.; Wang, Qian [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Shanghai Children' s Medical Center, Shanghai (China); Jaffe, Richard B. [Primary Children' s Medical Center, Department of Medical Imaging, Salt Lake City, UT (United States); Gao, Wei [Shanghai Jiao Tong University School of Medicine, Department of Cardiology, Shanghai Children' s Medical Center, Shanghai (China)

    2010-11-15

    The left pulmonary artery sling (LPAS) is a rare vascular anomaly where the left pulmonary artery arises from the right pulmonary artery, passes over the right bronchus, and goes posteriorly between the trachea and esophagus. The LPAS is frequently associated with cardiac and non-cardiac defects including tracheobronchial abnormalities. To evaluate the utility of multislice CT (MSCT) and helical CT (HCT) in diagnosing and defining the tracheobronchial anomaly and anatomic relationships between the trachea and aberrant left pulmonary artery. MSCT or HCT was performed in 27 children to determine the tracheobronchial anatomy and identify tracheobronchial stenosis. Eighteen children underwent surgery. According to the Wells [6] classification of LPAS, which includes two main types and two subtypes, there were eight cases of type 1A, five cases of type 1B, six cases of type 2A and eight cases of type 2B in this group. Twenty-four of the 27 children had substantial tracheobronchial stenosis. Four died before surgery; the 18 had reanastomosis of the left pulmonary artery. Five children also had tracheoplasty; three died after surgery. CT, especially MSCT, is an ideal modality for simultaneously identifying aberrant left pulmonary artery and any associated tracheobronchial anomaly. The Wells classification is useful for operative planning. (orig.)

  13. Assessment of stress in laboratory beagle dogs constrained by a Pavlov sling.

    Science.gov (United States)

    Stracke, Jenny; Bert, Bettina; Fink, Heidrun; Böhner, Jörg

    2011-01-01

    The 3Rs - Replacement, Reduction and Refinement - have become increasingly important in designing animal experiments. The Pavlov sling is thought to be a non-invasive method to restrain dogs for examinations. The aim of our study was to investigate whether laboratory Beagle dogs that had been trained to tolerate restraint by a Pavlov sling are stressed by this procedure and, furthermore, to analyze their behavior during this period. Five male and five female Beagle dogs were used, each three years of age. Animals were restrained in the Pavlov sling for 30 min on six days with an interval of at least two days. The following behaviors were recorded every minute for each session: postures of body, head, and ears, as well as state of eyes, tail, legs, and mouth. Additionally, the animals were observed for the occurrence of particular stress signs, including body shaking, sweating of the paws, increased saliva production, piloerection, blinking of eyes, snout licking, yawning, and panting. As an indicator for stress, salivary cortisol levels were measured before, during, and after each session. Our results show that for most behavioral parameters, e.g., body, leg, head, tail, and ear posture, the frequency of changes between different behavior patterns, as well as cortisol concentration, were not influenced by restraint in the Pavlov sling. Therefore, the Pavlov sling does not seem to be perceived as a stressful situation by the Beagle dogs. Our study demonstrates that under certain conditions the use of the Pavlov sling in trained dogs can substitute for more ordinary methods of immobilization, e.g., the use of narcotics.

  14. Adjustable Perineal Male Sling for the Treatment of Urinary Incontinence: Long-term Results.

    Science.gov (United States)

    Altan, Mesut; Asi, Tariq; Bilen, Cenk Yucel; Ergen, Ali

    2017-08-01

    To present the long-term results in patients with urinary incontinence who were treated with adjustable perineal male sling. An adjustable male sling procedure was performed in 45 patients with a mean age of 67.6 ± 7.8 years who had urinary incontinence. The mean period between primary prostatic surgery and the sling procedure was 36.7 months. The difference between the classical sling and the adjustable one is a 10 cm tissue expander between the 2 layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via this port, in case of recurrence or persistence of incontinence. Mean follow-up was 48 ± 29 months. Average operative time was 101.1 ± 25.5 minutes (45-150). Median daily pad use in these patients decreased from 8(2-12) to 1(0-10) (P dry rate was higher in patients with nonsevere incontinence compared to the others with severe incontinence (57.9% vs 23.1%, P = .029). Nevertheless, there was no significant difference in the case of total success rate (78.9% vs 57.7%, respectively; P = .135). Age was significantly greater in both complete dry group (71.1 ± 4.8 vs 65.4 ± 8.7) and total success group (70.1 ± 5.2 vs 62.4 ± 5.2) (P = .017 and P < .001, respectively). Adjustable male sling is an acceptable procedure with low complication rates especially in patients with mild and moderate incontinence. At the same time, this procedure may be offered to patients with previous incontinence surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Frontalis Sling Operation using Silicone Rod Compared with Autogenous Fascia Lata for Simple Congenital Ptosis

    Directory of Open Access Journals (Sweden)

    Purnima Rajkarnikar Sthapit

    2014-09-01

    Full Text Available Introduction: To evaluate the cosmetic results and recurrence of unilateral frontalis sling surgery using a silicone rod compared with autogenous fascia lata in cases of simple congenital ptosis. Methods: This is a retrospective comparative study of 59 patients who underwent a frontalis sling operation for congenital ptosis. Patients were divided into two groups according to the sling material used; an autogeneous fascia lata (fl group (n = 24 and a silicone rod group (sl (n = 35. Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the difference between the Margin Reflex Distance of both eyelids and graded as good if the difference in two eyes was ≤1mm and poor if it was 2mm or more. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category. Results: At postoperative day seven and 30, MRD of both the groups were good but on three months follow-up MRD of silicon rod group dropped, however it was not statistically significant .Lid contour was good in both the groups, however, lid symmetry was poor in two cases of fascia lata at three months follow-up. Repeat surgery for poor outcome was done in 8.6% of cases in silicon rod and 8.3% of fascia lata group. Conclusions: The frontalis sling operation using either a silicone rod or autogenous fascia lata showed equally good cosmetic results and lower recurrence rate at three months follow up. Keywords: congenital ptosis; fascia lata; frontalis sling surgery; margin reflex distance; silicone rod.

  16. Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

    Science.gov (United States)

    Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre

    2018-01-01

    Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.

  17. A Danish national survey of women operated with mid-urethral slings in 2001

    DEFF Research Database (Denmark)

    Ammendrup, Astrid Cecilie; Jørgensen, Anette; Sander, Pia

    2009-01-01

    OBJECTIVE: To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. DESIGN: A postal questionnaire survey. POPULATION: All Danish women who received an MUS operation...

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

    Directory of Open Access Journals (Sweden)

    Sukanda Bin Jaili

    2015-05-01

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

  19. The Influence of Preoperative Bladder Outlet Obstruction on Continence and Satisfaction in Patients with Stress Urinary Incontinence after Midurethral Sling

    Directory of Open Access Journals (Sweden)

    Su Jin Kim

    2010-12-01

    Full Text Available Purpose We studied the influence of preoperative bladder outlet obstruction (BOO on postoperative continence rates and patient satisfaction after the midurethral sling procedure. Methods A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction, Group II (n=89, mild obstruction, or Group III (n=33, moderate to severe obstruction. Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. Results There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05 but not in Group III. Conclusions BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.

  20. Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence.

    Science.gov (United States)

    Elshatanoufy, Solafa; Matthews, Alexandra; Yousif, Mairy; Jamil, Marcus; Gutta, Sravanthi; Gill, Harmanjit; Galvin, Shelley L; Luck, Ali M

    2018-05-04

    The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates. This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression. There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities. Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.

  1. To study the effect of orbital sling on post operative vision in cases of maxillary carcinoma undergoing total maxillectomy.

    Science.gov (United States)

    Shukla, Anirudh; Dudeja, Vivek

    2014-06-01

    To study effect of orbital sling on post operative vision in cases of maxillary carcinoma undergoing total maxillectomy. All patients with the principal procedure of "total maxillectomy" for histopathologically proven cases of carcinoma maxilla in department of otorhinolaryngology and head-neck surgery, N.S.C.B. medical college, Jabalapur, Madhya Pradesh, India from July 2011 to October 2013 were included. Out of the 20 patients irrespective of whether orbital sling was created or not, maximum number of patients 8 (40 %) showed a 3 step improvement, and maximum improvement seen was up to five steps. Out of the 14 patients in which orbital sling was created maximum number of patients 7 (50 %) showed a 3 step improvement, and maximum improvement seen was up to five steps. Out of the 6 patients in whom orbital sling was not created maximum number of patients 3 (50 %) showed a 2 step improvement, and maximum improvement seen was up to three steps. Infraorbital repair with the help of sling results in better improvement of vision as compared to those in whom sling was not or could not be made with no significant difference on eye movements.

  2. Modified Distal Urethral Polypropylene Sling (Canal Transobturator Tape Procedure: Efficacy for Persistent Stress Urinary Incontinence After a Conventional Midurethral Sling Procedure

    Directory of Open Access Journals (Sweden)

    Chang Hee Kim

    2013-03-01

    Full Text Available Purpose: Despite reports of persistent stress urinary incontinence (SUI in patients after the midurethral sling (MUS procedure, there is no widely accepted definition or cause of the condition. In many cases, the mesh implanted in the previous MUS procedure has been found to have migrated proximally. The aim of this study was to evaluate the efficacy of the modified distal urethral polypropylene sling, or canal transobturator tape (TOT, procedure for persistent SUI after a conventional MUS procedure on the assumption that persistent SUI after MUS is due to the location of the sling. Methods: From January 2008 to April 2012, 31 female patients who underwent the canal TOT procedure presented with incontinence or lower urinary tract symptoms (LUTS were included in this study. We identified patients who had been operated on by use of the conventional MUS procedure at other medical facilities, whose Valsalva leak pressure point was less than 120 cm-H2O by urodynamic study, and who were also diagnosed with persistent SUI. If vaginal or urethral mesh exposure was concomitant with persistent SUI, the mesh was removed completely or in part. Surgical procedures for canal TOT were identical to the original TOT procedures, except in the number and location of the vaginal incisions. Incontinence Impact Questionnaire-Short Form (IIQ-7 and Urogenital Distress Inventory-Short Form (UDI-6 scores were assessed preoperatively and at 3 months postoperatively. Results: There were no intraoperative or postoperative complications. Twenty-eight patients (90.3% showed improvement in incontinence or other LUTS. Postoperative scores of the IIQ-7 (0.65±0.48 and UDI-6 (3.48±2.28 were significantly improved compared with preoperative scores (1.26±0.58 and 7.52±4.30, respectively; P<0.05. Conclusions: Improper sling location is one of the major causes of persistent SUI after the conventional MUS procedure. Our results demonstrate that canal TOT may be an alternative

  3. Vaginocutaneous fistula and inguinal abcess presented 6 years after tension-free vaginal tape sling

    Directory of Open Access Journals (Sweden)

    Ali Feyzullah Sahin

    2013-06-01

    Full Text Available Surgical treatment of female stress urinary incontinence (SUI has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF plus inguinal abcess after tension-free vaginal tape (TVT. A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT.

  4. Randomized trial of a comparison of the efficacy of TVT-O and single-incision tape TVT SECUR systems in the treatment of stress urinary incontinent women-2-year follow-up

    Czech Academy of Sciences Publication Activity Database

    Mašata, J.; Švabík, K.; Zvára, Karel; Drahorádová, P.; Haddad El, R.; Hubka, P.; Martan, A.

    2012-01-01

    Roč. 23, č. 10 (2012), s. 1403-1412 ISSN 0937-3462 Institutional research plan: CEZ:AV0Z10300504 Keywords : Stress urinary incontinence * TVT-O * TVT-S * Surgical complication * Treatment failure Subject RIV: FK - Gynaecology, Childbirth Impact factor: 2.169, year: 2012

  5. Risk factors for postoperative urinary tract infection following midurethral sling procedures.

    Science.gov (United States)

    Doganay, Melike; Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Aksakal, Orhan Seyfi; Erkaya, Salim

    2017-04-01

    To identify the potential risk factors for urinary tract infections following midurethral sling procedures. 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (purinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies. Copyright © 2017. Published by Elsevier B.V.

  6. DSA - a helpful tool in diagnosis of aberrant left pulmonary artery (vascular sling) in adults

    International Nuclear Information System (INIS)

    Mooyaart, E.L.; Boomsma, J.H.B.; Postmus, P.E.; Formanek, G.A.

    1985-01-01

    Two new adult patients with aberrant origin of the left pulmonary artery from the right pulmonary artery - pulmonary artery sling - are described, totalling the published adult cases to eight. Differentiation from a mediastinal mass closely mimicking this vascular anomaly is discussed. For the definitive diagnosis, digital subtraction angiography was applied for the first time. The clearest demonstration of the anatomy is in 20-25 0 RPO and 20-25 0 sitting position. The aberrant left pulmonary artery in adults is asymptomatic.

  7. Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

    OpenAIRE

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

    2010-01-01

    Purpose Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. Materials and Methods A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2...

  8. Operative shortening of the sling as a second-line treatment after TVT failure

    Science.gov (United States)

    Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz

    2011-01-01

    Introduction Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. Materials and methods Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. Results All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. Conclusions The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure. PMID:24578885

  9. Protection from radiation enteritis by an absorbable polyglycolic acid mesh sling

    International Nuclear Information System (INIS)

    Devereux, D.F.; Thompson, D.; Sandhaus, L.; Sweeney, W.; Haas, A.

    1987-01-01

    Patients with malignant tumors of the pelvis who cannot be cured surgically often are treated with radiation after surgery. A devastating side effect of this treatment is radiation-associated small bowel injury (RASBI). The purpose of this study was to test the hypothesis that removal of the small bowel from the radiation field would protect it against RASBI. Twenty cebus monkeys underwent low anterior resection. In 10 animals an absorbable polyglycolic acid (PGA) mesh was sewn circumferentially around the interior of the abdominal cavity as a supporting apron, which prevented the small bowel's descent into the pelvis. The other 10 monkeys did not receive the mesh. All animals received 2000 rads by linear acceleration in a single dose. Twenty-four-hour stool fat, serum vitamin B12, and other serum values were obtained during the study. Animals were sacrificed after 1, 2, 3, 6, and 12 months, and the small bowel and rectum were examined histologically in a blind manner. Two monkeys who did not undergo surgery, or exposure to radiation served as controls. At all sacrifice periods, the animals with PGA mesh slings demonstrated normal small bowel function and histologic structure. Animals without mesh slings had abnormal stool and blood values at 1 month, and by 2 months all had died of small bowel necrosis. The animals that received the slings had no evidence of infection or obstruction, and by 6 months all evidence of the mesh was gone. Support of the small bowel out of the pelvis by an absorbable PGA mesh sling protects against RASBI and is without apparent complications

  10. Orbital floor reconstruction using a tensor fascia lata sling after total maxillectomy.

    Science.gov (United States)

    Jung, Bok Ki; Yun, In Sik; Lee, Won Jai; Lew, Dae Hyun; Choi, Eun Chang; Lee, Dong Won

    2016-05-01

    Reconstruction after total maxillectomy with extensive orbital floor defects poses a significant challenge for the reconstruction. The aim of this study is to present the outcomes of orbital floor reconstruction using tensor fascia lata slings after total maxillectomy and to compare these results to orbital floor reconstruction using alloplastic implants. This was a retrospective analysis of 19 consecutive patients who underwent tumor resection with orbital floor removal for malignancies. Reconstructions were performed using either tensor fascia lata slings (Group A) or alloplastic implants (Group B). The early and late postoperative outcomes such as wound infection, plate exposure, ectropion, diplopia, and enophthalmos, were analyzed and compared between the two groups. Patients in group A had significantly less wound complication than in group B (p < 0.05). In group A, there were no early or late wound complications after the operation. However, in group B, five patients had infection, the plate was exposed in eight of fourteen patients, and three patients had enophthalmos. Eight patients in group B underwent reoperation to correct their complications. Reconstruction of the orbital floor with a tensor fascia lata sling offers reliable support to the globe and prevents the ophthalmic complications associated with loss of orbital support. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Acellular dermal matrix slings in tissue expander breast reconstruction: are there substantial benefits?

    Science.gov (United States)

    Collis, George N; TerKonda, Sarvam P; Waldorf, James C; Perdikis, Galen

    2012-05-01

    Acellular dermal matrix (ADM) slings in breast reconstruction are increasingly used but are not yet validated. This study compares immediate, expander-based breast reconstruction with and without the use of inferolateral ADM slings. There were 63 patients (106 breasts) in the ADM group and 42 patients (68 breasts) in the control group. Initial intraoperative fill volumes were significantly greater in the ADM group, median 69% full (250 mL) versus 50% full (180 mL; P < 0.001). However, the number of days to complete expansion between the 2 groups was similar. One less office visit was required to complete the fills in the ADM group (P < 0.01). Drains were removed 3 days later in the ADM group (P < 0.01). Overall complication rate was greater in the ADM group (18.9% vs. 7.4%, P < 0.05), with a slightly higher percentage of expanders requiring removal due to infection in the ADM group (5.7% vs. 4.4%, P = NS). This study suggests inferolateral ADM slings in expander-based breast reconstruction allow for significantly increased initial fill volumes and may offer an aesthetic advantage; however, its use is costly and increases complications.

  12. Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings: analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

    Directory of Open Access Journals (Sweden)

    Elisabetta Costantini

    2008-02-01

    Full Text Available OBJECTIVE: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI. MATERIALS AND METHODS: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT or transobturator tape (TOT. They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6 and the impact of incontinence on quality of life (IIQ-7 questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS. Preoperative VLPP was correlated with primary and secondary outcome variables. RESULTS: Mean follow-ups were 32 + 12 months (range 12-55 for TVT and 31 + 15 months (range 12-61 for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5% patients showed a VLPP > 60 cm H2O and 50 (34.5% patients had a VLPP 60 cm H2O and 72% for those with VLPP 60 cm H2O (82 % vs. 68.9% p of 60 cm H2O, preoperative VLPP was not linked to outcome after TVT or TOT procedures.

  13. Obturator Neuralgia: A Rare Complication of Tension-free Vaginal Tape Sling-Complete Resolution After Laparoscopic Tension-free Vaginal Tape Removal.

    Science.gov (United States)

    Miklos, John R; Moore, Robert D; Chinthakanan, Orawee

    2015-01-01

    To show a technique of retropubic tension-free vaginal tape (TVT) removal using both a transvaginal and laparoscopic approach in the treatment of a rare condition, obturator neuralgia. A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and postoperative results using video, pictures, and medical illustrations (education video). TVT retropubic slings have become the gold standard for the treatment of stress urine incontinence over the last decade. Despite high cure rates, the TVT is not without potential complications. Typical complications include urine retention, incomplete bladder emptying, frequency, urgency, urethral erosion, vaginal extrusion, vaginal pain, and dyspareunia. The most common complication for sling removal/revision is chronic pain. The TVT obturator neuralgia is a rare and specific type of chronic pain that is normally associated with transobturator tape slings. The purpose of this video is to present an extremely rare complication of TVT retropubic slings, present symptoms and signs of obturator nerve compression, show the normal and the actual position of this patient's TVT sling, describe the laparoscopic removal of the TVT sling, and present the postoperative course and resolution of the patient's pain. The patient signed a release for her video to be used for educational and teaching purposes. A combined transvaginal and laparoscopic approach in a patient with lower abdominal, levator, and obturator-type pain after a TVT retropubic procedure. In patients suffering from obturator neuralgia after a retropubic sling, surgeons should include the sling as a potential causative factor in the differential diagnosis. Surgeons should consider removing the sling based on the patient's symptoms. If the patient suffers from only vaginal pain and dyspareunia, then the surgeon should consider only the removal of the vaginal portion of the sling. In patients with obturator neuralgia, retropubic, and/or lower abdominal

  14. Effects of Push-ups Plus Sling Exercise on Muscle Activation and Cross-sectional Area of the Multifidus Muscle in Patients with Low Back Pain.

    Science.gov (United States)

    Kim, Gye-Yeop; Kin, Se-Hun

    2013-12-01

    [Purpose] The purpose of this study was to examine the effect of lumbar stability exercises on chronic low back pain by using sling exercise and push-ups. [Subjects] Thirty adult subjects with chronic back pain participated, with 10 adults being assigned to each of 3 exercise groups: general physical therapy (PT), lumbar stability using sling exercises (Sling Ex), and sling exercise plus push-ups (Sling Ex+PU). Each group trained for 30 minutes 3 times a week for 6 weeks. The Oswestry Disability Index (ODI), surface electromyographic (sEMG) activity of the lumbar muscles, and cross-sectional area of the multifidus muscle on computed tomography (CT) were evaluated before and at 2, 4, and 6 weeks of therapy. [Results] A significant decrease in ODI was seen in all therapy groups, and this change was greater in the Sling Ex and Sling Ex+PU groups than in the PT group. No changes in sEMG activity were noted in the PT group, whereas significant increases in the sEMG activities of all lumbar muscles were found in the other 2 groups. The increases in the sEMG activities of the rectus abdominis and internal and external oblique muscles of the abdomen were greater in the Sling Ex+PU group than in the other 2 groups. [Conclusion] These findings demonstrate that Sling Ex+PU, similar to normal lumbar stabilization exercise, is effective in activating and improving the function of the lumbar muscles. These results suggest that Sling Ex+PU has a positive impact on stabilization of the lumbar region.

  15. Prospective Evaluation of the Effect of Thigh Dissection for Removal of Transobturator Mid Urethral Slings on Refractory Thigh Pain.

    Science.gov (United States)

    King, A B; Tenggardjaja, C; Goldman, H B

    2016-10-01

    Transobturator slings have higher rates of de novo neurologic symptoms than retropubic slings, most commonly related to the thigh. Cases refractory to conservative management may require removal of the thigh portion of the sling. In this series we prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from October 2012 to October 2015. Patients were assessed preoperatively, with a pain score using a visual analog scale, and postoperatively with a global response assessment. A total of 12 thigh dissections were performed from October 2012 to October 2015 in 8 patients. Mean (±SD) time from original mesh placement to presentation was 2.7 (±1.5) years. Average preoperative pain score was 7.9 (±1.7) out of 10, with pain in the thigh in all patients. Seven cases involved unilateral thigh dissection and 1 had concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. On postoperative evaluation the average global response rating was 1.6, with 1 defined as very much better and 2 defined as much better. Of the 8 patients 3 went on to have the contralateral side done with an average global response rating of 1.3 (±0.6). One patient underwent further treatment for stress urinary incontinence with placement of a retropubic mid urethral sling. Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. The procedure can be performed safely with positive outcomes for the patient. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos

    Directory of Open Access Journals (Sweden)

    Ramesh C Gupta

    2014-01-01

    Full Text Available Aim : To evaluate the efficacy of modified temporalis muscle transfer (TMT by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods : Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis : Paired t-test was applied to measure the statistical outcome. Results : Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD lid gap on eye closure was 7.7 (0.86 mm preoperatively, 0.5 (0.47 mm at 1 st postoperative day, and 0.7 (0.75 mm at 3 rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001 which is highly significant. The mean (SD vertical interpalpebral distance during primary gaze was 12.05 (1.12 mm preoperatively, 10 (0.94 mm at 1 st postoperative day, and 10.35 (1.08 mm at 3 rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001 which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion : Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

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

    Science.gov (United States)

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

    2017-01-01

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

  18. Management of female congenital short patulous urethra with urethral tapering and pubovaginal sling: A report of two cases.

    Science.gov (United States)

    Gahlawat, Sumit; Goel, Hemant; Khattar, Nikhil

    2018-01-01

    Congenital short patulous urethra is a rare entity and may be associated with developmental anomalies of mullerian ducts or urogenital sinus. We report the management of two cases of congenital short patulous urethra with stress urinary incontinence (SUI). Both the patients presented with SUI; one was diagnosed with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and the other had uterus didelphys with longitudinally septated vagina. Both patients were successfully managed by excisional tapering of the urethra and pubovaginal sling placement. SUI with congenital short patulous urethra can be managed with excisional tapering of urethra and pubovaginal sling placement.

  19. Incontinência urinária tratamento pela técnica do sling pubovaginal

    Directory of Open Access Journals (Sweden)

    William Luis de Oliveira

    2007-05-01

    Full Text Available Os autores deste trabalho procuram mostrar os benefícios para a mulher com incontinência urinária, através da correção da mesma pela técnica do Sling pubovaginal. Estudaram-se clínica e cirurgicamente, 60 pacientes, relatando a técnica, os métodos e os resultados obtidos. Concluiu-se que houve melhora acentuada da incontinência urinária (I.U.E. com o uso desta técnica, em relação às técnicas convencionais.

  20. Effect of Resident Performance on Midurethral Sling Cure and Complication Rates

    Directory of Open Access Journals (Sweden)

    Sabri Cavkaytar

    2016-01-01

    Full Text Available Aim: To evaluate the cure rates and complications of midurethral slings performed by residents under an experienced surgeon supervision. Material and Method: Between January 2013 and January 2014, one hundred forty-one midurethral slings performed in the urogynecology clinic of Ankara Zekai Tahir Burak Women%u2019s Health Research and Education Hospital were reviewed.Age, parity,body mass index,menopausal status, grade 2 preoperative pelvic organ prolapsus,concomitant vaginal surgery and intraoperative (bladder and bowel perforations,bleeding,vaginal laceration and early postoperative (urinary retention etc.complications were recorded.All women were re-examined at postoperative 6 th month and symptoms were questioned. The patients were classified as %u2018%u2019cured%u2019%u2019 if the stress test was negative , %u2018%u2019partially cured%u2019%u2019 if continence frequency decreased but still continued and %u2018%u2019unsatisfied%u2019%u2019 if there was no change in symptoms. Both TVT and TOT groups were compared in case of complications and cure rates. Results: Among 141 patients who had undergone midurethral sling due to urinary stress incontinence,50(35.5% were TOT , 91(64.5% were TVT. In the TVT group, 3 (3.3% patients had bleeding which requires transfusion and 5(5.5% patients had bladder perforations. But in the TOT group,there was no bladder perforation and bleeding that requires transfusion. In the early postoperative period, urinary retention was encountered in 7(14.0% patients in TOT group and in 17(18.7% patients in TVT group. There was no statistically significant difference between the groups in case of complications. At postoperative 6th month, in the TOT group 76% of patients were cured,18% were partially cured and 6% were unsatisfied. In the TVT group, 83.5% of patients were cured, 12.1% were partially cured and 4.4% were unsatisfied and there was no significant difference in cure rates between the groups. Discussion: The

  1. Synthetic pubovaginal sling (TVT: failure in conservative treatment following vaginal exteriorization

    Directory of Open Access Journals (Sweden)

    Edgar Thorell

    2004-04-01

    Full Text Available Female, 57 year-old patient, reported having undergone surgery for correction of urinary incontinence due to sphincteric insufficiency with the implantation of a synthetic pubovaginal sling 14 months earlier. Though she did not present urine loss any longer, approximately 60 days following the surgical procedure she started to report dysuria, pollakiuria and dyspareunia. Attempts of a conservative solution were ineffective. The appearance of a vaginal infra-urethral granuloma and the exteriorization of the synthetic material led to its removal.

  2. Long-term follow-up of the AdVance®/AdVanceXP® sling. What are the surgeons' impressions? What are the patients'?

    Science.gov (United States)

    Romero Hoyuela, A; Reina Alcaina, L; Izquierdo Morejon, E; Rosino Sanchez, A; Carrillo George, C; Rivero Guerra, A; Barcelo Bayonas, I; Pardo Martinez, A; Muñoz Guillermo, V; Pietricica, B; Fernandez Aparicio, T; Hita Villaplana, G; Miñana Lopez, B

    2018-04-01

    To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance ® and AdvanceXP ® slings. The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance ® and AdVanceXP ® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. The Advance ® and AdvanceXP ® system are effective over time in terms of urinary continence and patient satisfaction. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Muscle Activation of Vastus Medialis Oblique and Vastus Lateralis in Sling-Based Exercises in Patients with Patellofemoral Pain Syndrome: A Cross-Over Study

    Directory of Open Access Journals (Sweden)

    Wen-Dien Chang

    2015-01-01

    Full Text Available Objectives. To examine what changes are caused in the activity of the vastus medialis oblique (VMO and vastus lateralis (VL at the time of sling-based exercises in patients with patellofemoral pain syndrome (PFPS and compare the muscular activations in patients with PFPS among the sling-based exercises. Methods. This was a cross-over study. Sling-based open and closed kinetic knee extension and hip adduction exercises were designed for PFPS, and electromyography was applied to record maximal voluntary contraction during the exercises. The VMO and VL activations and VMO : VL ratios for the three exercises were analyzed and compared. Results. Thirty male (age = 21.19 ± 0.68 y and 30 female (age = 21.12 ± 0.74 y patients with PFPS were recruited. VMO activations during the sling-based open and closed kinetic knee extension exercises were significantly higher (P=0.04 and P=0.001 than those during hip adduction exercises and VMO : VL ratio for the sling-based closed kinetic knee extension and hip adduction exercises approximated to 1. Conclusions. The sling-based closed kinetic knee extension exercise produced the highest VMO activation. It also had an appropriate VMO : VL ratio similar to sling-based hip adduction exercise and had beneficial effects on PFPS.

  4. Perinatal/Neonatal case presentation: pulmonary artery sling associated with respiratory distress.

    Science.gov (United States)

    Healey, David; Ron, Nitin; Hromada, Andrew; Chhabra, Manoj

    2016-01-01

    Pulmonary artery sling is a very rare cause of pediatric respiratory distress. The estimated prevalence of the disease was first determined by Yu et al. in 2008 as 59 per million school-aged children. Associated symptoms are cough, wheezing, and feeding difficulty, all of which are common in routine outpatient pediatric clinical encounters. We report a case of a premature male neonate twin who was admitted to the neonatal intensive care unit with respiratory distress and pneumothorax. His presentation, as well as the etiology of his pulmonary disease, was felt to be consistent with those of numerous other premature infants. Akin to this was his delayed discharge on account of his slow progress with oral feeding. Parents gave a history of tachypnea and feeding difficulty to his doctors. He presented twice to the emergency room in respiratory distress. At 4 months of age, while in hospital for a pulmonary infection, he had an echocardiogram that revealed a pulmonary artery sling. We review the literature on this vascular anomaly, discuss its diagnosis and management, and critique the clinical thinking that determined this child's course from the perspective of availability heuristics.

  5. Gunshot-like wound caused by sling shot injury – a case report

    Directory of Open Access Journals (Sweden)

    Vinuthinee N

    2015-02-01

    Full Text Available Naidu Vinuthinee,1,2 Anuar Azreen-Redzal,1 Jaafar Juanarita,1 Embong Zunaina2 1Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia; 2Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia Abstract: We report a rare case of sling shot injury that presented with a gunshot-like wound with preseptal cellulitis, in a toddler. An 11-month-old Malay child presented with a gunshot-like wound over the forehead following sling shot injury. On examination, he had a deep circular laceration wound over the forehead, measuring 2.0 cm in diameter, with minimal bleeding. There was no obvious foreign body seen inside the wound and no palpable foreign body surrounding the wound. The gunshot-like wound was associated with left preseptal cellulitis. A skull X-ray showed a white opaque foreign body in the left frontal bone. Computed tomography (CT scan of orbit and brain revealed a left comminuted fracture of the left orbital roof, and left frontal brain contusion with prelesional edema. Wound exploration was performed and revealed a 0.5 cm unshattered marble embedded in the left frontal bone. The marble and bone fragments were removed. The left preseptal cellulitis responded well to intravenous antibiotic and topical antibiotic. Keywords: preseptal cellulitis, orbital roof fracture, pediatric trauma

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

    Science.gov (United States)

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

    2010-06-01

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

  7. Self-reported urinary continence outcomes for repeat midurethral synthetic sling placement

    Directory of Open Access Journals (Sweden)

    Jonathan A. Eandi

    2008-06-01

    Full Text Available OBJECTIVE: To evaluate our experience with tension-free transvaginal tape (TVT placement for the management of stress urinary incontinence (SUI in women who had previously undergone a failed midurethral synthetic sling (MUS procedure. MATERIALS AND METHODS: Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. RESULTS: All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33. Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. CONCLUSIONS: TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.

  8. Removal of obstructing synthetic sling from a urethra: English and Spanish version.

    Science.gov (United States)

    Pizarro-Berdichevsky, Javier; Goldman, Michelle P; Goldman, Howard B

    2016-12-01

    Urethral perforations after synthetic midurethral sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction. A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo transvaginal sling removal and reconstruction. The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI. Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely transvaginal approach.

  9. Comparison of complication rates related to male urethral slings and artificial urinary sphincters for urinary incontinence: national multi-institutional analysis of ACS-NSQIP database.

    Science.gov (United States)

    Alwaal, Amjad; Harris, Catherine R; Awad, Mohannad A; Allen, Isabel E; Breyer, Benjamin N

    2016-10-01

    Male stress urinary incontinence (SUI) can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male SUI. Our objective is to evaluate 30-day complications in patients undergoing male slings and AUS placement from a national multicenter database. Data from the American College of Surgeons National Surgical Quality of Improvement Program for 2008-2013 were used to identify patients who underwent male slings and AUS implantation. Trained coders abstracted complication data from the patient record independent of the surgical team. We compared 30-day postoperative complications for male slings and AUS. We examined the relationship between patient factors and complication rates for each procedure type. Overall, 1205 incontinence surgeries in men were identified: 597 male sling placements and 608 AUS implantations. Male sling placement had a lower 30-day postoperative complication rate compared to AUS (2.8 vs. 5.1 %, p = 0.046). Compared to AUS, male sling was associated with fewer urinary tract infections (0.3 vs. 2.0 %, p = 0.020) and return trips to the operating room (1.0 vs. 3.0 %, p < 0.001). Patients with higher BMI were more likely to have a complication, while age, race and Charlson comorbidity index were not associated with higher or lower complication rates. Complications rates for both male sling and AUS are low. Male sling is associated with a lower rate of complications than AUS. These findings allow for better patient perioperative counseling regarding 30-day perioperative complications.

  10. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

    Directory of Open Access Journals (Sweden)

    Nicole Szell, DO

    2017-06-01

    Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.

  11. The Impact of Midurethral Sling Surgery on Sexual Activity and Function in Women With Stress Urinary Incontinence

    NARCIS (Netherlands)

    Mengerink, Bianca B.; van Leijsen, Sanne A. L.; Vierhout, Mark E.; IntHout, Joanna; Mol, Ben W. J.; Milani, Alfredo L.; Roovers, Jan-Paul W. R.; van Eijndhoven, Hugo W. F.; van der Vaart, Carl H.; van Gestel, Iris; Hartog, Francis E.; Heesakkers, John F. A.; Kluivers, Kirsten B.

    2016-01-01

    Introduction: Stress urinary incontinence has a negative impact on sexual function. Aim: To assess the effect of midurethral sling surgery on sexual activity and function in women with stress urinary incontinence. Methods: This is a secondary analysis of the Value of Urodynamics Prior to Stress

  12. Predictive Value of Urodynamics on Outcome After Midurethral Sling Surgery for Female Stress Urinary Incontinence EDITORIAL COMMENT

    NARCIS (Netherlands)

    Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Kil, Paul J. M.; Vervest, Harry A. M.

    2009-01-01

    Urodynamic investigation (UDI) is routinely performed before midurethral sling surgery (MUS) for female stress urinary incontinence to detect factors that may adversely affect the surgical outcome or confirm the diagnosis. A recent review, however, concluded that there was insufficient evidence to

  13. Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence

    Directory of Open Access Journals (Sweden)

    Melih Balci

    2015-04-01

    Full Text Available Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79 years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74 months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25 mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2% were dry (11 patients, 0 pads; 5 patients using safety pads, 3 patients (14% had mild and 2 (9.8% had moderate degree post-prostatectomy urinary incontinence (PPI. The average maximum urine flow rate of the patients was 15.6±4.7 (10-31 mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI.

  14. Single Incision Laparoscopic Surgery for a Large Endometriotic Cyst

    African Journals Online (AJOL)

    In the last decade, laparoscopy has become the standard treatment for many gynecological conditions.[1,2] Today, laparoscopy is hailed as the standard approach in the surgical treatment of benign adnexal pathology.[1,2] Attempts to minimize access-related injuries and complications resulted in development of single port ...

  15. Single-incision laparoscopic surgery and conventional laparoscopic ...

    African Journals Online (AJOL)

    Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated “en bloc,” clipped and cut. Operating time, visual analogue scale and post-operative results were ...

  16. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence : a randomised trial

    NARCIS (Netherlands)

    van der Ploeg, J M; Oude Rengerink, K; van der Steen, A; van Leeuwen, J H S; Stekelenburg, J; Bongers, M Y; Weemhoff, M; Mol, B W; van der Vaart, C H; Roovers, J-P W R

    OBJECTIVE: To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. DESIGN: Multi-centre randomised trial. SETTING: Fourteen teaching hospitals in the Netherlands. POPULATION: Women with symptomatic stage two or greater pelvic organ prolapse (POP),

  17. Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial.

    Science.gov (United States)

    Mazloomdoost, Donna; Pauls, Rachel N; Hennen, Erin N; Yeung, Jennifer Y; Smith, Benjamin C; Kleeman, Steven D; Crisp, Catrina C

    2017-11-01

    Midurethral slings are commonly used to treat stress urinary incontinence. Pain control, however, may be a concern. Liposomal bupivacaine is a local anesthetic with slow release over 72 hours, demonstrated to lower pain scores and decrease narcotic use postoperatively. The purpose of this study was to examine the impact of liposomal bupivacaine on pain scores and narcotic consumption following retropubic midurethral sling placement. This randomized, placebo-controlled trial enrolled women undergoing retropubic midurethral sling procedures with or without concomitant anterior or urethrocele repair. Subjects were allocated to receive liposomal bupivacaine (intervention) or normal saline placebo injected into the trocar paths and vaginal incision at the conclusion of the procedure. At the time of drug administration, surgeons became unblinded, but did not collect outcome data. Participants remained blinded to treatment. Surgical procedures and perioperative care were standardized. The primary outcome was the visual analog scale pain score 4 hours after discharge home. Secondary outcomes included narcotic consumption, time to first bowel movement, and pain scores collected in the mornings and evenings until postoperative day 6. The morning pain item assessed "current level of pain"; the evening items queried "current level of pain," "most intense pain today," "average pain today with activity," and "average pain today with rest." Likert scales were used to measure satisfaction with pain control at 1- and 2-week postoperative intervals. Sample size calculation deemed 52 subjects per arm necessary to detect a mean difference of 10 mm on a 100-mm visual analog scale. To account for 10% drop out, 114 participants were needed. One hundred fourteen women were enrolled. After 5 exclusions, 109 cases were analyzed: 54 women received intervention, and 55 women received placebo. Mean participant age was 52 years, and mean body mass index was 30.4 kg/m 2 . Surgical and

  18. EFFECT OF MID URETHRAL SLING (TVT SURGERY ON FEMALE SEXUAL FUNCTION

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-09-01

    Full Text Available INTRODUCTION: Mid Urethral Slings is the main stay of therapy in the management of stress urinary incontinence in the female, w e evaluated the effect of TVT on sexual function in women who are from the rural backward districts of Rayalaseema districts of Andhra Pradesh. MATERIALS & METHODS: 30 Women with a mean age of 44 yrs with SUI were evaluated before TVT procedure and then every 3months for 1yr for sexual health using NSF - 9 questionnaire . RESULTS: The sexual function in all the domains including desire, frequency ar ousal , orgasm remained the same as before surgery in more than 80% pts. The satisfaction rate was better in pts who were leaking during sex before surgery in six out of ten patients. CONCLUSIONS: TVT surgery does not have any significant impact on sexual function Sexual function is not an important issue for the female beyond the age of 40 yrs in the perimenopau s e/ post menopause period

  19. Mid-urethral slings on YouTube: quality information on the internet?

    Science.gov (United States)

    Larouche, Maryse; Geoffrion, Roxana; Lazare, Darren; Clancy, Aisling; Lee, Terry; Koenig, Nicole A; Cundiff, Geoffrey W; Stothers, Lynn

    2016-06-01

    Scant literature exists about the quality of urogynecological content on social media. Our objective was to measure the accuracy and comprehensiveness of YouTube videos related to mid-urethral sling (MUS) procedures. YouTube was searched using the terms "mid-urethral sling," "vaginal tape," "TVT," "TOT," "TVT surgery," and "TOT surgery." Duplicates and videos with less than 1,000 views were excluded. We developed a standardized questionnaire for this project, assessing each video's target audience, main purpose, relevance, informed consent elements, surgical steps, and bias. The primary outcome was the presence of all elements of informed consent. Inter-rater reliability (IRR) was calculated using the Fleiss' kappa statistic. Descriptive statistics were also obtained. Five reviewers each rated 56 videos. Mean IRR was moderate (Fleiss' kappa 0.58 ± 0.24). Video content was classified as physician educational material (67.9 %), patient information (16.1 %), advertisement (10.7 %), lawsuit recruitment (1.8 %), and unclear (3.6 %). MUS was the primary topic for 82.1 % of the videos. The remainder discussed other types of anti-incontinence procedures or prolapse surgery. None of the videos mentioned all four elements of informed consent. Of 32 videos demonstrating surgical technique, none showed the complete list of pre-determined surgical steps. The mean number of listed steps was 7.6/16. Only four videos mentioned at least one post-operative patient instruction. A marketing element was shown in 26.8 % of videos. Patient information about MUS on YouTube is lacking and often biased. Physicians and students viewing YouTube videos for educational purposes should be cognizant of the variability in the surgical steps demonstrated.

  20. Use of 3D models of vascular rings and slings to improve resident education.

    Science.gov (United States)

    Jones, Trahern W; Seckeler, Michael D

    2017-09-01

    Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners' scores on a board-style examination. Patients with normal and abnormal aortic arches were selected and anonymized to generate 3D printed models. A cohort of pediatric and combined pediatric/emergency medicine residents were then randomized to intervention and control groups. Each participant was given a subjective survey and an objective board-style pretest. Each group received the same 20-minutes lecture on vascular rings and slings. During the intervention group's lecture, 3D printed physical models of each lesion were distributed for inspection. After each lecture, both groups completed the same subjective survey and objective board-style test to assess their comfort with and postlecture knowledge of vascular rings. There were no differences in the basic demographics of the two groups. After the lectures, both groups' subjective comfort levels increased. Both groups' scores on the objective test improved, but the intervention group scored higher on the posttest. This study demonstrated a measurable gain in knowledge about vascular rings and pulmonary artery slings with the addition of 3D printed models of the defects. Future applications of this teaching modality could extend to other congenital cardiac lesions and different learners. © 2017 Wiley Periodicals, Inc.

  1. Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence

    DEFF Research Database (Denmark)

    Weltz, V; Guldberg, R; Lose, G

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more......) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women. METHODS: A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms "Stress urinary incontinence", "Overweight", "Obesity" and "Surgery". We included 13 full-text papers published...... from January 1995 to May 2014. We defined two groups of women: non-obese (BMI below 30 kg/m(2)) and obese (BMI above 30 kg/m(2)). Data regarding subjective and objective cure and selected perioperative complications were pooled and compared. RESULTS: The pooled data from the 13 studies showed that 76...

  2. A Rare Case of Pulmonary Artery Sling with the VACTERL Association in a 20-Month-Old Infant.

    Science.gov (United States)

    Ghandi, Yazdan; Shafiee, Akbar; Sharifi, Mehrazad; Bolandnazar, Najmeh Sadat

    2017-07-01

    The VACTERL association, co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, genitourinary, and limb malformations, is a rare congenital anomaly. Several cardiac anomalies have been reported as a part of the VACTERL association, particularly ventricular and atrial septal defects. Pulmonary artery sling is a rare congenital abnormality in which the left pulmonary artery arises from the right pulmonary artery. This anomaly is not frequently observed in the VACTERL association and has been rarely reported. A 20-month-old girl was admitted to our hospital due to pneumonia in the right lung, which had pulmonary artery sling as a part of the VACTERL association. Barium meal X-ray showed pressure effects on the esophagus, and computed tomography angiography revealed pulmonary artery sling. Pneumonia management was done. However, the parents of our patient refused to give consent for the surgical correction of this vascular anomaly. Three months after discharge from the hospital, the patient was visited, at which time the parents again refused surgery and treatment for their daughter despite our recommendations.

  3. "Sling" retropúbico e transobturatório no tratamento da incontinênca urinária de esforço Retropubic and transobturator sling in treatment of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Andrea Lopes Salzedas Tanuri

    2010-01-01

    Full Text Available OBJETIVO: Comparar resultados das técnicas de "sling" retropúbico e transobturador para o tratamento de mulheres com incontinência urinária de esforço (IUE. MÉTODOS: Foram randomizadas 30 pacientes, sendo que 20 se submeteram ao sling retropúbico e 10 ao transobturador. As pacientes foram avaliadas antes e após o tratamento com um, seis e 12 meses, por meio de história clínica, exame físico, questionário de qualidade de vida ("King's Health Questionnaire", teste do absorvente e avaliação urodinâmica. Os grupos foram homogêneos no pré-operatório. RESULTADOS: Houve melhora significante na avaliação da qualidade de vida em ambos os grupos após a terapêutica, sem diferença entre os grupos. Houve diminuição no peso do absorvente para os dois grupos. As taxas de cura pela avaliação urodinâmica em 12 meses foram de 84,2% para o grupo transobturador e 88,8% para o retropúbico. Da mesma forma, a cura subjetiva foi de 85% e 88,8%, respectivamente. Não observamos diferenças entre os grupos consoante as complicações. CONCLUSÃO: As cirurgias deste sling, pelas vias retropúbica e transobturadora, foram eficazes para o tratamento de mulheres com IUE, no seguimento de 12 meses. Observamos elevada taxa de cura e melhora da qualidade de vida com baixos índices de complicações.OBJECTIVE: The aim of this study was to compare results of retropubic and transobturator sling for surgical treatment of female stress urinary incontinence (SUI. METHODS: Thirty randomized patients with SUI were divided in two groups, twenty who underwent the transobturator sling and ten the retropubic sling procedure. .Patients were assessed before and after one, six and twelve months of treatment by clinical history, physical examination, quality of life questionnaire (King's Health Questionnaire, pad test and urodynamic parameters. At preoperative both groups were homogenous. RESULTS: One year after surgery, incontinence and quality of life

  4. Decreasing transobturator sling groin pain without decreasing efficacy using TVT-Abbrevo.

    Science.gov (United States)

    Shaw, Jonathan S; Jeppson, Peter C; Rardin, Charles R

    2015-09-01

    Groin pain following a transobturator (TO) midurethral sling is not uncommon and can be difficult to manage. We sought to determine if decreasing the mesh burden in the groin would decrease pain. The primary objective was to compare the incidence of post-operative groin pain following placement of full-length TVT-Obturator versus the shorter TVT-Abbrevo. Secondarily, we aimed to compare the efficacy between both devices 6 months after surgery. This is a retrospective cohort study of all women who underwent a TO midurethral sling by the division of urogynecology at one institution between 1 January 2007 and 31 October 2013. Charts were reviewed and the incidence of post-operative groin pain in the two groups dichotomized as present or absent and compared using a Chi-squared test. Validated questionnaire scores of the groups were compared using t tests. There were 125 patients who received a TVT-Obturator and 100 patients who received a TVT-Abbrevo. No differences in demographic data were present between the groups. Twelve patients (9.6 %) in the TVT-Obturator group and 1 patient (1 %) in the TVT-Abbrevo group experienced bothersome groin pain (P value = 0.007). The complete pre- and 6-month post-operative ISI, UDI-6 and PFIQ-7 scores were available for 76 (61 %), 47 (38 %), and 45 (36 %) patients following TVT-Obturator and 57 (57 %), 30 (30 %), and 28 (28 %) following TVT-Abbrevo treatment. At 6 months the mean improvement in questionnaire scores for the TVT-Obturator and TVT-Abbrevo groups were as follows: 5.0 and 5.1 for ISI (P value = 0.9), 8.3 and 7.9 for UDI-6 (P value = 0.8), and 4.8 and 6.1 for PFIQ-7 (P value = 0.4). Use of TVT-Abbrevo reduces post-operative groin pain compared with the full-length TVT-Obturator, without any reduction in efficacy.

  5. Effect of Sling Exercise Training on Balance in Patients with Stroke: A Meta-Analysis.

    Science.gov (United States)

    Chen, Lianghua; Chen, Junqi; Peng, Qiyuan; Chen, Jingjie; Zou, Yucong; Liu, Gang

    2016-01-01

    This study aims to evaluate the effect of sling exercise training (SET) on balance in patients with stroke. PubMed, Cochrane Library, Ovid LWW, CBM, CNKI, WanFang, and VIP databases were searched for randomized controlled trials of the effect of SET on balance in patients with stroke. The study design and participants were subjected to metrological analysis. Berg balance Scale (BBS), Barthel index score (BI), and Fugl-Meyer Assessment (FMA) were used as independent parameters for evaluating balance function, activities of daily living(ADL) and motor function after stroke respectively, and were subjected to meta-analysis by RevMan5.3 software. Nine studies with 460 participants were analyzed. Results of meta-analysis showed that the SET treatment combined with conventional rehabilitation was superior to conventional rehabilitation treatments, with increased degrees of BBS (WMD = 3.81, 95% CI [0.15, 7.48], P = 0.04), BI (WMD = 12.98, 95% CI [8.39, 17.56], P risk of bias. Therefore, more multi-center and large-sampled randomized controlled trials are needed to confirm its clinical applications.

  6. Pregnancy and delivery following midurethral sling surgery for stress urinary incontinence.

    Science.gov (United States)

    Huser, Martin; Belkov, Ivan A; Janku, Petr; Sedlakova, Katerina

    2012-11-01

    To analyze the available clinical evidence on the continued effectiveness of midurethral sling (MUS) surgery for stress urinary incontinence (SUI) in women who become pregnant and undergo delivery, and then to determine the optimal mode of delivery for such women. An online search was carried out to retrieve the available evidence regarding the risk of SUI recurrence during pregnancy and after delivery following a successful MUS treatment. Appropriate keywords were used to identify all relevant reports published from 1996 through 2011. Basic patient characteristics, mode of delivery, and presence of SUI during pregnancy and the postpartum were analyzed. No more than 36 relevant cases were found. The overall urinary continence rates were 91.7% during pregnancy and 80.6% during the postpartum. Most (58.3%) of the women were delivered vaginally. The evidence indicates that the risk of SUI recurrence is not significantly different after a vaginal or a cesarean delivery. In women successfully treated with a MUS, pregnancy care and delivery mode therefore need to be considered case by case, according to factors other than the risk of recurrence. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

    LENUS (Irish Health Repository)

    Joyce, M

    2012-02-01

    BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.

  8. Virtue male sling for post-prostatectomy stress incontinence: a prospective evaluation and mid-term outcomes.

    Science.gov (United States)

    Ferro, Matteo; Bottero, Danilo; D'Elia, Carolina; Matei, Deliu Victor; Cioffi, Antonio; Cozzi, Gabriele; Serino, Alessandro; Cordima, Giovanni; Bianchi, Roberto; Incarbone, Piero Giacomo; Brescia, Antonio; Musi, Gennaro; Fusco, Ferdinando; Detti, Serena; Mirone, Vincenzo; de Cobelli, Ottavio

    2017-03-01

    To evaluate the efficacy and safety of the Virtue ® male sling (Coloplast, Humlebaek, Denmark) in a cohort of patients affected by post-prostatectomy stress urinary incontinence (SUI). All 29 consecutive patients treated with a Virtue male sling at our Institution between July 2012 and October 2013 were included in the present prospective, non-randomized study. Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery using a 24-h pad weight test, the International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Urinary Symptom Profile (USP) questionnaire, a bladder diary, uroflowmetry and the Patient Global Impression of Improvement (PGI-I) and Patient Global Impression of Severity questionnaires. The mean patient age was 65.5 years. A total of 72.4% of patients had preoperative mild incontinence (1-2 pads/day), while nine patients used 3-5 pads/day. There were a total of 17 complications, which occurred in 29 patients (58.6%); all were Clavien-Dindo grade I. At 12-month follow-up patients showed a significant improvement in 24-h pad test (128.6 vs 2.5 g), number of pads per day (2 vs 0), ICIQ-SF score (14.3 vs 0.9) and USP score for SUI (4 vs 0), and outcomes remained stable at 36 months. At last follow-up, the median score on the PGI-I questionnaire was 1 (very much better). The Virtue male sling is an effective treatment option for low to moderate post-prostatectomy incontinence. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  9. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up

    Directory of Open Access Journals (Sweden)

    Dubuisson Jean-Bernard

    2009-09-01

    Full Text Available Abstract Backround The transobturator tape procedure (TOT is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. Methods It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®. Follow-up information was available for 225 (96.6% women. Results There were few per operative complications. Forty-eight women (21.3% reported late complications including de novo or worsening of preexisting urgencies (10.2%, perineal pain (2.2%, de novo dyspareunia (9%, and vaginal erosion (7.6%. The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001. The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4% compared to women who did not (78.4% (RR 0.14, 95% CI 0.05-0.38, P Conclusion Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.

  10. Sling-based Exercise for External Rotator Muscles: Effects on Shoulder Profile in Young Recreational Tennis Players

    Science.gov (United States)

    Goulet, Charles; Rogowski, Isabelle

    2016-12-19

    Context: Tennis playing generates specific adaptations, particularly at the dominant shoulder. It remains to be established whether shoulder strength balance can be restored by sling-based training for adolescent recreational tennis players. Objective: We added a sling-based exercise for shoulder external rotators to investigate its effects on external rotator muscle strength, on internal rotator muscle strength, on glenohumeral range of motion and on tennis serve performance. Design: Test-retest design. Setting: Tennis training sports facilities. Participants: Twelve adolescent male players volunteered to participate in this study (age: 13.3 ± 0.5 years; height: 1.64 ± 0.07 cm, mass: 51.7 ± 5.8 kg, International Tennis Number: 8). Intervention: The procedure spanned 10 weeks. For the first five weeks, players performed their regular training (RT) twice a week. For the last five weeks, a sling-based exercise (SE) for strengthening the shoulder external rotator muscles was added to their regular training. Main Outcome Measures: Maximal isometric strength of shoulder external and internal rotator muscles and glenohumeral range of motion in external and internal rotation were assessed in both shoulders. Serve performance was also evaluated by accuracy and post-impact ball velocity, using a radar gun. Results: No change was found in any measurement after the RT period. Significant increases in external (~+5%; pexternal/internal strength ratio (~+4%; pexternal rotator muscles appears effective in restoring strength balance at the dominant shoulder, and may prevent adolescent tennis players from sustaining degenerative shoulder problems which could later impair their performance of daily and work-related tasks.

  11. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female

    OpenAIRE

    Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi

    2017-01-01

    We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). ...

  12. Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery

    DEFF Research Database (Denmark)

    Weltz, Vibeke; Guldberg, Rikke; Larsen, Michael D.

    2018-01-01

    Introduction and hypothesis: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. Methods: Data were retrieved from the national Danish Urogynaecological Database, including women...... was defined as any new surgical procedure for stress urinary incontinence performed within the study period. Results: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence...

  13. Report on the investigation into the snagging of hooks and their indiscriminate shedding of slings/pennants. Phase 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    The Health and Safety Executive (HSE) initiated studies to (a) identify reasons why hooks snag on various objects and (b) into the unsolicited discharge or shedding of slings/pennants from non-loaded hooks during offshore operations with cranes. In practical testing, both Single Point Hooks and Load Closing Hooks were used. The author of the report has assumed the reader is familiar with the offshore environment and with the terminology associated with lifting equipment. The tests were recorded on video which is available from the HSE. The report includes various safety recommendations.

  14. Clinical trial comparing autogenous fascia lata sling and Gore-Tex suspension in bilateral congenital ptosis

    Directory of Open Access Journals (Sweden)

    Elsamkary MA

    2016-03-01

    Full Text Available Mahmoud Ahmed Elsamkary,1 Maged Maher Salib Roshdy1,2 1Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 2Pediatric Ophthalmology Department, Al Watany Eye Hospital, Cairo, Egypt Purpose: To study the effect of autogenous fascia lata sling (AFLS versus Gore-Tex suspension (GTS regarding the functional and aesthetic outcomes in patients with bilateral congenital ptosis. Patients and methods: A prospective comparative randomized single-center study enrolled 110 patients with bilateral congenital ptosis. One group (n=55 underwent AFLS and the second group (n=55 underwent GTS. Exclusion criteria were good levator function, absent Bell’s phenomenon, and abnormal ocular motility. Follow-up period was 2 years. Functional outcome was measured from digital photos by analysis of upper eyelid margin position relative to the superior limbus and classified as very good (<3 mm, good (3–5 mm, poor (>5 mm, and recurrent. Aesthetic outcome was assessed in terms of lid contour, symmetry of eyelid height, and lid crease presence. Complications were also reported. Results: Failure rate (recurrence and complications was less in AFLS (P=0.035. Symmetrical lid height and good contour were more frequently attained by AFLS (P=0.007 and 0.047, respectively. However, the frequency of very good, good, poor, recurrence, lagopthalmos, ectropion, infection, and formed lid crease individually showed no statistically significant difference (P=0.252, 0.482, 1, 0.489, 0.438, 1, 0.618, and 0.506, respectively. Conclusion: AFLS is a better choice in surgery for patients with bilateral congenital ptosis because it has fewer complications and a lesser recurrence rate than GTS. Keywords: ptosis surgery, surgical outcomes, ptosis recurrence, lagophthalmos

  15. Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial--design and methods.

    Science.gov (United States)

    Wei, John; Nygaard, Ingrid; Richter, Holly; Brown, Morton; Barber, Matthew; Xiao Xu; Kenton, Kimberly; Nager, Charles; Schaffer, Joseph; Visco, Anthony; Weber, Anne

    2009-04-01

    The primary aims of this trial are to determine whether the use of a concomitant prophylactic anti-incontinence procedure may prevent stress urinary incontinence symptom development in women undergoing vaginal prolapse surgery and to evaluate the cost-effectiveness of this prophylactic approach. To present the rationale and design of a randomized controlled surgical trial (RCT), the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) Trial highlighting the challenges in the design and implementation. The challenges of implementing this surgical trial combined with a cost-effectiveness study and patient preference group are discussed including the study design, ethical issues regarding use of sham incision, maintaining the masking of study staff, and pragmatic difficulties encountered in the collection of cost data. The trial is conducted by the NICHD-funded Pelvic Floor Disorders Network. The ongoing OPUS trial started enrollment in May 2007 with a planned accrual of 350. The use of sham incision was generally well accepted but the collection of cost data using conventional billing forms was found to potentially unmask key study personnel. This necessitated changes in the study forms and planned timing for collection of cost data. To date, the enrollment to the patient preference group has been lower than the limit established by the protocol suggesting a willingness on the part of women to participate in the randomization. Given the invasive nature of surgical intervention trials, potential participants may be reluctant to accept random assignment, potentially impacting generalizability. Findings from the OPUS trial will provide important information that will help surgeons to better counsel women on the benefits and risks of concomitant prophylactic anti-incontinence procedure at the time of vaginal surgery for prolapse. The implementation of the OPUS trial has necessitated that investigators consider ethical issues up front, remain flexible

  16. Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs. TVT™.

    Science.gov (United States)

    Thubert, Thibault; Canel, Virginie; Vinchant, Marie; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2016-03-01

    Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT). This retrospective study compared TVT-E (n=49) and TVT (n=49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc.) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs. Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively (p=1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8.0 vs. 15.9, p=0.01). The first post-void residual was increased in the TVT-E group (153.9 vs. 78.9mL, p=0.045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p=0.02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p=0.16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p=1). The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal.

    Science.gov (United States)

    Lee, Dominic; Bacsu, Chasta; Dillon, Benjamin; Zimmern, Philippe E

    2017-06-28

    To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center. Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively. The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies. © 2017 John Wiley & Sons Australia, Ltd.

  18. Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling?

    Directory of Open Access Journals (Sweden)

    John T. Stoffel

    2008-12-01

    Full Text Available OBJECTIVE: Our purpose was to determine if women with mixed urinary incontinence (MUI and urodynamic detrusor overactivity (DO have less improvement in urinary symptoms after pubovaginal sling surgery (PVS, compared to MUI without DO. MATERIALS AND METHODS: Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H20 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6 questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. RESULTS: 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59. Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30 for Group A and B. Mean changes in total UDI-6 after PVS were - 8.0 and - 10.2 (p = 0.030, respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83. There were no differences between the groups when comparing demographic, urodynamic, or operative data. CONCLUSION: MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.

  19. Sling de aponeurose e com faixa sintética sem tensão para o tratamento cirúrgico da incontinência urinária de esforço feminina Pubovaginal sling and tension-free vaginal tape for surgical treatment of stress urinary incontinence in women

    Directory of Open Access Journals (Sweden)

    João Paulo Sartori

    2008-03-01

    Full Text Available OBJETIVO: comparar as cirurgias de sling de aponeurose e TVT (do inglês tension-free vaginal tape para correção da incontinência urinária de esforço (IUE quanto às taxas de cura subjetiva e objetiva, à mobilidade do colo vesical ao ultra-som, à variação do teste do absorvente, às alterações urodinâmicas e à incidência de complicações. MÉTODOS: foram selecionadas 80 pacientes com IUE. Destas, 61 foram operadas pela técnica de TVT e 19 por sling de aponeurose do reto abdominal. As médias de idade, índice de massa corpórea e paridade foram 50,1 anos, 29,7 kg/m² e 4,5 partos (mediana=3 para as pacientes com sling de aponeurose e de 51,7 anos, 28,1 kg/m² e 4,1 partos (mediana=3 para aquelas com TVT. Todas se submeteram a anamnese, exame físico, ultra-sonografia do colo vesical, teste do absorvente e estudo urodinâmico no pré-operatório e após, pelo menos, seis meses depois da cirurgia. Após 15 ou 19 meses e depois de cerca de quatro a cinco anos, foram novamente entrevistadas quanto aos resultados da cirurgia. RESULTADOS: quanto à avaliação subjetiva, após seis meses, julgaram-se curadas 96,7% das mulheres com TVT e 89,5% das com sling. Porém, após 15 a 19 meses, o Grupo TVT manteve a mesma taxa de cura subjetiva, enquanto que no Grupo Sling houve redução para 77,8%. Houve diminuição significativa da mobilidade do colo vesical, similar em ambos os grupos, e melhora no teste do absorvente. No final do estudo urodinâmico, foram classificadas como cura objetiva 93,4% das mulheres do Grupo TVT e 78,9% daquelas do Grupo Sling. O tempo médio de sondagem vesical foi maior no Grupo Sling. Observou-se retenção urinária em 42,1% dos casos de sling e em 9,8% de TVT. As taxas de cura tardia foram 90% para TVT e 55,6% para sling. CONCLUSÕES: a cirurgia de TVT propiciou melhor taxa de cura subjetiva após 15 ou 19 meses, porém, a taxa de cura objetiva foi igual em ambas as técnicas neste tempo. Entre as complica

  20. Mid-term follow-up of the TVT-Secur midurethral sling for primary stress incontinence.

    Science.gov (United States)

    Angleitner-Flotzinger, Johannes; Aigmueller, Thomas

    2014-09-01

    The TVT-Secur was introduced in 2006 as a less invasive alternative to retropubic and transobturator suburethral slings. This retrospective cohort study evaluated objective and subjective results in a series of 158 consecutive patients as well as complications and the reoperation rate after TVT-Secur procedure. Between November 2006 and June 2010 a total of 158 patients underwent a TVT-Secur procedure at a single institution. All patients underwent preoperative urodynamic testing. All patients were invited for follow-up including physical examination, urodynamic studies and subjective evaluation. A total of 96 patients (61%) were available for follow-up with a mean follow-up of 29.8 months (range 5-50, median 30). At follow-up, eight (8%) of 96 patients had reoperations for stress incontinence. There were no reoperations for bleeding/hematoma, tape erosions or obstructed micturition and there were no tape erosions or exposures. 29 patients (30%) had a negative cough stress test and 44 patients (46%) subjectively considered themselves "cured". Nine of 43 patients (21%) without urgency symptoms preoperatively developed de novo urgency; 24 of 35 patients (69%) with preoperative urgency complaints were free of urgency symptoms. At 2.4 years, the TVT-Secur appears to have a low adverse events profile but inferior results compared with traditional midurethral slings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. [Bladder injury during sling operation in the treatment of SUI--review of literature and case report].

    Science.gov (United States)

    Gałczyński, Krzysztof; Futyma, Konrad; Bar, Krzysztof; Rechberger, Tomasz

    2012-10-01

    Sling operations have been performed for over 15 years. In recent years these operations have become the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy safety and low invasiveness. Approximately 4% of women will undergo a surgery for SUI in the course of their life. As with any surgical intervention, there may be some technical problems, as well as intra- and postoperative complications, the most common of which is bladder injury Other complications encountered during mid-urethral slings procedures include bleeding (retropubic or vaginal hematomas), urethral perforation, urinary tract infections, postoperative vaginal or urethral erosions, bowel perforation, chronic pelvic pain, wound infection, nerve injury transient and persistent voiding dysfunction such as de novo urgency incomplete bladder emptying or urinary retention. Below we present a case of a patient with diagnosed vesicovaginal fistula after sling operation (TVT-tension-free vaginal tape). Upon admission the patient reported dysuria, persistent urinary leakage and abnormal, abundant vaginal discharge. Case report and review of literature concerning surgical treatment of stress urinary incontinence and its complications. Analysis of medical documentation of the patient treated at the Second Department of Gynecology Medical University of Lublin. Review of abstracts or papers in the Medline database related to surgical treatment of urinary incontinence and its complications. Bladder perforation is one of the most common complications of the retropubic approach for MUS placement. The presence of mesh within the bladder may arise from direct bladder perforation or from subsequent erosion of the sling. Such lesions do not cause any serious health consequences for patients on condition they are detected intraoperatively and appropriately repaired, but when unrecognized, they results in the development of considerable symptoms and negatively influence the quality of

  2. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

    NARCIS (Netherlands)

    van der Ploeg, J. M.; Oude Rengerink, K.; van der Steen, A.; van Leeuwen, J. H. S.; Stekelenburg, J.; Bongers, M. Y.; Weemhoff, M.; Mol, B. W.; van der Vaart, C. H.; Roovers, J.-P. W. R.; Bergmans, Martin G.; Bongers, Marlies Y.; Dekker, Karin S.; van Gestel, Iris; Kluivers, Kirsten B.; Milani, A. L. Fred; van der Ploeg, J. Marinus; Oude Rengerink, Katrien; Schagen van Leeuwen, Jules H.; Schram, Aaltje J.; van der Steen, Annemarie; Stekelenburg, Jelle; van der Vaart, C. Huub; Weemhoff, Mirjam; Weis-Potters, Annemarie E.; Wijma, Jac

    2015-01-01

    To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. Multi-centre randomised trial. Fourteen teaching hospitals in the Netherlands. Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress

  3. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence : a randomised trial

    NARCIS (Netherlands)

    van der Ploeg, J. M.; Rengerink, K. Oude; van der Steen, A.; van Leeuwen, J. H. S.; Stekelenburg, J.; Bongers, M. Y.; Weemhoff, M.; Mol, B. W.; van der Vaart, C. H.; Roovers, J-P W. R.

    ObjectiveTo compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. DesignMulti-centre randomised trial. SettingFourteen teaching hospitals in the Netherlands. PopulationWomen with symptomatic stage two or greater pelvic organ prolapse (POP), and

  4. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial

    NARCIS (Netherlands)

    van der Ploeg, J. Marinus; Oude Rengerink, Katrien; van der Steen, Annemarie; van Leeuwen, Jules H. Schagen; van der Vaart, C. Huub; Roovers, Jan-Paul W. R.

    2016-01-01

    We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or

  5. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence : a randomized trial

    NARCIS (Netherlands)

    van der Ploeg, J Marinus; Rengerink, Katrien Oude; van der Steen, Annemarie; van Leeuwen, Jules H Schagen; van der Vaart, C Huub; Roovers, Jan-Paul W R

    INTRODUCTION AND HYPOTHESIS: We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). METHODS: This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of

  6. TVT-Secur (Hammock) versus TVT-Obturator: a randomized trial of suburethral sling operative procedures.

    Science.gov (United States)

    Hota, Lekha S; Hanaway, Katherine; Hacker, Michele R; Disciullo, Anthony; Elkadry, Eman; Dramitinos, Patricia; Shapiro, Alexander; Ferzandi, Tanaz; Rosenblatt, Peter L

    2012-01-01

    This study aimed to compare TVT-Secur (TVT-S) and TVT-Obturator (TVT-O) suburethral slings for treatment of stress urinary incontinence (SUI). This was a single-center, nonblinded, randomized trial of women with SUI who were randomized to TVT-S or TVT-O from May 2007 to April 2009. The primary outcome, SUI on cough stress test (CST), and quality-of-life and symptom questionnaires (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor Impact Questionnaire [PFIQ-7]) were assessed at 12 weeks and 1 year. Forty-three women were randomized to TVT-S and 44 to TVT-O. There were no differences in median baseline PFDI-20 and PFIQ-7. Twenty-two (52.4%) of 42 participants randomized to TVT-S had a positive CST result at evaluation after 12 weeks or 1 year, whereas 4 (9.1%) of the 44 in the TVT-O group had a positive CST result. The intent-to-treat analysis showed that the risk of a positive CST result was 6 times higher after TVT-S than TVT-O (risk ratio, 6.0; 95% confidence interval [CI], 2.3-16.0). Among women not lost to follow-up, the risk ratio for a positive CST result after TVT-S compared with TVT-O was 17.9 (95% CI, 2.5-128.0) at 12 weeks and 3.5 (95% CI, 1.1-11.0) at 1 year. Both TVT-S and TVT-O resulted in improved quality of life and symptoms at 12 weeks. There was no difference between the groups for PFDI-20 (P = 0.40) or PFIQ-7 (P = 0.43). A similar pattern was seen at 1 year (P = 0.85 and P = 0.36). The TVT-S seems to have a higher risk of positive postoperative CST result; however, the procedures result in similar improvements in quality of life and symptoms.

  7. An evaluation of the sling surgical method of the bulbar urethra in the treatment of men's stress urinary incontinence at Shohadaye Ashayer Teaching Hospital in 2008.

    Science.gov (United States)

    Heidari, Mohammad; Khorramabadi, Manoochehr Shams

    2012-11-01

    To evaluate the utility and efficacy of bulbar urethera sling in the management of sphincter insufficiency that usually occurs after prostate surgery or posterior urethral injuries and may lead to moderate to severe stress incontinence. A total of 30 patients underwent sling surgery with rectus fascia in a four-year period at the Shohadaye Ashayer Teaching Hospital in Iran. Urinary incontinence occurred in 8 patients after open prostatectomy, in 12 patients after prostatectomy through urethra, in 8 patients after radical prostatectomy. For the purpose of the study, 2 patients in whom incontinence occurred after pelvic fracture were excluded. The 28 patients were followed up for a one-year period after the operation. All patients had incontinence from one to six years. After hospitalisation, an 18 gauge Foley's catheter was introduced in the urethra in every patient. The perineum was incised longitudinally, and the bulbar urethra was freed and a 2x7 cm span of rectus fascia was separated and placed under the bulbar urethra. Treatment was defined as use of one or no pad per day and recovery, as a reduction of at least 50% in the number of the used pads after sling operation. After operation, all patients suffering from moderate to severe stress incontinence were treated with 0-1 pad per day. Four patients were unable to urinate; in 2 patients the sling was modified and loosened, and in two others dilatation resolved their problems. Bulbar urethra sling can be carried out in moderate to severe urinary incontinence treatment in any hospital at a modest cost with satisfactory results.

  8. Use of the adjustable trans-obturator male sling system for the ...

    African Journals Online (AJOL)

    M.S. El Badry

    2016-03-25

    Mar 25, 2016 ... procedure for the treatment of male urinary incontinence. It has the advantage of ... However, a lack of postoperative adjustment and the risk of dis- location of the ... of male SUI due to different etiological factors. Subjects and ...

  9. A randomised controlled trial comparing TVT, Pelvicol and autologous fascial slings for the treatment of stress urinary incontinence in women.

    Science.gov (United States)

    Guerrero, K L; Emery, S J; Wareham, K; Ismail, S; Watkins, A; Lucas, M G

    2010-11-01

    To compare TVT(TM) , Pelvicol(TM) and autologous fascial slings (AFSs). A multicentre randomised control trial. Four units in the UK. Women requiring primary surgery for stress urinary incontinence (SUI). A total of 201 women with urodynamically proven stress incontinence were randomised into three groups and assessed at baseline, 6 weeks, 6 months and 1 year. The primary outcome was patient-reported improvement rates. Secondary outcomes included operative complications/time, intermittent self-catheterisation (ISC) and re-operation rates. The quality-of-life tools used were the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL. Fifty women had a Pelvicol(TM) sling, 79 had AFSs and 72 had TVT(TM). At 6 months the Pelvicol(TM) arm had poorer improvement rates (73%) than TVT(TM) (92%)/AFS (95%); P=0.003. At 1 year only 61% of the Pelvicol(TM) slings remained as improved, versus 93% of TVTs and 90% of AFSs (PTVT(TM) (55%)/AFS (48%) (P=0.001) at 1 year; hence, the Pelvicol(TM) arm was suspended following interim analysis. There is no difference in the success rates between TVT(TM) and AFS. One in five women in the Pelvicol(TM) arm had further surgery for SUI by 1 year, but none required further surgery in the other arms. AFS took longer to do (54 minutes versus 35 minutes for TVT(TM) /36 minutes for Pelvicol(TM) ) and had higher ISC rates (9.9 versus 0% Pelvicol(TM) /TVT(TM) 1.5%). Hospital stay was shortest for TVT(TM) (2 days). Most BFLUTS domains showed improvement in all three arms. The improvement for women in the Pelvicol(TM) arm, however, was less than for women in the other arms in several key domains. Pelvicol(TM) cannot be recommended for the management of SUI. TVT(TM) does not have greater efficacy than AFS, but does utilise fewer resources. © 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

  10. A randomized clinical trial of how to best position retropubic slings for stress urinary incontinence: Development of a study protocol for the mid-urethral sling tensioning (MUST) trial.

    Science.gov (United States)

    Brennand, Erin A; Kim-Fine, Shunaha

    2016-08-15

    The goal of this trial is to compare two techniques for tensioning retropubic midurethral slings: a Mayo scissor between the tape and urethra vs. a Babcock clamp creating a measured loop underneath the urethra. The primary outcome is a composite of abnormal bladder function at 12 months post surgery. Abnormal bladder function is defined as bothersome stress incontinence or worsening over active bladder symptoms, a positive cough stress test, re-treatment of stress urinary incontinence, post-operative urinary retention requiring either catheterization beyond 6 weeks or surgical intervention. Secondary outcomes include the duration of post operative urinary retention, quality of life scores, and physical examination. This article describes the rationale and design of this clinical trial, which will be of interest to those who care for patient with pelvic floor disorders such as stress urinary incontinence.

  11. Transobturator tension-free “inside-to-out” suburethral sling procedure for the treatment of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Laketić Darko

    2012-01-01

    Full Text Available Introduction. Stress urinary incontinence is an involuntary leakage of urine on a sudden increase of intra-abdominal pressure by physical activity, exercise, coughing, sneezing or laughing. Objective. To assess symptoms, functional and anatomical status of voiding function, complications and short term success of a novel procedure, tension-free vaginal tape obturator technique (TVT-O in the treatment of stress urinary incontinence. Methods. A prospective study was performed on 40 female patients who underwent the TVT-O suburethral sling at the Urology Department of the Health Centre in Prokuplje and Urology Hospital in Niš between May 2009 and February 2010. The mean patients’ age was 58 years (range 34-84 years. Preoperative evaluation included a detailed history and gynaecologic examination including urodynamic testing and voiding studies.UDI-6 and UIQ-7 score testing was performed before, and six months after surgery. All patients who demonstrated stress urinary incontinence with a Q-tip test-angle during maximal straining were included into the study. Postoperatively, outcomes evaluation included voiding function, anatomical parameters, complications, as well as subjective success rates. Results. In 30 patients surgery was performed under spinal and in ten under general anaesthesia. The average intraoperative blood loss during the TVT-O was minimal (<50 ml. There were no vascular, bladder, bowel, and neurological injuries. Thirty-eight patients (95% were discharged voiding satisfactorily. There was a statistically significant difference in symptoms between UDI-6 and UIQ-7 before and after surgery. Conclusion. Initial experience with TVT-O suburethral sling is promising. The TVT-O differs from retropubic procedures by resulting in lower postoperative morbidity, intraoperative and postoperative complications.

  12. Effects of 6-week sling-based training of the external-rotator muscles on the shoulder profile in elite female high school handball players.

    Science.gov (United States)

    Genevois, Cyril; Berthier, Philippe; Guidou, Vincent; Muller, Franck; Thiebault, Boris; Rogowski, Isabelle

    2014-11-01

    In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. Crossover study. National elite handball training center. 25 elite female high school handball players. The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

  13. Pedicled rectus abdominis muscle and fascia flap sling the bulbar urethra for treatment for male-acquired urinary incontinence: report of ten cases.

    Science.gov (United States)

    Xu, Yue-Min; Zhang, Xin-Ru; Xie, Hong; Song, Lu-Jie; Feng, Chao; Fei, Xiao-Fang

    2014-03-01

    Male urinary incontinence is relatively common complication of radical prostatectomy and of posterior urethroplasty following traumatic pelvic fracture. Here, we investigate the use of pedicled rectus abdominis muscle and fascia flap sling of the bulbar urethra for treatment for male-acquired urinary incontinence. Ten patients with acquired urinary incontinence were included in the study. Urinary incontinence was secondary to TURP in three patients and was secondary to posterior urethroplasty performed following traumatic pelvic fracture in seven patients. Pedicled rectus abdominalis muscle and fascial flaps, approximately 2.5 cm wide and 15 cm long, were isolated. The flaps were inserted into a perineal incision through a subcutaneous tunnel. The free end of the flap was sectioned to form two muscle strips, each 3 cm in length, and inserted into the space between bulbar urethra and corpus cavernosa. After adequate sling tension had been achieved, the two strips of muscle were anastomosed around the bulbar urethra using a 2-zero polyglactin suture. The patients were followed up for between 12 and 82 months (mean 42.8 months). Complete continence was achieved with good voiding in seven of the 10 patients. In other three patients achieved good voiding following catheter removal, but incontinence was only moderately improved. A pedicled rectus muscle fascial sling of the bulbar urethra is an effective and safe treatment for male patients with mild to moderate acquired urinary incontinence, but it may not be suitable for severe incontinence or for patients with weak rectus abdominalis muscles.

  14. Effects of cross-education on the muscle after a period of unilateral limb immobilization using a shoulder sling and swathe.

    Science.gov (United States)

    Magnus, Charlene R A; Barss, Trevor S; Lanovaz, Joel L; Farthing, Jonathan P

    2010-12-01

    The purpose of this study was to apply cross-education during 4 wk of unilateral limb immobilization using a shoulder sling and swathe to investigate the effects on muscle strength, muscle size, and muscle activation. Twenty-five right-handed participants were assigned to one of three groups as follows: the Immob + Train group wore a sling and swathe and strength trained (n = 8), the Immob group wore a sling and swathe and did not strength train (n = 8), and the Control group received no treatment (n = 9). Immobilization was applied to the nondominant (left) arm. Strength training consisted of maximal isometric elbow flexion and extension of the dominant (right) arm 3 days/wk. Torque (dynamometer), muscle thickness (ultrasound), maximal voluntary activation (interpolated twitch), and electromyography (EMG) were measured. The change in right biceps and triceps brachii muscle thickness [7.0 ± 1.9 and 7.1 ± 2.2% (SE), respectively] was greater for Immob + Train than Immob (0.4 ± 1.2 and -1.9 ± 1.7%) and Control (0.8 ± 0.5 and 0.0 ± 1.1%, P effect on maximal voluntary activation or EMG. The cross-education effect on the immobilized limb was greater after elbow extension training. This study suggests that strength training the nonimmobilized limb benefits the immobilized limb for muscle size and strength.

  15. [A comparative study between two procedures of TVT retropubic mid-urethral sling placement for treatment of female stress urinary incontinence].

    Science.gov (United States)

    Sergent, F; Gay-Crosier, G; Resch, B; Pons, J-C; Marpeau, L

    2014-03-01

    To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (PTVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (PTVT, it is possible to reduce its complications while maintaining its efficacy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  16. Functional outcomes of polypropylene midurethral sling resection for treatment of mesh exposure/extrusion: Does it lead to a relapse of incontinence?

    Science.gov (United States)

    Töz, Emrah; Sahin, Cağdaş; Apaydin, Nesin; Ozcan, Aykut; Taner, Cüneyt E

    2015-07-01

    The Burch colposuspension, which was regarded as the gold standard treatment for stress urinary incontinence for several years, has been replaced by minimally invasive sling devices. Although these procedures are simple and minimally invasive, they are associated with complications such as infection, mesh erosion, chronic pain, and de novo detrusor overactivity, which may necessitate surgical resection or tape removal. The aim of the study was to assess urinary function outcomes including continence, after partial resection of suburethral tapes. Patients were admitted for resection of tape due to extrusion/exposure, between 2011 and 2014. Patients were evaluated with physical examination, transvaginal ultrasound, cough stress test, 24-hour bladder diary, Incontinence Impact Questionnairre-7 form and Urogenital Distress Inventory-6 form. Minimum follow-up time was 2 months after treatment of the tape complication (mean 20, range 2 to 38). Recurrence of incontinence after partial tape resection was observed in 9% (3/32) cases. In two patients due to stress urinary incontinence recurrence repeat anti-incontinence surgery was necessary. Although one patient had suffered from incontinence after resection of tape, she did not desire operation. The results of this study indicated that preservation of the anti-incontinence effects of slings might not be dependent on the intactness of the sling. Recurrence of incontinence after partial tape resection is uncommon and in the majority of cases this stress incontinence is minimally and does not require repeat operation.

  17. Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery.

    Science.gov (United States)

    Weintraub, Adi Y; Reuven, Yonatan; Paz-Levy, Dorit; Yohay, Zehava; Idan, Inbal; Elharar, Debi; Glinter, Hannah; Tzur, Tamar; Yohay, David

    2018-03-01

    To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Did surgical failure and complications affect incontinence-related quality of life in women after transobturator sling procedure?

    Directory of Open Access Journals (Sweden)

    Wen-Chu Huang

    2018-04-01

    Full Text Available Objective: To report the objective outcome, subjective measurement of incontinence-related quality of life (QoL for female urodynamic stress incontinence (USI after transobturator sling surgery (TVT-O and to evaluate the effects of surgical failure and complications on QoL. Materials and methods: We analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6 and Incontinence Impact Questionnaire (IIQ-7 preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. Results: A total of 78 women were followed for a median of 13.5 months (range 12–15 months after surgery. Within this group, 75 (96% were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. Conclusions: TVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL. Keywords: Complication, Quality of life, Stress urinary incontinence, Transobturator tape, Urodynamic stress incontinence

  19. Patients' perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence.

    Science.gov (United States)

    Casteleijn, Fenne M; Zwolsman, Sandra E; Kowalik, Claudia R; Roovers, Jan-Paul P W R

    2018-04-19

    The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option. In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers. Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option. Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.

  20. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female.

    Science.gov (United States)

    Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi

    2017-09-01

    We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). Bronchial asthma is considered an exacerbating factor in infantile period and frequently required treatment with bronchodilator. After the age of 10, the patient had recurrent breathing difficulties during physical activity and during night time, and this condition was assessed to be related to the pressure from the blood vessel on the ring. We repeated the 3D-CT evaluation later and discovered that the internal diameter of the trachea had grown to 5 mm. Eventually, patient's breathing difficulties disappeared after the treatment of bronchial asthma and restriction of physical activities. Our patient remained in stable condition without undergoing any surgical procedures even after she passed the age of 10.

  1. Structural differences and architectural features of two different polypropylene slings (TVT-O and I-STOP) have no impact on biocompatibility and tissue reactions.

    Science.gov (United States)

    Przydacz, Mikolaj; Adli, Oussama El Yazami; Mahfouz, Wally; Loutochin, Oleg; Bégin, Louis R; Corcos, Jacques

    2017-06-30

    To evaluate the impact of design features of the synthetic mid-urethral slings on tissue integrity and inflammatory responses. In total 30 female Sprague-Dawley rats were implanted with type I monofilamentous, macroporous polypropylene meshes: Gynecare TVT-Obturator tape ® (Ethicon Inc., Johnson & Johnson, Somerville, NJ, USA) and I-STOP ® (CL Medical Inc., Lyon, France). All animal groups were sacrificed at set time intervals - 6 weeks, 3 months, 6 months, 9 months and 12 months - and the abdominal wall was harvested with mesh strips for histological evaluation. All mesh strips appeared to be well incorporated into the abdominal wall, and no signs of shrinkage was noticed. All specimens showed a thin/delicate, loose, fibrous interface between the synthetic graft plate and abdominal wall, along with mild inflammatory reactions from 6 weeks to 12 months. Both mesh brands induced comparable, minimal foreign body reactions and integrated well into the host tissues despite differences in architectural features. TVT-O ® and I-STOP ® evoked similar low-grade inflammatory responses up to 12 months in this animal model. Structural differences and architectural features of polypropylene slings used in this study have had no impact on tissue integrity and inflammatory responses.

  2. Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices

    NARCIS (Netherlands)

    Houwert, R. Marijn; Roovers, Jan Paul W. R.; Venema, Pieter L.; Bruinse, Hein W.; Dijkgraaf, Marcel G. W.; Vervest, Harry A. M.

    2010-01-01

    OBJECTIVE: We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN: This was a

  3. Male synthetic sling versus artificial urinary sphincter trial for men with urodynamic stress incontinence after prostate surgery (MASTER): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Constable, Lynda; Cotterill, Nikki; Cooper, David; Glazener, Cathryn; Drake, Marcus J; Forrest, Mark; Harding, Chris; Kilonzo, Mary; MacLennan, Graeme; McCormack, Kirsty; McDonald, Alison; Mundy, Anthony; Norrie, John; Pickard, Robert; Ramsay, Craig; Smith, Rebecca; Wileman, Samantha; Abrams, Paul

    2018-02-21

    Stress urinary incontinence (SUI) is a frequent adverse effect for men undergoing prostate surgery. A large proportion (around 8% after radical prostatectomy and 2% after transurethral resection of prostate (TURP)) are left with severe disabling incontinence which adversely effects their quality of life and many are reliant on containment measures such as pads (27% and 6% respectively). Surgery is currently the only option for active management of the problem. The overwhelming majority of surgeries for persistent bothersome SUI involve artificial urinary sphincter (AUS) insertion. However, this is expensive, and necessitates manipulation of a pump to enable voiding. More recently, an alternative to AUS has been developed - a synthetic sling for men which elevates the urethra, thus treating SUI. This is thought, by some, to be less invasive, more acceptable and less expensive than AUS but clear evidence for this is lacking. The MASTER trial aims to determine whether the male synthetic sling is non-inferior to implantation of the AUS for men who have SUI after prostate surgery (for cancer or benign disease), judged primarily on clinical effectiveness but also considering relative harms and cost-effectiveness. Men with urodynamic stress incontinence (USI) after prostate surgery, for whom surgery is judged appropriate, are the target population. We aim to recruit men from secondary care urological centres in the UK NHS who carry out surgery for post-prostatectomy incontinence. Outcomes will be assessed by participant-completed questionnaires and 3-day urinary bladder diaries at baseline, 6, 12 and 24 months. The 24-h urinary pad test will be used at baseline as an objective assessment of urine loss. Clinical data will be completed at the time of surgery to provide details of the operative procedures, complications and resource use in hospital. At 12 months, men will also have a clinical review to evaluate the results of surgery (including another 24-h pad test) and to

  4. [Study on reductive surgery for pelvic organ prolapse concomitant with anti-incontinence sling for treatment of occult stress urinary incontinence].

    Science.gov (United States)

    Zhang, Xiaolong; Lu, Yongxian; Shen, Wenjie; Liu, Jingxia; Ge, Jing; Liu, Xin; Zhao, Ying; Niu, Ke; Zhang, Yinghui; Wang, Wenying; Qiu, Chengli

    2014-06-01

    To evaluate the clinical outcome of anti-incontinence sling in the treatment of occult stress urinary incontinence (OSUI) during reductive surgery for advanced pelvic organ prolapse (POP). From Jun. 2003 to Dec. 2012, 78 patients with OSUI underwent reductive surgery for advanced POP such as high uterosacral ligament suspension, sacrospinous ligament suspension and sacral colpopexy in the First Affiliated Hospital, General Hospital of People's Liberation Army. Among them, 41 patients received reductive surgery alone was enrolled in non-concomitant anti-incontinence group and the other 37 patients who underwent same surgery with tension-free vaginal tape (TVT) or tension-free vaginal tape-obturator technique (TVT-O) was in anti-incontinence group. The patient's demography, objective and subjective outcomes, as well as complications and injures were compared between the two groups. The pelvic organ prolapse quantitation (POP-Q) was used to evaluate the objective outcomes of POP. Urinary distress inventory (UDI-6) and incontinence impact questionnaire short form (IIQ-7) were used to evaluate the subjective outcomes of stress urinary incontinence (SUI). Compared with the non-concomitant anti-incontinence group, the objective outcomes of reductive surgery exhibited no significant differences (100%, 78/78), and only the operation time of anti-incontinence group slightly increased 16 minutes. The occurrence rate of postoperative SUI was 12% (5/41), 15% (6/41), 17% (7/41) respectively after the operation at 2-month, 6-month and 12-month follow up in the non-concomitant anti-incontinence group; and the occurrence rate of the anti-incontinence group was 3% (1/37), 3% (1/37), 3% (1/37); but none of patients in the two groups require further surgery for stress urinary incontinence. Mean score of UDI-6 and IIQ-7 in all the patients decreased significantly after operation at 2-month, 6-month and 12-month follow up (all P statistic difference between the two groups (P > 0.05). It

  5. Outcomes of Single-Incision Laparoscopic Surgery for Colon Cancer: A Case-Matched Comparative Study

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    Atthaphorn Trakarnsanga

    2016-03-01

    Full Text Available Background: Single-incisionlaparoscopiccolectomy(SILC isanevolvingtechnique withpotentialadvantages by reducing number of incisions that can reduce port-related complications and improve cosmetic results. The purposeof thisstudy wastocomparetheshort-termoutcomesbetweenSILC,hand-assistedlaparoscopiccolectomy (HALC andstandard multi-port laparoscopic colectomy (MLC. Methods: Retrospectiveanalysesofatotalof90patientsbetweenMay2010and December2011, whounderwent SILC for coloncancer surgery, wereperformedin30patients. Clinicopathologicalparameters were matched1:1 withpatients whounderwent HALC (n=30andMLC (n=30.Short-term outcomes werecollectedandanalyzed. Results: Operativetime wassignificantlyshorter inSILC comparedto HALC andMLC (p<0.001,as wellasless estimatedbloodloss (p=0.02. There werenosignificantdifferences inconversionrateandnumberofharvested lymphnodes.SILChadtheadvantageofless24-hrpostoperativepainscorecomparedtoHALCandMLC(p<0.001, whereas length of stayandtime to full diet werenotdifferent. Conclusion: Inselectedpatients,SILC canbesuccessfullyandsafelyperformed withshorteroperativetime, less estimated blood loss andless postoperativepainscore.

  6. Bunion correction using proximal chevron osteotomy: a single-incision technique.

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    Sammarco, G J; Russo-Alesi, F G

    1998-07-01

    Proximal chevron first metatarsal osteotomy with lateral capsulotomy, adductor tenotomy, and binding of the first and second metatarsals was reviewed in 88 consecutive cases. Seventy-two cases in 55 patients are reported, with an average clinical follow-up of 41 months. The hallux valgus angle improved an average of 15 degrees , from 32.0 degrees preoperatively to an average of 17.0 degrees postoperatively. The intermetatarsal I-II angle improved an average of 5.5 degrees, from 15.3 degrees preoperatively to 9.0 degrees postoperatively. The lateral plantar first metatarsal angle did not change. First metatarsal length was decreased by 2.0 mm. Union occurred at an average of 2 months. Sesamoid position improved 49%, from a preoperative average subluxation of 80% to a postoperative average subluxation of 29%. Subjective foot score profiles improved from a preoperative average of 70.1/100 to a postoperative average of 94.4/100 with respect to pain, deformity, motion, disability, and cosmesis. There were 10 patients with complications, including three patients with delayed unions, two with second metatarsal stress fractures, one with hallux varus, two with hallux limitus, one with progressive arthritis, one with cellulitis, and one with hallux elevatus. Eighty-four percent of the patients stated that they would undergo the procedure again without reservation, 9% would proceed with reservation, and 7% would not proceed with surgery again if offered. This technique provides reliable successful long-term results for the treatment of moderate and severe symptomatic bunion, hallux valgus, and metatarsus primus varus.

  7. Effect of midurethral sling (transobturator tape surgery on female sexual function

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    Fredrick Paul

    2015-01-01

    Full Text Available Introduction: Transobturator tapes (TOT are frequently used in the management of female stress urinary incontinence (SUI. We evaluated the effect of TOT on sexual function in Indian women with stress urinary incontinence. Materials and Methods: 34 sexually active women (mean age 42.38 years with SUI were evaluated before TOT placement for sexual function using the NSF-9 sexual scoring system questionnaire. The evaluation was repeated at the 3 rd , 6 th and 12 th months post surgery and then yearly. Results: There was significant improvement in scores in all domains of sexual function post-surgery. The frequency improved in 24 (70.5% patients, lubricacy improved in 12 (57.1% patients, orgasm improved in 21 (67.1% patients, pain improved in 14 (70% patients and, in leaking patients, sexual satisfaction improved in 85.7% while in non-leaking patients improvement was seen in 40%. Sexual relation was not satisfactory in 26 (76.4% of the patients before surgery; of them, 21 (80% patients had improved sexual satisfaction after surgery. De novo urgency and dyspareunia developed in one and two patients, respectively. Conclusions: The TOT procedure has no significant negative impact on sexual function and it significantly improves female sexual function and overall sexual satisfaction in majority of the patients with SUI.

  8. Analysis of 1,000 cases of synthetic midurethral slings used for treatment of female urinary incontinence – a single-center experience

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    Kasyan, George; Gvozdev, Michail; Sosnowski, Roman

    2011-01-01

    Introduction This study summarized our experience in the treatment of 1,081 women with stress urinary incontinence (SUI) using mid-urethral slings. Material and methods The study included 1,081 operated patients. Pure SUI was diagnosed in 77.80% (841) of the patients; another 18.68% (202) had mixed symptoms. The remaining 3.52% (38) suffered from recurrent SUI. Group 1 included the SUI patients treated with TVT. Group 2 – SUI managed with TVT-O. In Group 3, mixed urinary incontinent (MUI) patients were treated with TVT-O. Results Retropubic TVT was used in 273 patients (25.25%) and TVT-O in 740 (68.45%). Other slings were used in 68 patients (6.3%). Mean follow-up for the groups was 50.1, 31.1, and 32.6 months respectively. For objective evaluation of cure rate we used the cough stress test. Subjective efficacy was studied via a visual analog scale. The complication rate in each group of the patients was used as a secondary end point. A negative cough test was found in 85.58% of patients in Group 1. For the TVT-O group, the objective cure rate was 84.36%. Intra-operative complications for TVT and TVT-O were not related to age, BMI, or parity. Bladder perforation and pelvic hematoma developed more frequently in the TVT group. There is a higher risk of vaginal perforation for TVT-O. The objective and subjective cure rates for MUI patients were 86.15% and 87.69% respectively. Conclusions TVT and TVT-O are equally effective and safe methods of treatment for women suffering from SUI and MUI. PMID:24578904

  9. Transversal incision of the vagina favors the remaining of the tape in the middle-third urethra compared to longitudinal incision during transobturator sling procedures for stress urinary incontinence.

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    Pirtea, L; Sas, I; Ilina, Razvan; Grigoraș, D; Mazilu, O

    2015-07-17

    To describe a new type of incision of the vagina during transobturator sling procedure and to evaluate by ultrasound the tape position at 3, 6 and 12 months after surgery. We conducted a prospective study including 51 patients with urinary stress incontinence who underwent sling procedure using the transversal vaginal incision. Tape position was evaluated by ultrasound at 3, 6 and 12 months after surgery and expressed as a percentage of the urethral length (the proximal third of the urethral length 0-39 %, the middle third 40-60 %, and the distal third 60-100 %). Informed consent was obtained from all patients prior to their inclusion in the study. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of "Victor Babeş" University of Medicine and Pharmacy Timisoara before the beginning of the study (no 7/17.04.2012). At 3 months after surgery, 3.92 % of the slings were located in the proximal third of the urethra, 88.23 % in the middle third of the urethra and 7.84 % in the distal third. At 6 and 12 months after surgery we obtained similar results: 9.81 % of the slings were located in the proximal third of the urethra, 82.35 % in the middle third and 7.84 % in the distal third of the urethra. The transversal incision of the vagina offers a minimal dissection along the long axis of the urethra favoring the remaining of the tape in the middle third of the urethra.

  10. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data.

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    Gibson, W; Wagg, A

    2016-07-01

    To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling. Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. All surgical procedures for SUI in the National Health Service (NHS) in England. Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS). Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation. © 2015 Royal College of Obstetricians and Gynaecologists.

  11. Autologous inferior dermal sling (autoderm) with concomitant skin-envelope reduction mastectomy: an excellent surgical choice for women with macromastia and clinically significant ptosis.

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    Dietz, Jill; Lundgren, P; Veeramani, A; O'Rourke, C; Bernard, S; Djohan, R; Larson, J; Isakov, R; Yetman, R

    2012-10-01

    Skin-sparing mastectomy and prosthetic reconstruction can be complicated by poor surgical outcomes in large-breasted, obese women. This article describes a single surgeon's experience comparing conventional skin-sparing mastectomy (SSM) and skin-reduction mastectomy using an autologous vascularized inferior dermal/cutaneous sling (autoderm). From July 2007 to May 2012, patients undergoing skin-sparing mastectomy were evaluated for surgical outcomes. After July 2009, the surgeon performed skin-reduction mastectomies with autoderm (SRM-AD) on all patients with macromastia or grade 3-4 ptosis. Remaining patients in this time period (SSM-cont) underwent conventional skin-sparing mastectomies while all previous patients (historical) also underwent skin-sparing mastectomies (SSM-hist). A predictive model was used to compare the large historical patients (who would have had reduction mastectomy if available) with the smaller historical patients to evaluate the effect of the procedure. Body mass index (BMI) and specimen weight were higher in both the SRM group and large historical group. The hazard ratio for having skin-reduction mastectomy was 0.53 (P = 0.51) compared with the historical group. There was a total of 16 complications for the whole study. Smoking was the only significant risk factor. This study shows that mastectomy with prosthetic reconstruction using a skin-reduction technique with autoderm can be done safely with a low complication rate and improved cosmetic outcomes in the traditionally "at-risk" group of women with high BMI and large ptotic breasts.

  12. The use of porcine small intestinal submucosa mesh (SURGISIS as a pelvic sling in a man and a woman with previous pelvic surgery: two case reports

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    Al-Sahaf Osama

    2009-02-01

    Full Text Available Abstract Introduction Closing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy. Achieving this could be difficult because sufficient native tissue is unavailable; we report on the use of small intestine submucosa extra-cellular matrix mesh in the obliteration of the pelvic brim. Case presentation We describe two cases in which submucosa extra-cellular matrix mesh was used to obliterate the pelvic brim following resection of a recurrent rectal tumour; the first patient, a 78-year-old Caucasian man, presented with small bowel obstruction caused by adhesions to a recurrent rectal tumour. The second patient, an 84-year-old Caucasian woman, presented with vaginal discharge caused by an entero-vaginal fistula due to a recurrent rectal tumour. Conclusion We report on the use of submucosa extra-cellular matrix mesh as a pelvic sling in cases where primary closure of the pelvic peritoneum is unfeasible. Its use had no infective complications and added minimal morbidity to the postoperative period. This is an original case report that would be of interest to general and colorectal surgeons.

  13. Effect of Preoperative Low Maximal Flow Rate on Postoperative Voiding Trials after the Midurethral Sling Procedure in Women with Stress Urinary Incontinence.

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    Chae, Ji Y; Bae, Jae H; Lee, Jeong G; Park, Hong S; Moon, Du G; Oh, Mi M

    2017-06-02

    To evaluate the effects of preoperative low maximal flow rate (Qmax) on voiding trials after the midurethral sling (MUS) procedure in women with stress urinary incontinence (SUI). One hundred and sixty-eight women who underwent MUS procedure were enrolled. Preoperative free uroflowmetry was performed and patients were divided by Qmax. Low Qmax was defined as a Qmax under 15 mL/sec with voided volume at least 150 mL. Surgical results, failure of voiding trial, and postoperative uroflowmetry parameters were compared between the groups. Failure of voiding trial was defined by a PVR more than 100 mL on postoperative uroflowmetry. At the discharge day, there were 42 cases showing failure of voiding trial and 33 cases requiring CIC, but only one patient showed failure of voiding trial at 12 months postoperatively. Overall, 48 patients had preoperative low Qmax. Low Qmax group showed lower Qmax in all of postoperative uroflowmetry, but there were no significant differences in the rate of postoperative voiding trial failure or CIC. The low Qmax group was then divided into two groups according to the preoperative detrusor pressure at Qmax over and under 20 cmH 2 O in pressure flow study. Comparing the two groups, no significant differences were observed in the cure rate, voiding trial failure or CIC. Our results suggest that women with preoperative low Qmax experienced no definite unfavorable voiding problem from the MUS procedure compared to those with normal voiding function. MUS procedure may be regarded as a safe and successful procedure in SUI women with low Qmax. © 2017 John Wiley & Sons Australia, Ltd.

  14. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial.

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    van der Ploeg, J Marinus; Oude Rengerink, Katrien; van der Steen, Annemarie; van Leeuwen, Jules H Schagen; van der Vaart, C Huub; Roovers, Jan-Paul W R

    2016-07-01

    We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or greater POP. Women with occult SUI were randomly assigned to vaginal prolapse repair with or without MUS. Women without occult SUI received POP surgery. Main outcomes were the absence of SUI at the 12-month follow-up based on the Urogenital Distress Inventory and the need for additional treatment for SUI. We evaluated 231 women, of whom 91 randomized as follows: 43 to POP surgery with and 47 without MUS. A greater number of women in the MUS group reported absence of SUI [86 % vs. 48 %; relative risk (RR) 1.79; 95 % confidence interval (CI) 1.29-2.48]. No women in the MUS group received additional treatment for postoperative SUI; six (13 %) in the control group had a secondary MUS. Women with occult SUI reported more urinary symptoms after POP surgery and more often underwent treatment for postoperative SUI than women without occult SUI. Women with occult SUI had a higher risk of reporting SUI after POP surgery compared with women without occult SUI. Adding a MUS to POP surgery reduced the risk of postoperative SUI and the need for its treatment in women with occult SUI. Of women with occult SUI undergoing POP-only surgery, 13 % needed additional MUS. We found no differences in global impression of improvement and quality of life.

  15. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial.

    Science.gov (United States)

    van der Ploeg, J M; Oude Rengerink, K; van der Steen, A; van Leeuwen, J H S; Stekelenburg, J; Bongers, M Y; Weemhoff, M; Mol, B W; van der Vaart, C H; Roovers, J-P W R

    2015-06-01

    To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only. Multi-centre randomised trial. Fourteen teaching hospitals in the Netherlands. Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction. Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat. The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications. One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54). Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A well-informed decision balancing risks and benefits of both strategies should be tailored to individual women. © 2015 Royal College of Obstetricians and Gynaecologists.

  16. Comparison of Polypropylene Sling with Combined Transconjunctival Retractor Plication and Lateral Tarsal Strip for Correction of Involutional Lower Eye Lid Ectropion.

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    Goel, Ruchi; Sanoria, Abhilasha; Kumar, Sushil; Arya, Deepanjali; Nagpal, Smriti; Rathie, Neha

    2017-01-01

    The study aims to compare the effectiveness and complications of transconjunctival retractor plication (TRP) with lateral tarsal strip (LTS) and the polypropylene sling (PS) surgery for treatment of involutional lower lid ectropion. A prospective randomised pilot study was conducted on 30 eyes of 30 patients suffering from epiphora having horizontal eyelid laxity >6mm and age >50 years at a tertiary care centre from December 2014 to March 2015. They were randomly divided into two equal groups for TRP with LTS (group A) and PS (group B). Success was defined as relief in epiphora and lid laxity ≤4mm at 12 months post operatively. There were 19 male and 11 female patients with age ranging from 55-80 years. The mean grade of ectropion was 2.80±1.32 in group A and 2.87±1.60 in group B. The preoperative horizontal laxity increased with the grade of ectropion (p <0.001) while medial canthal laxity was variable. The average surgical time per procedure in group A was 66 minutes and in group B was 24 minutes. Group A had a success rate of 93.33%, while group B had a success rate of 87%. Post-operative complications occurred in 2 eyes in group B only. Both LTS with TRP and PS are effective in the management of involutional ectropion. LTS with TRP though more invasive has higher success rates and a lower incidence of complications as compared to PS. However, PS is an easy to perform out- patient procedure that is faster and better tolerated in old patients.

  17. [Low obstruction tract by system Reemex].

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    Bujons Tur, A; Errando Smet, C; Prados Saavedra, M; Báez, C; Arañó Bertrán, P; Gutiérrez Ruiz, C; Villavicencio Mavrich, H

    2007-01-01

    The Remeex system it's a sling with regulable tension created for the surgical correction of the female urinary incontinente. The system contains a varitensor central part of the protesis that regulates the tension of the uretra. The screwdriver that acts against the varitensor to the modify the tension under the uretra in the postop inmediately or time after also. We present a clinic case of a patient with diagnostic of urinary stress incontinence and the surgical treatment with advantages against others kind of systems used for incontinence treatment at this time.

  18. Baby Sling: Is It Safe?

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    ... RL, et al. Low birth weight in the United States. American Journal of Clinical Nutrition. 2007;85:584S. Jana LA, et al. Thinking outside of the house. In: Heading Home With Your Newborn: From Birth to Reality. 3rd ed. Elk Grove Village, Ill.: ...

  19. Tension-free vaginal tape versus lata fascia sling: The importance of transvulvar ultrasound in the assessment of relevant anatomical parameters in treatment of women with stress urinary incontinence

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    Frederico Teixeira Brandt

    2009-01-01

    Full Text Available Objective: To describe the relevance of transvulvar ultrasound in the assessment of anatomical differences induced by the lata fascia sling (LFS and tension-free vaginal tape (TVT procedures. Materials and Methods: Forty women with stress urinary incontinence (SUI, aged 30 to 60 years, have been treated with either LFS (20 patients or TVT (20 patients. The transvulvar ultrasound of the urethrovesical junction (UVJ and proximal urethra (PU has been used as the main investigational tool both pre- and post-operatively. The studied parameters were the vertical (VUVJD and horizontal (HUVJD UVJ distances, the pubourethral distance (PUD and the PU length. Results: The VUVJD did not vary significantly after the LFS surgery (P=0.10. The PUD became shorter (P=0.001 and the HUVJD became shorter only at rest (P=0.03 after the correction by LFS. The TVT procedure has led to shortening of the VUVJ displacement (P=0.0005 and of the PU length (P=0.02. Conclusions: The transvulvar ultrasound was of utmost importance in the demonstration that both the LFS and TVT surgical procedures elongate the PU, even though the LFS technique does it more efficiently. The LFS technique focus more on shortening the PUD and the TVT procedure focus more on the correction of the vertical UVJ displacement.

  20. Surgical treatment of female stress urinary incontinence with the Gynecare TVT Secur™ System – preliminary report

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    Włodzimierz Baranowski

    2010-02-01

    Full Text Available Introduction: Sling procedures were first introduced over 100 years ago in the treatment of stress urinaryincontinence. Since then they have evolved to become less invasive and safer. The sling procedure using theGynecare TVT Secur™ system is a new therapeutic option for women with stress urinary incontinence.Objectives: To evaluate the efficacy and safety of Gynecare TVT Secur™ in the surgical treatment of stressurinary incontinence in women. Material and methods: The study comprised consecutive female patients admitted to the Department ofGynaecology and Gynaecological Oncology of the Military Institute of Health Services in Warsaw, Poland, whohad been qualified for surgical treatment of stress urinary incontinence on the basis of physical signs and symptomsand the findings of a urodynamic study. The procedure was performed using the Gynecare TVT Secur™system with tapes introduced in an H- or U-shape mode. Results: Between October 2006 and September 2009, 77 sling procedures using the Gynecare TVT Secur™system were performed in women with stress urinary incontinence. Their mean age was 55.1 (30-76 years, meanBMI 28.5 (20.2-43.8 kg/m2. Sixty-nine implants were positioned in H-shape mode, 8 in U-shape mode. Fortyninewomen (63.6% were menopausal, 14 (18.2% previously had three or more natural deliveries, 13 (16.8%had a history of gynaecological surgeries. Thirty-one procedures were performed under general anaesthesia and46 under local anaesthesia. The mean duration of the surgery was 9 (4-42 minutes. It was possible to dischargefifty-seven (74% women on the day of the surgery. Urine retention was observed only in 1 (1.7% woman. Noother complications were recorded. Conclusions: The surgical treatment of urinary incontinence with sling procedures using the Gynecare TVTSecur™ system shows good immediate efficacy and safety. Considering this as well as the short duration ofthe procedure and its good tolerability under local anaesthesia, use

  1. What are the Predictive Factors of the Cure and Complication Rates for Midurethral Slings in the Treatment of Stress Urinary Incontinence in Women: A Multicenter and Multivariate Analysis Study

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    Sinharib Çitgez

    2017-09-01

    Full Text Available Objective: Predictive factors that could affect the cure and complication rates of midurethral slings (MUS in the treatment of stress urinary incontinence (SUI were investigated. Materials and Methods: A total of 594 women (outside-in transobturator in 285, inside-out transobturator in 91, and retropubic in 218 with SUI and who had undergone MUS were evaluated. The median age was 53.9 (27-82 years. Univariate analyses were done using chi-square test, Student’s t-test and the Mann-Whitney U test. Multivariate analyses were done using logistic regression analysis to determine predictive factors affecting cure and complication rates. Results: The mean follow-up time was 48 months. The subjective cure rate was 84% and complication rate was 11.2%. On univariate and multivariate analyses, the cure rate was found to be increased in younger patients [odds ratio (OR: 0.97, 95% confidence interval (CI: 0.95-0.99, p=0.038] and in patients with pure SUI (OR: 2.17, 95% CI: 1.31-3.60, p=0.002. The type of surgery was the only statistically significant parameter affecting the complication rate, which was significantly higher in retropubic MUS procedure (OR: 6.28, 95% CI: 3.51-11.22, p<0.001. Conclusion: MUS is an effective and safe surgical procedure in the treatment of SUI. In this study, age and type of incontinence were the only significant predictive factors affecting the cure rate. Our study suggests that retropubic approach could be considered a risk factor for complication after MUS.

  2. One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR® vs. CureMesh®

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    Joo, Young Min; Choe, Jin Ho

    2010-01-01

    Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures. PMID:20495697

  3. Fiscal 2000 report on results of R and D of welfare techno-system in West Ward, Kobe City; 2000 nendo walfare techno system kenkyu kaihatsu (Kobe-shi Nishi-ku) seika hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    R and D was conducted on devices for promoting self-support, mitigating nursing care, and improving safety and comfort for the elderly and the disabled, with the fiscal 2000 results reported. In the development of a wheelchair system (small arm sling mountable on a wheelchair) capable of assisting self-support for eating and vocational activity at home, a mounting device of an arm sling was experimentally manufactured for five different types of wheelchairs. In the research on the welfare device support system at a disaster or emergency, the system was modified based on the result of the system operation in the preceding year. Consequently, it became possible to make use of a power from a solar battery, a storage battery and an utility line, and also to reduce instantaneous interruption caused by switching of the self-sustaining operation for example. Further, a load control adaptor linked with an inverter was developed, enabling the system to use electricity for a long period even at the time of power failure. In addition, a conventional simple charge/discharge control was found to cause a marked deterioration in storage cell properties; hence, an accurate charge controller was added. (NEDO)

  4. SAGES TAVAC safety and effectiveness analysis: da Vinci ® Surgical System (Intuitive Surgical, Sunnyvale, CA).

    Science.gov (United States)

    Tsuda, Shawn; Oleynikov, Dmitry; Gould, Jon; Azagury, Dan; Sandler, Bryan; Hutter, Matthew; Ross, Sharona; Haas, Eric; Brody, Fred; Satava, Richard

    2015-10-01

    The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. There are substantial numbers of peer-reviewed papers regarding the da Vinci(®) Surgical System, and a thoughtful assessment of evidence framed by clinical opinion is warranted. The SAGES da Vinci(®) TAVAC sub-committee performed a literature review of the da Vinci(®) Surgical System regarding gastrointestinal surgery. Conclusions by the sub-committee were vetted by the SAGES TAVAC Committee and SAGES Executive Board. Following revisions, the document was evaluated by the TAVAC Committee and Executive Board again for final approval. Several conclusions were drawn based on expert opinion organized by safety, efficacy, and cost for robotic foregut, bariatric, hepatobiliary/pancreatic, colorectal surgery, and single-incision cholecystectomy. Gastrointestinal surgery with the da Vinci(®) Surgical System is safe and comparable, but not superior to standard laparoscopic approaches. Although clinically acceptable, its use may be costly for select gastrointestinal procedures. Current data are limited to the da Vinci(®) Surgical System; further analyses are needed.

  5. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  6. Application of single-incision transvaginal mesh in a woman undergoing peritoneal dialysis and suffering from refractory advanced stage pelvic organ prolapse

    OpenAIRE

    Sun, Yi-Hung; Kan, Wei-Chih; Wu, Ming-Ping

    2016-01-01

    Objective: We would like to provide an option of minimal invasive surgical intervention for a patient with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis, who was at the advanced-stage pelvic organ prolapse (POP) and who also failed to be treated conservatively. Materials and method: We present a case of uterine prolapse stage IV in a woman who underwent continuous ambulatory peritoneal dialysis due to end-stage renal disease. Her severity of POP had only limi...

  7. Application of single-incision transvaginal mesh in a woman undergoing peritoneal dialysis and suffering from refractory advanced stage pelvic organ prolapse

    Directory of Open Access Journals (Sweden)

    Yi-Hung Sun

    2017-05-01

    Conclusion: Patients with POP at an advanced stage during peritoneal dialysis who failed to be treated conservatively may require a surgical intervention. Uterus-sparing transvaginal mesh was a feasible minimal invasive option.

  8. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation.

    Science.gov (United States)

    Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter

    2017-12-01

    To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.

  9. 29 CFR 1918.81 - Slinging.

    Science.gov (United States)

    2010-07-01

    ... unitized loads during hoisting shall be employed to ensure safe lifting of such loads having damaged... the winch or crane operator(s) can clearly see the draft itself or see the signals of a signalman who... or descending lifting gear. (l) The employer shall not permit employees to ride the hook or the load...

  10. Accelerators: the large slings of small particles

    International Nuclear Information System (INIS)

    Crozon, M.

    1987-01-01

    This paper reviews the different types of accelerators, of particles or heavy ions, which have been developed or are in project, their performance, their limits, which noting briefly the technologies used [fr

  11. 29 CFR 1910.184 - Slings.

    Science.gov (United States)

    2010-07-01

    ... coils and cross rods. Female handle (choker) is a handle with a handle eye and a slot of such dimension... Tucked Splice and Hidden Tuck Splice. For hidden tuck splice (IWRC) use values in HT columns. MS....0 2 6×37 26.0 30.0 33.0 20.0 23.0 25.0 53.0 61.0 66.0 HT = Hand Tucked Splice. For hidden tuck...

  12. [Meta-analysis of clinical efficacy of TVT-S versus TVT-O/TOT in the treatment of stress urinary incontinence].

    Science.gov (United States)

    Zhou, Quan; Song, Yan-feng; Chen, Jie; Qiu, Lin-lin; Yuan, Xiao-dong

    2012-10-09

    To assess the current evidence of effectiveness and safety of Single-incision mini-slings (TVT-S) versus transobturator tension-free vaginal tapes (TVT-O/TOT) in the management of female stress urinary incontinence (SUI). Literature searches were conducted for all randomized controlled trials (RCTs) comparing TVT-S and TVT-O/TOT from CNKI, CBM, VIP, MEDLINE, OVID, FMJS and Cochrane Library between November 1996 and November 2011. The Revman 5.1.0 software was used for Meta-analysis according to Cochrane system evaluation method. A total of 1545 females in 7 RCTs were included. Meta-analysis showed that no statistical differences existed in the rate of postoperative voiding dysfunction and dyspareunia between TVT-S and TVT-O/TOT (P > 0.05). But the rate of objective cure, re-operation, inner thigh and groin pain and de novo urgency were statistically significant (P TVT-O/TOT, TVT-S procedure is associated with less postoperative inner thigh and groin pain, but a lower objective cure rate and relatively higher rates of de novo urgency and re-operation.

  13. Pelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up.

    Science.gov (United States)

    Rodrigues, Claudinei A; Bianchi-Ferraro, Ana Maria H M; Zucchi, Eliana Viana Monteiro; Sartori, Marair G F; Girão, Manoel J B C; Jarmy-Di Bella, Zsuzsanna I K

    2017-09-01

    Objective  Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results. Methods  A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t -test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons. Results  Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p  TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm; p  = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p  = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p  = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2%; p  = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p  = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT

  14. Resultados del cabestrillo suburetral transobturatriz con cinta de polipropileno para el tratamiento quirúrgico de la incontinencia de orina de esfuerzo Results obtained with the trans-obturation subureteral sling procedure with polypropylen3 strip for surgical treatment of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Radamés Isaac Adefna Pérez

    2011-09-01

    Full Text Available Introducción: la incontinencia urinaria de esfuerzo constituye un problema frecuente en el sexo femenino, con una prevalencia de un 30 %. Aunque no es letal, provoca un impacto importante en las esferas psíquica, social y económica para las que la padecen. Objetivo: demostrar la posibilidad de realizar la técnica de cabestrillo suburetral transobturatriz con medios propios sin afectar la continencia ni seguridad de la paciente. Métodos: se realizó un estudio descriptivo y prospectivo para evaluar las principales variables demográficas y el impacto en la calidad de vida y continencia mediante la escala Cuestionario de Calidad de Vida para Pacientes con Incontinencia Urinaria, Forma corta. Resultados: fueron intervenidas 36 pacientes con un seguimiento de 12 meses. La edad promedio es de 51,2 años, con predominio de las de edades posmenopáusicas y multíparas. Todas presentaban incontinencia de esfuerzo genuina o mixta. Se comprobó una mejoría significativa del puntaje preoperatorio con el posoperatorio. El porcentaje de éxitos al año fue de un 86,1 %. La principal complicación fue la erosión de prótesis e infecciones urinarias. Conclusiones: la realización del cabestrillo suburetral con prótesis por vía transobturatriz es una opción real y factible de ser realizada en nuestro país en pacientes con incontinencia urinaria de esfuerzo o mixta, pues logra una continencia similar a otras técnicas, con una morbilidad menor y un ahorro económico significativo.Introduction: the stress urinary incontinence is a frequent problem in the female sex with a prevalence of 30 %. Although is not lethal it to provokes a significant impact on the psychic, social and economic spheres for those suffering this disease. Objective: to demonstrate the chance of performing the trans-obturation subureteral sling procedure with own means without involve the continence and the safety of patient. Methods: a prospective and descriptive study was

  15. Indications and Complications Associated with the Removal of 506 Pieces of Vaginal Mesh Used in Pelvic Floor Reconstruction: A Multicenter Study.

    Science.gov (United States)

    Miklos, John R; Chinthakanan, Orawee; Moore, Robert D; Karp, Deborah R; Nogueiras, Gladys M; Davila, G Willy

    2016-10-26

    Synthetic mesh utilized to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can often result in postoperative complications. The objectives of this study were to determine: 1) the most common indications for mesh removal; 2) the incidences of the removal of specific mesh procedures (such as suburethral sling [SUS], transvaginal mesh [TVM], or sacrocolpopexy); and 3) the idences and types of surgical complications associated with mesh removal. This was a retrospective study. Design Classification: Canadian Task Force II-3. Three tertiary referral centers in the United States. We examined data from all patients at the three centers who underwent surgical removal of synthetic materials from previous SUS, TVM, and sacrocolpopexy procedures for mesh-related complications from 2011 to 2013. Patients underwent vaginal, intra-abdominal, and inguinal mesh revisions by cutting, partial removal, or total removal of the mesh for mesh-related complications. Overall, 445 patients with complications underwent mesh removal laparoscopically, via groin dissection and/or transvaginally. There were a total of 506 mesh products removed. Of these, 56.5% were slings and 43.5% were for pelvic organ prolapse (POP). Synthetic mesh removed from patients included: transvaginal mesh (TVM) anterior for anterior vaginal prolapse, TVM posterior for posterior vaginal prolapse, sacrocolpopexy mesh, and suburethral slings (SUS) for stress urinary incontinence. Synthetic SUS removed included: retropubic (RPS), transobturator (TOT), and single-incision slings (SIS). TOT was the most common type of sling removed. Patients with a sling who only complained of vaginal pain with or without intercourse underwent a vaginal approach for surgical revision/removal of the sling (86.6%). Patients with an RPS with lower abdominal/suprapubic pain and vaginal pain underwent a vaginal and laparoscopic approach for sling removal (18.4%). Patients with a TOT sling who complained of vaginal and

  16. Ergebnissse nach arthroskopisch assistiert durchgeführter vorderer Kreuzbandplastik mit Semitendinosussehne als Triple-Implantat in Single-Incision-Technik und femoraler Endobutton-Fixation : Nachuntersuchungen über einen Zeitraum von 1 Jahr

    OpenAIRE

    Seel, Matthias

    2004-01-01

    Das Ziel dieser Arbeit ist die Überprüfung des Stabilitätsgewinnes infolge einer operativen Therapie des rupturierten vorderen Kreuzbandes mit einer ipsilateralen autogenen, femoral mit einem Endobutton fixierten, Semitendinosussehne als Dreifachschlinge bei 103 Patienten, die in der Zeit vom Juli 1993 bis zum Januar 1995 an der Orthopädischen Klinik der Justus-Liebig-Universität in Gießen operiert wurden. Des weiteren sollten im Rahmen dieser Arbeit geschlechtsspezifische Unterschiede, Unter...

  17. Reconstructive surgery for male stress urinary incontinence: Experiences using the ATOMS system at a single center

    Directory of Open Access Journals (Sweden)

    Krause, Jens

    2014-12-01

    Full Text Available Objective: To propose possible success-driven solutions for problem and complication rates encountered with the ATOMS sling system, based on first-hand experience; and to provide possible actual alternative scenarios for the treatment of male . Patients and methods: During the defined period (between 4/2010 and 04/2014, 36 patients received ATOMS system implants at our clinic. We collected pre- and post-operative evaluation data using the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF. As an expansion of the questionnaire, we added questions about post-operative perineal pain, the general satisfaction with the results of the intervention and willingness to recommend the operation to a best friend. Results: Our data shows a relatively high explantation rate, but a surprisingly high patient satisfaction rate. Explantation was required mainly due to late onset infections or other symptomatic factors. Compared to other studies early onset infections were rare. Conclusion: A non-invasive, uncomplicated adjustable system to alleviate male stress urinary incontinence remains a challenge. Although there are various systems available for the treatment of male stress urinary incontinence, it seems that despite the advantages of the ATOMS system, an artificial sphincter system may pose more advantages based on our experience, understanding and knowledge of its well-documented long-term solutions and problems.

  18. Systems

    International Nuclear Information System (INIS)

    Anon.

    1980-01-01

    Papers in this session describe the concept of mined geologic disposal system and methods for ensuring that the system, when developed, will meet all technical requirements. Also presented in the session are analyses of system parameters, such as cost and nuclear criticality potential, as well as a technical analysis of a requirement that the system permit retrieval of the waste for some period of time. The final paper discusses studies under way to investigate technical alternatives or complements to the mined geologic disposal system. Titles of the presented papers are: (1) Waste Isolation System; (2) Waste Isolation Economics; (3) BWIP Technical Baseline; (4) Criticality Considerations in Geologic Disposal of High-Level Waste; (5) Retrieving Nuclear Wastes from Repository; (6) NWTS Programs for the Evaluation of Technical Alternatives or Complements to Mined Geologic Repositories - Purpose and Objectives

  19. systems

    Directory of Open Access Journals (Sweden)

    Alexander Leonessa

    2000-01-01

    Full Text Available A nonlinear robust control-system design framework predicated on a hierarchical switching controller architecture parameterized over a set of moving nominal system equilibria is developed. Specifically, using equilibria-dependent Lyapunov functions, a hierarchical nonlinear robust control strategy is developed that robustly stabilizes a given nonlinear system over a prescribed range of system uncertainty by robustly stabilizing a collection of nonlinear controlled uncertain subsystems. The robust switching nonlinear controller architecture is designed based on a generalized (lower semicontinuous Lyapunov function obtained by minimizing a potential function over a given switching set induced by the parameterized nominal system equilibria. The proposed framework robustly stabilizes a compact positively invariant set of a given nonlinear uncertain dynamical system with structured parametric uncertainty. Finally, the efficacy of the proposed approach is demonstrated on a jet engine propulsion control problem with uncertain pressure-flow map data.

  20. Martius flap and anterior vaginal wall sling for correction of ...

    African Journals Online (AJOL)

    UVF) associated with stress urinary incontinence (SUI) after vaginal delivery. ... Follow-up included history, physical examination, urine analysis and pelvic ultrasonography for the assessment of residual urine. Urodynamic evaluation was ...

  1. Risk factors for failure of retropubic and transobturator midurethral slings

    NARCIS (Netherlands)

    Houwert, R. Marijn; Venema, Pieter L.; Aquarius, Annelies E.; Bruinse, Hein W.; Roovers, Jan Paul W. R.; Vervest, Harry A. M.

    2009-01-01

    OBJECTIVE: The aim of our study was to identify and compare risk factors for failure of retropubic and transobturator procedures. STUDY DESIGN: This was a retrospective cohort study. Women with predominant stress urinary incontinence who underwent a retropubic (n = 214) or transobturator tape

  2. The slings and arrows of communication on nanotechnology

    International Nuclear Information System (INIS)

    Simons, Johannes; Zimmer, Rene; Vierboom, Carl; Haerlen, Ingo; Hertel, Rolf; Boel, Gaby-Fleur

    2009-01-01

    According to numerous surveys the perceived risk of nanotechnology is low and most people feel that the benefits outweigh the risks. This article provides greater insight into risk perception and concludes that the positive attitude to nanotechnology is based not on knowledge but on hope and fascination. The perceived risk is low because of a lack of vivid and frightening images of possible hazards. If news flashes were to link nanotechnology to concrete hazards or actual harm to people, attitudes might suddenly change. Risk communication faces the problem of dealing with a public at large that has little or no knowledge about the technology. As it takes time and extensive additional research to develop appropriate communication strategies and disseminate them to the relevant institutions, this exercise should be started immediately.

  3. The slings and arrows of LHC restart schedules

    CERN Document Server

    2015-01-01

    We should now have been celebrating the first circulating beams of LHC Run 2, but, as I reported last Tuesday, I find myself instead having to write about a delay in proceedings. Against a backdrop of great progress in the powering tests for running at 6.5 TeV, a short to ground in one of the LHC’s thousands of circuits became apparent on 21 March.   Although a simple job to repair, it is compounded by the fact that the short is in a cold section of the machine, and it might therefore require a few weeks to warm up, carry out the repair and cool down again. Nevertheless, all the signs are good for a great Run 2, and in the grand scheme of things, a delay of weeks in humankind’s quest to understand our universe is little more than the blink of an eye. The impact of the delay on the experiments will be minimal, as 2015 was always foreseen as a year for preparing the upgraded machine for full-scale physics running in 2016-2018. When the LHC’s first run got underway...

  4. Influence of TVT properties on outcomes of midurethral sling procedures

    DEFF Research Database (Denmark)

    Prien-Larsen, Jens Christian; Prien-Larsen, Thomas; Cieslak, Lars

    2016-01-01

    .I.F.T versus low-stiffness Intramesh L.I.F.T. tape. Our null hypothesis was that in terms of performance, SOFT tape equaled L.I.F.T. tape. METHODS: Six hundred and sixty women underwent prospective transvaginal tape (TVT) surgery for SUI: 210 had the SOFT tape placed and 450 the L.I.F.T. tape. Follow-ups were...

  5. Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems.

    Science.gov (United States)

    Edlich, Richard F; Winters, Kathryne L; Hudson, Mary Anne; Britt, L D; Long, William B

    2004-01-01

    immediately has resulted in numerous denials of claims for rehabilitation and compensation that nurses deserve. Experts believe that training in proper body mechanics does not prevent back injury. Consequently, focus has been placed on other innovative injury prevention programs, including the use of engineering controls as well as the "lift team" method. Ergonomics involves the use of mechanical devices (e.g., walking belt and mechanical hoist) to aid in patient lifting and transferring tasks. Guldmann Inc. has devised ceiling lift systems and slings during the past 20 years. They have successfully completed thousands of installations worldwide, covering a wide range of challenging conditions and complex environments. The Guldmann ceiling-mounted hoist system consists of a wide range of lifting units, rail components, and a complete assortment of lifting slings and accessories. Its sling is made of polyester, which is characterized by its strength and elasticity. It retains its shape and is dirt repellent and easy to maintain. The Guldmann network has one of the largest and indisputably most experienced group of certified installers in the United States. The "lift team" method was devised to remove nursing personnel from the everyday task of moving patients. This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques.

  6. SYSTEM

    Directory of Open Access Journals (Sweden)

    K. Swarnalatha

    2013-01-01

    Full Text Available Risk analysis of urban aquatic systems due to heavy metals turns significant due to their peculiar properties viz. persis tence, non-degradab ility, toxicity, and accumulation. Akkulam Veli (AV, an urba n tropical lake in south India is subjected to various environmental stresses due to multiple waste discharge, sand mining, developmental activities, tour ism related activitie s etc. Hence, a comprehensive approach is adopted for risk assessment using modified degree of contamination factor, toxicity units based on numerical sediment quality guidelines (SQGs, and potentialecological risk indices. The study revealed the presence of toxic metals such as Cr, C d, Pb and As and the lake is rated under ‘low ecological risk’ category.

  7. [Laparoscopic colorectal surgery - SILS, robots, and NOTES.

    NARCIS (Netherlands)

    D'Hoore, André; Wolthuis, Albert M.; Mizrahi, Hagar; Parker, Mike; Bemelman, Willem A.; Wara, Pål

    2011-01-01

    Single incision laparoscopic surgery resection of colon is feasible, but so far evidence of benefit compared to standard laparoscopic technique is lacking. In addition to robot-controlled camera, there is only one robot system on the market capable of performing laparoscopic surgery. The da Vinci

  8. Risk of Damage to the Somatic Innervation of the Penis during the AdVanceProcedure: An Anatomical Study.

    Science.gov (United States)

    Hogewoning, Cornelis R C; Elzevier, Henk W; Pelger, Rob C M; Bekker, Milou D; DeRuiter, Marco C

    2015-08-01

    One of the methods to treat post radical prostatectomy stress urinary incontinence is the AdVance (American Medical Systems, Minnetonka, MN, USA) male sling procedure. During this procedure, the somatic innervation of the penis may be at risk for injury. Six AdVance procedures were performed in six donated bodies at the Anatomy and Embryology Department of the Leiden University Medical Centre. The pelves were dissected and the shortest distance between the sling and the dorsal nerve of the penis (DNP) was documented. The aim of this study was to describe the anatomical relation between the AdVance male sling and penile nerves based on the dissection of six adult male pelves. The AdVance male sling procedure was conducted in six donated male bodies. After placement, the pelves were dissected and the shortest distance between sling and the DNP was documented. The main outcome measure was the distance between the AdVance male sling and the DNP. The mean distance of the sling to the DNP was 4.1 mm and was found situated directly next to the nerve (distance 0 mm) in 4 out of 12 (33%) hemipelves. The distance of the sling to the obturator neurovascular bundle was 30 mm or more in all six bodies. Damage to the DNP caused by the AdVance male sling procedure appears to be an extremely rare complication, which has not been described in current literature. The proximity of the AdVance to the DNP could, however, pose a risk that should be taken into consideration by physicians and patients when opting for surgery. © 2015 International Society for Sexual Medicine.

  9. Medline Plus

    Full Text Available ... Medical Center, Winston-Salem, NC, 2/28/2014) Male Reproductive System Circumcision Circumcision (Broward Health Coral Springs, ... Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling Placement: Aiding in a Faster Return to ...

  10. Resuspension of mild to moderate jawline laxity using a minimally invasive technique.

    Science.gov (United States)

    Bisaccia, Emil; Khan, Azim J; Herron, Joel B; Scarborough, Dwight A

    2003-08-01

    A practical approach for superficial musculoapponeurotic system plication and neck lift is indicated for early aging changes of jawline. A single or series of small punches or single incisions at the earlobe and then minor undermining to lift the superficial musculoapponeurotic system followed by removal of skin laxity in neck and jowl result in a seamless scar via a simple V to Y closure. A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

  11. Concept design of robotic modules for needlescopic surgery.

    Science.gov (United States)

    Sen, Shin; Harada, Kanako; Hewitt, Zackary; Susilo, Ekawahyu; Kobayashi, Etsuko; Sakuma, Ichiro

    2017-08-01

    Many minimally invasive surgical procedures and assisting robotic systems have been developed to further minimize the number and size of incisions in the body surface. This paper presents a new idea combining the advantages of modular robotic surgery, single incision laparoscopic surgery and needlescopic surgery. In the proposed concept, modules carrying therapeutic or diagnostic tools are inserted in the abdominal cavity from the navel as in single incision laparoscopic surgery and assembled to 3-mm needle shafts penetrating the abdominal wall. A three degree-of-freedom robotic module measuring 16 mm in diameter and 51 mm in length was designed and prototyped. The performance of the three connected robotic modules was evaluated. A new idea of modular robotic surgery was proposed, and demonstrated by prototyping a 3-DOF robotic module. The performance of the connected robotic modules was evaluated, and the challenges and future work were summarized.

  12. Long-term risk of complications after mid-urethral sling IVS implantation

    Directory of Open Access Journals (Sweden)

    Grzegorz Surkont

    2015-02-01

    Full Text Available [b]Introduction[/b]. Results of short-term evaluation of multifilament microporous midurethral tape IVS differ a great deal. During the first year of implantation, erosions have been observed in 0%–26% of operated women. Long-term observations are rare. They suggest high risk of extrusion and infection even after years of implantation. [b]Objective[/b]. The purpose of the study was to evaluate long-term risk of complications after IVS implantation. Material and methods. Between 2001–2005, 72 women were operated on with the use of IVS mid-urethral tape. [b]Results[/b]. Two women had vaginal erosions during the first 3 months after the operation. Twelve women had vaginal erosions, purulent vaginal discharge, with IVS tape sticking out of the abdominal wall or vagina, and abdominal abscess. These complications were diagnosed between 9 months and 6 years after IVS implantation. The patients were operated on vaginally and open abdominally, 1–5 times because of complications after IVS implantation. [b]Conclusions[/b]. In the case of post-IVS complication, as much tape as possible should be excised. Long-term follow up on patients with IVS implantation should be recommended to the centres where IVS tape was used, even to patients after removal of the tape. Risk of erosion, extrusion and infection after midurethral multifilament microporous IVS tape implantation is too high – which is the reason it should no longer be used.

  13. Design, Development, and Evaluation of the Helicopter Sling Load Rapid Aerial Delivery Equipment

    Science.gov (United States)

    2015-09-01

    structure and release them remotely. The development and verification process included payload releases from a helicopter and a crane prior to frame...23  4.1  Lift  Provision Testing...30  4.4  Crane  Payload Deployment Tests .............................................................................................. 30  5

  14. Female sexual function following a novel transobturator sling procedure without paraurethral dissection (modified-TOT

    Directory of Open Access Journals (Sweden)

    Burak Arslan

    Full Text Available ABSTRACT Purpose To determine whether there is a difference in sexual function after modified and classical TOT procedures. Materials and Methods Of the 80 sexually active women with SUI, 36 underwent an original outside-in TOT as described by Delorme, and 44 underwent modified TOT procedure, between 2011 and 2015. The severity of incontinence and sexual function were evaluated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF and Female Sexual Function Index (FSFI questionnaires preoperatively and 3 months after surgery. Results The postoperative ICIQ-SF score was significantly lower than the preoperative ICIQ-SF score in both groups (p=0.004 for modified TOT and p=0.002 for classical TOT. There was no significant difference in the ICIQ-SF score reduction between the two groups (14.1±2.1 vs. 14.4±1.9; p=0.892. Complication rates according to the Clavien-Dindo classification were also similar in both groups. In both groups, difference between preoperative and postoperative FSFI scores revealed a statistically significant improvement in all domains. Comparison of postoperative 3-month FSFI scores of modified and classical TOT groups showed statistically significant differences in arousal, lubrication and orgasm domains. Desire, satisfaction, pain and total FSFI scores did not differ significantly between two groups. Conclusion The modified TOT technique is a simple, reliable and minimal invasive procedure. The cure rate of incontinence and complication rates are the same as those of the classical TOT technique. However, due to the positive effects of minimal tissue damage on sexual arousal and orgasmic function, modified TOT has an advantage over the classical TOT.

  15. Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

    Science.gov (United States)

    Steinhaus, Michael E; Dare, David M; Gulotta, Lawrence V

    2016-10-01

    The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures. The purpose of this review is to highlight the strengths and weaknesses of the PROFHER trial and to assess the validity of its conclusion in the context of existing literature. The authors found no difference in the Oxford Shoulder Score (OSS) between the surgical and nonsurgical groups. Additionally, no difference was found between groups in any of the secondary outcomes, which included the Short-Form 12 (SF-12) health survey, surgical and fracture-related complications, additional surgery or therapy, inpatient medical complications, and mortality. They concluded that the recent increase in surgical management of proximal humerus fractures is perhaps unwarranted. While the randomization was successful and the pragmatic design may enable greater generalizability, this study possesses numerous flaws inherent in such an ambitious endeavor, including an inability to identify specific factors which explain the lack of superiority of surgical management. Despite its weaknesses, this study is a valuable datapoint which encourages surgeons to reexamine their surgical indications for this injury.

  16. Vascular rings and slings: A challenging diagnostic and therapeutic rare disease entity

    Directory of Open Access Journals (Sweden)

    Yasser Mohamed Menaissy

    2017-12-01

    Conclusions: In our series, Echocardiography and MSCT were essential for proper diagnosis and planing for surgery. Left thoracotomy or median sternotomy provided good exposure in the operated cases. Surgery was done with low mortality and morbidity.

  17. Exploratory study assessing efficacy and complications of TVT-O, TVT-Secur, and Mini-Arc: results at 12-month follow-up.

    Science.gov (United States)

    Oliveira, Rui; Botelho, Francisco; Silva, Pedro; Resende, Alexandre; Silva, Carlos; Dinis, Paulo; Cruz, Francisco

    2011-06-01

    Contemporary surgical treatment of female stress urinary incontinence (SUI) includes retropubic and transobturator (TO) midurethral slings (MUS). Case series of single-incision slings (SIS) have shown similar outcomes with lower morbidity. Our aim was to assess the cure rates, complications, and quality-of-life impact of one standard TO MUS and two SIS. Ninety consecutive patients with clinically and urodynamically proven SUI were enrolled in an exploratory randomised phase 2 trial. Patients with previous SUI surgery, major pelvic organ prolapse, mixed incontinence, or detrusor overactivity were excluded. Patients were treated randomly with TVT-O, TVT-Secur, or Mini-Arc. Postoperative visits were scheduled at 6 and 12 mo. The King's Health Questionnaire (KHQ) was repeated at 6 mo. Cure was defined as the absence of urine leakage, no pad use, and a negative cough test at 12 mo. Pain and other complications were also investigated. Cure rate was 83% after TVT-O, 67% after TVT-Secur, and 87% after Mini-Arc. Improvement was found in 10%, 13%, and 7% of the patients, respectively. Failures were 7% after TVT-O and Mini-Arc and 20% after TVT-Secur. TVT-O and Mini-Arc improved at least 15 points in >80% of the patients in six KHQ domains, whereas TVT-Secur could only achieve improvement in three of the nine domains. The pain score was lower in the Mini-Arc group. Complications were more numerous after TVT-O. This study has the limitations inherent in a phase 2 trial with a follow-up limited to 12 mo. Mini-Arc offers cure and improvement rates similar to TVT-O, whereas TVT-Secur may yield an inferior outcome. These findings recommend the urgent launch of large randomised phase 3 studies comparing conventional MUS with SIS, with Mini-Arc the advised option. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  18. Randomized controlled trial comparing TVT-O and TVT-S for the treatment of stress urinary incontinence: 2-year results.

    Science.gov (United States)

    Bianchi-Ferraro, Ana Maria H M; Jarmy-DiBella, Zsuzsanna I K; de Aquino Castro, Rodrigo; Bortolini, Maria Augusta T; Sartori, Marair G F; Girão, Manoel J B C

    2014-10-01

    The aim was to compare the efficacy and safety of single-incision sling TVT-Secur (TVT-S) and transobturator midurethral sling (TVT-O) for the treatment of stress urinary incontinence (SUI) over 2 years' follow-up. This is a randomized controlled trial in which women with SUI were randomly assigned to have either TVT-O (n = 56) or TVT-S (n = 66). Exclusion criteria included: voiding dysfunction, detrusor overactivity, and pelvic organ prolapse beyond the hymen. The primary outcomes were objective and subjective cure rates at a follow-up visit at 24 months, defined as a negative stress test and pad test as well as absence of self-reported SUI symptoms. Secondary endpoints included quality of life assessment using the King's Health Questionnaire (KHQ), and complication and reoperation rates. Analysis was performed using intention to treat, and statistical significance was fixed at 5% (p TVT-S and TVT-O groups were 77.3% and 83.6%, while subjective cure rates were 75.7% and 80.3% respectively, with no statistically significant differences between the techniques. There was a significant improvement in all KHQ domains in both groups (p TVT-O, while the long-term one was tape exposure observed in 5.3% of TVT-O and in 7.5% of TVT-S cases. The efficacy of the TVT-S was similar to that of the TVT-O after 2 years' assessment. This cohort will continue to be followed in order to maintain commitment to contributing data on long-term results.

  19. Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

    Directory of Open Access Journals (Sweden)

    Almog Levi

    Full Text Available Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI. Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI cure rate in patients with mixed urinary incontinence (MUI, intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10 and from the local anesthesia. Visual analog scale (VAS rating was low during and after the procedure (2.38 and 2.69 respectively. Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

  20. System Budgets

    DEFF Research Database (Denmark)

    Jeppesen, Palle

    1996-01-01

    The lecture note is aimed at introducing system budgets for optical communication systems. It treats optical fiber communication systems (six generations), system design, bandwidth effects, other system impairments and optical amplifiers.......The lecture note is aimed at introducing system budgets for optical communication systems. It treats optical fiber communication systems (six generations), system design, bandwidth effects, other system impairments and optical amplifiers....

  1. Ventilation systems

    International Nuclear Information System (INIS)

    Gossler

    1980-01-01

    The present paper deals with - controlled area ventilation systems - ventilation systems for switchgear-building and control-room - other ventilation systems for safety equipments - service systems for ventilation systems. (orig./RW)

  2. Right pulmonary aplasia, aberrant left pulmonary artery, and bronchopulmonary sequestration with an esophageal bronchus

    International Nuclear Information System (INIS)

    Lee, Peter; McCauley, Roy; Westra, Sjirk; Baba, Timothy

    2006-01-01

    Pulmonary aplasia and bronchopulmonary foregut malformations in which a patent communication between the foregut and the pulmonary system is present are rare congenital abnormalities. Pulmonary aplasia associated with a pulmonary sling is an even rarer abnormality. We report a unique case of right pulmonary aplasia, aberrant left pulmonary artery, and bronchopulmonary sequestration with an esophageal bronchus diagnosed by multidetector helical CT. (orig.)

  3. Sadhana | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Keywords. Vortical flows; inertial particles; preferential clustering; sling caustics; particle collisions; warm rain initiation. ... (i) We introduce the reader to the basic ideas, and explain why the problem is interesting. (ii) Using an N-vortex system we present an interesting case where particles are attracted to the vicinity of ...

  4. Medline Plus

    Full Text Available ... Medical Center, Winston-Salem, NC, 2/28/2014) Male Reproductive System Circumcision Circumcision (Broward Health Coral Springs, Coral Springs, FL, 3/31/2014) Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling Placement: Aiding in a Faster Return to ...

  5. Efficacy and Safety of Tension-Free Vaginal Tape-Secur Mini-Sling Versus Standard Midurethral Slings for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Wang, Tao; Zhang, Yong

    2015-01-01

    Purpose: To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI). Methods: A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register. Results: Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (PTVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22–1.08; P=0.08), objective cure rate (OR, 0.49; 95% CI, 0.22–1.09; P=0.08), or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT. Conclusions: This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur. PMID:26739179

  6. Efficacy and Safety of Tension-Free Vaginal Tape-Secur Mini-Sling Versus Standard Midurethral Slings for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

    OpenAIRE

    Wei Huang; Tao Wang; Huantao Zong; Yong Zhang

    2015-01-01

    Purpose: To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI). Methods: A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register. Results: Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had s...

  7. Efficacy and Safety of Tension-Free Vaginal Tape-Secur Mini-Sling Versus Standard Midurethral Slings for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Wei Huang

    2015-12-01

    Full Text Available Purpose: To assess the efficacy and safety of tension-free vaginal tape (TVT-Secur for stress urinary incontinence (SUI. Methods: A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register. Results: Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (P<0.00001, lower objective cure rate (P<0.00001, and higher intraoperative complication rate, compared with TVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22–1.08; P=0.08, objective cure rate (OR, 0.49; 95% CI, 0.22–1.09; P=0.08, or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT. Conclusions: This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur.

  8. Embedded Systems

    Indian Academy of Sciences (India)

    Embedded system, micro-con- troller ... Embedded systems differ from general purpose computers in many ... Low cost: As embedded systems are extensively used in con- .... operating systems for the desktop computers where scheduling.

  9. Thermal systems; Systemes thermiques

    Energy Technology Data Exchange (ETDEWEB)

    Lalot, S. [Valenciennes Univ. et du Hainaut Cambresis, LME, 59 (France); Lecoeuche, S. [Ecole des Mines de Douai, Dept. GIP, 59 - Douai (France)]|[Lille Univ. des Sciences et Technologies, 59 - Villeneuve d' Ascq (France); Ahmad, M.; Sallee, H.; Quenard, D. [CSTB, 38 - Saint Martin d' Heres (France); Bontemps, A. [Universite Joseph Fourier, LEGI/GRETh, 38 - Grenoble (France); Gascoin, N.; Gillard, P.; Bernard, S. [Laboratoire d' Energetique, Explosion, Structure, 18 - Bourges (France); Gascoin, N.; Toure, Y. [Laboratoire Vision et Robotique, 18 - Bourges (France); Daniau, E.; Bouchez, M. [MBDA, 18 - Bourges (France); Dobrovicescu, A.; Stanciu, D. [Bucarest Univ. Polytechnique, Faculte de Genie Mecanique (Romania); Stoian, M. [Reims Univ. Champagne Ardenne, Faculte des Sciences, UTAP/LTM, 51 (France); Bruch, A.; Fourmigue, J.F.; Colasson, S. [CEA Grenoble, Lab. Greth, 38 (France); Bontemps, A. [Universite Joseph Fourier, LEGI/GRETh, 38 - Grenoble (France); Voicu, I.; Mare, T.; Miriel, J. [Institut National des Sciences Appliquees (INSA), LGCGM, IUT, 35 - Rennes (France); Galanis, N. [Sherbrooke Univ., Genie Mecanique, QC (Canada); Nemer, M.; Clodic, D. [Ecole des Mines de Paris, Centre Energetique et Procedes, 75 (France); Lasbet, Y.; Auvity, B.; Castelain, C.; Peerhossaini, H. [Nantes Univ., Ecole Polytechnique, Lab. de Thermocinetiquede Nantes, UMR-CNRS 6607, 44 (France)

    2005-07-01

    This session about thermal systems gathers 26 articles dealing with: neural model of a compact heat exchanger; experimental study and numerical simulation of the thermal behaviour of test-cells with walls made of a combination of phase change materials and super-insulating materials; hydraulic and thermal modeling of a supercritical fluid with pyrolysis inside a heated channel: pre-dimensioning of an experimental study; energy analysis of the heat recovery devices of a cryogenic system; numerical simulation of the thermo-hydraulic behaviour of a supercritical CO{sub 2} flow inside a vertical tube; mixed convection inside dual-tube exchangers; development of a nodal approach with homogenization for the simulation of the brazing cycle of a heat exchanger; chaotic exchanger for the cooling of low temperature fuel cells; structural optimization of the internal fins of a cylindrical generator; a new experimental approach for the study of the local boiling inside the channels of exchangers with plates and fins; experimental study of the flow regimes of boiling hydrocarbons on a bundle of staggered tubes; energy study of heat recovery exchangers used in Claude-type refrigerating systems; general model of Carnot engine submitted to various operating constraints; the free pistons Stirling cogeneration system; natural gas supplied cogeneration system with polymer membrane fuel cell; influence of the CRN coating on the heat flux inside the tool during the wood unrolling process; transport and mixture of a passive scalar injected inside the wake of a Ahmed body; control of a laser welding-brazing process by infrared thermography; 2D self-adaptative method for contours detection: application to the images of an aniso-thermal jet; exergy and exergy-economical study of an 'Ericsson' engine-based micro-cogeneration system; simplified air-conditioning of telephone switching equipments; parametric study of the 'low-energy' individual dwelling; brief synthesis of

  10. Standardized UXO Technology Demonstration Site Blind Grid Scoring Record No. 810 (FEREX Fluxgate Gradient Magnetometer/Sling)

    National Research Council Canada - National Science Library

    Fling, Rick; McClung, Christina; Banta, Matthew; Burch, William; Karwatka, Michael; McDonnell, Patrick

    2007-01-01

    ...) utilizing the APG Standardized UXO Technology Demonstration Site Blind Grid. This Scoring Record was coordinated by Michael Karwatka and the Standardized UXO Technology Demonstration Site Scoring Committee...

  11. One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women.

    Science.gov (United States)

    Killingsworth, Lindsay B; Wheeler, Thomas L; Burgio, Kathryn L; Martirosian, Tovia E; Redden, David T; Richter, Holly E

    2009-09-01

    The purpose of this study was to assess the impact of body mass index (BMI) on tension-free vaginal tape (TVT) success rates, patient satisfaction, and complications 1 year following surgery. Baseline and 1-year postsurgery outcomes were abstracted, including Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores, and patient satisfaction ratings. Multivariable logistic and linear regression analyses were performed to examine relationships between outcomes and BMI. Subjects (N = 195) with a mean age of 59.3 +/- 12.6 were included. There was significant improvement within each group (all p values 0.05). Differential counseling of overweight or obese women regarding outcomes of the TVT procedure is not supported by these results; longer follow-up is warranted.

  12. Standardized UXO Technology Demonstration Site, Open Field Scoring Record No. 770. Magnetometer FEREX DLG GPS/Sling

    National Research Council Canada - National Science Library

    Karwatka, Mike; Packer, Bonnie

    2006-01-01

    ...) utilizing the YPG Standardized UXO Technology Demonstration Site open field. Scoring Records have been coordinated by Mike Karwatka and the Standardized UXO Technology Demonstration Site Scoring Committee...

  13. One Year Outcomes of Tension-Free Vaginal Tape (TVT) Mid-Urethral Slings in Overweight and Obese Women

    Science.gov (United States)

    Killingsworth, Lindsay B.; Wheeler, Thomas L.; Burgio, Kathryn L.; Martirosian, Tovia E.; Redden, David T.; Richter, Holly E.

    2011-01-01

    Introduction The purpose of this study was to assess the impact of body mass index (BMI) on tension-free vaginal tape (TVT) success rates, patient satisfaction, and complications one year following surgery. Methods Baseline and one-year post-surgery outcomes were abstracted, including Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores, and patient satisfaction ratings. Multivariable logistic and linear regression analyses were performed to examine relationships between outcomes and BMI. Results 195 subjects with a mean age of 59.3 ±12.6 were included. There was significant improvement within each group (all p-values 0.05) Conclusion Differential counseling of overweight or obese women regarding outcomes of the TVT procedure is not supported by these results; longer follow-up is warranted. PMID:19448965

  14. Influence of TVT properties on outcomes of midurethral sling procedures: high-stiffness versus low-stiffness tape.

    Science.gov (United States)

    Prien-Larsen, Jens Christian; Prien-Larsen, Thomas; Cieslak, Lars; Dessau, Ram B

    2016-07-01

    Although there is clear consensus on the use of monofilament polypropylene tapes for treating stress urinary incontinence (SUI), tapes differ in weight, stiffness, and elasticity. In this study, we compared outcomes of two tape types: high-stiffness Intramesh SOFT L.I.F.T versus low-stiffness Intramesh L.I.F.T. tape. Our null hypothesis was that in terms of performance, SOFT tape equaled L.I.F.T. tape. Six hundred and sixty women underwent prospective transvaginal tape (TVT) surgery for SUI: 210 had the SOFT tape placed and 450 the L.I.F.T. tape. Follow-ups were scheduled at 3 and 12 months. Objective cure at 3-months' follow-up was 87 % in the SOFT group vs 94 % in the L.I.F.T. group (p = 0.003) and at 12 months 86 vs 96 % (p = 0.0004), respectively. Subjective outcomes were equal. For SOFT tape, the objective failure rate at 3 months was especially pronounced in women older than 70 years: 31 vs 10 % (p = 0.008), and subjective failure was 24 vs 7 % (p = 0.01). At 12 months, objective failure for the SOFT tape was significantly higher in both age groups compared with L.I.F.T. [odds ratio (OR) 2.17]. Multivariate analysis showed that body mass index (BMI) ≥30 (OR 2.41), mixed incontinence (MUI) (OR 2.24), use of SOFT tape (OR 2.17), and age ≥ 70 years are significant independent risk factors for surgical failure. Outcomes with SOFT tape are significantly inferior than with L.I.F.T. tape, especially among elderly women. Therefore, the two variants of monofilament polypropylene tape are not interchangeable.

  15. Persistent groin pain following a trans-obturator sling procedure for stress urinary incontinence: a diagnostic and therapeutic challenge

    NARCIS (Netherlands)

    Hazewinkel, Menke H.; Hinoul, Piet; Roovers, Jan-Paul

    2009-01-01

    Groin pain after a tension-free vaginal tape-obturator (TVT-O) procedure can occur but mostly disappears within 4 weeks. Persistent groin pain is extremely rare and there is a paucity of literature on how to diagnose and manage this adverse event. We present two cases with severe persistent groin

  16. Data Systems vs. Information Systems

    OpenAIRE

    Amatayakul, Margret K.

    1982-01-01

    This paper examines the current status of “hospital information systems” with respect to the distinction between data systems and information systems. It is proposed that the systems currently existing are incomplete data dystems resulting in ineffective information systems.

  17. EXPERT SYSTEMS

    OpenAIRE

    Georgiana Marin; Mihai Catalin Andrei

    2011-01-01

    In recent decades IT and computer systems have evolved rapidly in economic informatics field. The goal is to create user friendly information systems that respond promptly and accurately to requests. Informatics systems evolved into decision assisted systems, and such systems are converted, based on gained experience, in expert systems for creative problem solving that an organization is facing. Expert systems are aimed at rebuilding human reasoning on the expertise obtained from experts, sto...

  18. Multibody Systems

    DEFF Research Database (Denmark)

    Wagner, Falko Jens

    1999-01-01

    Multibody Systems is one area, in which methods for solving DAEs are of special interst. This chapter is about multibody systems, why they result in DAE systems and what kind of problems that can arise when dealing with multibody systems and formulating their corresponding DAE system....

  19. System dynamics

    International Nuclear Information System (INIS)

    Kim, Do Hun; Mun, Tae Hun; Kim, Dong Hwan

    1999-02-01

    This book introduces systems thinking and conceptual tool and modeling tool of dynamics system such as tragedy of single thinking, accessible way of system dynamics, feedback structure and causal loop diagram analysis, basic of system dynamics modeling, causal loop diagram and system dynamics modeling, information delay modeling, discovery and application for policy, modeling of crisis of agricultural and stock breeding products, dynamic model and lesson in ecosystem, development and decadence of cites and innovation of education forward system thinking.

  20. Coupling component systems towards systems of systems

    OpenAIRE

    Autran , Frédéric; Auzelle , Jean-Philippe; Cattan , Denise; Garnier , Jean-Luc; Luzeaux , Dominique; Mayer , Frédérique; Peyrichon , Marc; Ruault , Jean-René

    2008-01-01

    International audience; Systems of systems (SoS) are a hot topic in our "fully connected global world". Our aim is not to provide another definition of what SoS are, but rather to focus on the adequacy of reusing standard system architecting techniques within this approach in order to improve performance, fault detection and safety issues in large-scale coupled systems that definitely qualify as SoS, whatever the definition is. A key issue will be to secure the availability of the services pr...

  1. Systems effectiveness

    CERN Document Server

    Habayeb, A R

    1987-01-01

    Highlights three principal applications of system effectiveness: hardware system evaluation, organizational development and evaluation, and conflict analysis. The text emphasizes the commonality of the system effectiveness discipline. The first part of the work presents a framework for system effectiveness, partitioning and hierarchy of hardware systems. The second part covers the structure, hierarchy, states, functions and activities of organizations. Contains an extended Appendix on mathematical concepts and also several project suggestions.

  2. Auxiliary systems

    International Nuclear Information System (INIS)

    Meyer, P.J.

    1981-01-01

    Systems included under the heading ''Reactor Auxillary Systems'' are those immediately involved with the reactor operation. These include the systems for dosing and letdown of reactor coolant, as well as for the chemical dosing, purification and treatment of the reactor coolant and the cooling system in the controlled area. The ancillary systems are mainly responsible for liquid and gaseous treatment and the waste treatment for final storage. (orig.)

  3. Bitcoin System

    Directory of Open Access Journals (Sweden)

    Jan Lánský

    2017-06-01

    Full Text Available Cryptocurrency systems are purely digital and decentralized systems that use cryptographic principles to confirm transactions. Bitcoin is the first and also the most widespread cryptocurrency. The aim of this article is to introduce Bitcoin system using a language understandable also to readers without computer science education. This article captures the Bitcoin system from three perspectives: internal structure, network and users. Emphasis is placed on brief and clear definitions (system components and their mutual relationships. A new system view of the stated terms constitutes author’s own contribution.

  4. JOSHUA system

    International Nuclear Information System (INIS)

    Honeck, H.C.

    1975-04-01

    A major computational system called JOSHUA has been under development at the Savannah River Laboratory since 1968. The JOSHUA System has two major parts: the Operating System and the Application System. The Operating System has been in production use since 1970 and provides data management, terminal, and job execution facilities. The Application System uses these facilities in solving problems in reactor physics and engineering. Features of the Application System are the two-dimensional lattice physics and three-dimensional transient reactor physics capabilities, which have been in use since 1971 and 1974, respectively. The capabilities of the JOSHUA System are summarized, and statistics on size, use, and development effort are provided. (U.S.)

  5. Systems thinking.

    Science.gov (United States)

    Cabrera, Derek; Colosi, Laura; Lobdell, Claire

    2008-08-01

    Evaluation is one of many fields where "systems thinking" is popular and is said to hold great promise. However, there is disagreement about what constitutes systems thinking. Its meaning is ambiguous, and systems scholars have made diverse and divergent attempts to describe it. Alternative origins include: von Bertalanffy, Aristotle, Lao Tsu or multiple aperiodic "waves." Some scholars describe it as synonymous with systems sciences (i.e., nonlinear dynamics, complexity, chaos). Others view it as taxonomy-a laundry list of systems approaches. Within so much noise, it is often difficult for evaluators to find the systems thinking signal. Recent work in systems thinking describes it as an emergent property of four simple conceptual patterns (rules). For an evaluator to become a "systems thinker", he or she need not spend years learning many methods or nonlinear sciences. Instead, with some practice, one can learn to apply these four simple rules to existing evaluation knowledge with transformative results.

  6. Cognitive Systems

    DEFF Research Database (Denmark)

    The tutorial will discuss the definition of cognitive systems as the possibilities to extend the current systems engineering paradigm in order to perceive, learn, reason and interact robustly in open-ended changing environments. I will also address cognitive systems in a historical perspective...... to be modeled within a limited set of predefined specifications. There will inevitably be a need for robust decisions and behaviors in novel situations that include handling of conflicts and ambiguities based on the capability and knowledge of the artificial cognitive system. Further, there is a need...... in cognitive systems include e.g. personalized information systems, sensor network systems, social dynamics system and Web2.0, and cognitive components analysis. I will use example from our own research and link to other research activities....

  7. Crystal Systems.

    Science.gov (United States)

    Schomaker, Verner; Lingafelter, E. C.

    1985-01-01

    Discusses characteristics of crystal systems, comparing (in table format) crystal systems with lattice types, number of restrictions, nature of the restrictions, and other lattices that can accidently show the same metrical symmetry. (JN)

  8. Filter systems

    International Nuclear Information System (INIS)

    Vanin, V.R.

    1990-01-01

    The multidetector systems for high resolution gamma spectroscopy are presented. The observable parameters for identifying nuclides produced simultaneously in the reaction are analysed discussing the efficiency of filter systems. (M.C.K.)

  9. Expert systems

    International Nuclear Information System (INIS)

    Haldy, P.A.

    1988-01-01

    The definitions of the terms 'artificial intelligence' and 'expert systems', the methodology, areas of employment and limits of expert systems are discussed. The operation of an expert system is described, especially the presentation and organization of knowledge as well as interference and control. Methods and tools for expert system development are presented and their application in nuclear energy are briefly addressed. 7 figs., 2 tabs., 6 refs

  10. Expert System

    DEFF Research Database (Denmark)

    Hildebrandt, Thomas Troels; Cattani, Gian Luca

    2016-01-01

    An expert system is a computer system for inferring knowledge from a knowledge base, typically by using a set of inference rules. When the concept of expert systems was introduced at Stanford University in the early 1970s, the knowledge base was an unstructured set of facts. Today the knowledge b...... for the application of expert systems, but also raises issues regarding privacy and legal liability....

  11. Retrofitting Systems

    DEFF Research Database (Denmark)

    Rose, Jørgen

    1997-01-01

    This report gives an overview of the different retrofitting possibilities that are available today. The report looks at both external and internal systems for external wall constructions, roof constructions, floor constructions and foundations. All systems are described in detail in respect to use...... and methods, and the efficiency of the different systems are discussed....

  12. Multifunction system

    International Nuclear Information System (INIS)

    Wauthier, J.; Fiori, R.

    1990-01-01

    The development, the characteristics and the applications of a multifunction system are presented. The system is used on the RBES laboratory pipes, at Marcoule. The system was developed in order to allow, without time loss, the modification of the circuit function by replacing only one component. The following elements form the multifunction system: a fixed base, which is part of the tube, a removable piece, which is inserted into the base, a cover plate and its locking system. The material, chosen among commercial trade marks, required small modifications in order to be used in the circuit [fr

  13. Operating systems

    CERN Document Server

    Tsichritzis, Dionysios C; Rheinboldt, Werner

    1974-01-01

    Operating Systems deals with the fundamental concepts and principles that govern the behavior of operating systems. Many issues regarding the structure of operating systems, including the problems of managing processes, processors, and memory, are examined. Various aspects of operating systems are also discussed, from input-output and files to security, protection, reliability, design methods, performance evaluation, and implementation methods.Comprised of 10 chapters, this volume begins with an overview of what constitutes an operating system, followed by a discussion on the definition and pr

  14. Systems integration.

    Science.gov (United States)

    Siemieniuch, C E; Sinclair, M A

    2006-01-01

    The paper presents a view of systems integration, from an ergonomics/human factors perspective, emphasising the process of systems integration as is carried out by humans. The first section discusses some of the fundamental issues in systems integration, such as the significance of systems boundaries, systems lifecycle and systems entropy, issues arising from complexity, the implications of systems immortality, and so on. The next section outlines various generic processes for executing systems integration, to act as guides for practitioners. These address both the design of the system to be integrated and the preparation of the wider system in which the integration will occur. Then the next section outlines some of the human-specific issues that would need to be addressed in such processes; for example, indeterminacy and incompleteness, the prediction of human reliability, workload issues, extended situation awareness, and knowledge lifecycle management. For all of these, suggestions and further readings are proposed. Finally, the conclusions section reiterates in condensed form the major issues arising from the above.

  15. Ternary systems

    International Nuclear Information System (INIS)

    Kagan, D.N.; Hubberstey, P.; Barker, M.G.

    1985-01-01

    The paper reviews the experimental and theoretical studies carried out on multicomponent alkali metal systems. Solid-liquid phase equilibria studies are mainly concerned with the systems Na-K-Rb and Na-K-Cs, and data on the liquidus temperatures in these systems are presented. The thermodynamic properties of the ternary Na-K-Cs eutectic system have been determined experimentally, and the enthalpy, heat capacity and excess functions of the alloy are given. An analysis of calculational methods used in determining thermodynamic functions of ternary liquid metals systems is described. Finally, data are tabulated for the density, compressibility, saturated vapour pressure, viscosity and thermal conductivity of the ternary Na-K-Cs eutectic system. (UK)

  16. Recommender systems

    CERN Document Server

    Kembellec, Gérald; Saleh, Imad

    2014-01-01

    Acclaimed by various content platforms (books, music, movies) and auction sites online, recommendation systems are key elements of digital strategies. If development was originally intended for the performance of information systems, the issues are now massively moved on logical optimization of the customer relationship, with the main objective to maximize potential sales. On the transdisciplinary approach, engines and recommender systems brings together contributions linking information science and communications, marketing, sociology, mathematics and computing. It deals with the understan

  17. Material Systems

    DEFF Research Database (Denmark)

    Jensen, Mads Brath; Mortensen, Henrik Rubæk; Mullins, Michael

    2009-01-01

    This paper describes and reflects upon the results of an investigative project which explores the setting up of a material system - a parametric and generative assembly consisting of and taking into consideration material properties, manufacturing constraints and geometric behavior. The project...... approaches the subject through the construction of a logic-driven system aiming to explore the possibilities of a material system that fulfills spatial, structural and performative requirements concurrently and how these are negotiated in situations where they might be conflicting....

  18. Systems Engineering

    OpenAIRE

    Vaughan, William W.

    2016-01-01

    The term “systems engineering” when entered into the Google search page, produces a significant number of results, evidence that systems engineering is recognized as being important for the success of essentially all products. Since most readers of this item will be rather well versed in documents concerning systems engineering, I have elected to share some of the points made on this subject in a document developed by the European Cooperation for Space Standardization (ECSS), a component of t...

  19. Energetic Systems

    Data.gov (United States)

    Federal Laboratory Consortium — The Energetic Systems Division provides full-spectrum energetic engineering services (project management, design, analysis, production support, in-service support,...

  20. Intelligent systems

    CERN Document Server

    Irwin, J David

    2011-01-01

    Technology has now progressed to the point that intelligent systems are replacing humans in the decision making processes as well as aiding in the solution of very complex problems. In many cases intelligent systems are already outperforming human activities. Artificial neural networks are not only capable of learning how to classify patterns, such images or sequence of events, but they can also effectively model complex nonlinear systems. Their ability to classify sequences of events is probably more popular in industrial applications where there is an inherent need to model nonlinear system

  1. Systemic darwinism.

    Science.gov (United States)

    Winther, Rasmus Grønfeldt

    2008-08-19

    Darwin's 19th century evolutionary theory of descent with modification through natural selection opened up a multidimensional and integrative conceptual space for biology. We explore three dimensions of this space: explanatory pattern, levels of selection, and degree of difference among units of the same type. Each dimension is defined by a respective pair of poles: law and narrative explanation, organismic and hierarchical selection, and variational and essentialist thinking. As a consequence of conceptual debates in the 20th century biological sciences, the poles of each pair came to be seen as mutually exclusive opposites. A significant amount of 21st century research focuses on systems (e.g., genomic, cellular, organismic, and ecological/global). Systemic Darwinism is emerging in this context. It follows a "compositional paradigm" according to which complex systems and their hierarchical networks of parts are the focus of biological investigation. Through the investigation of systems, Systemic Darwinism promises to reintegrate each dimension of Darwin's original logical space. Moreover, this ideally and potentially unified theory of biological ontology coordinates and integrates a plurality of mathematical biological theories (e.g., self-organization/structure, cladistics/history, and evolutionary genetics/function). Integrative Systemic Darwinism requires communal articulation from a plurality of perspectives. Although it is more general than these, it draws on previous advances in Systems Theory, Systems Biology, and Hierarchy Theory. Systemic Darwinism would greatly further bioengineering research and would provide a significantly deeper and more critical understanding of biological reality.

  2. Caste System

    OpenAIRE

    Hoff, Karla

    2016-01-01

    In standard economics, individuals are rational actors and economic forces undermine institutions that impose large inefficiencies. The persistence of the caste system is evidence of the need for psychologically more realistic models of decision-making in economics. The caste system divides South Asian society into hereditary groups whose lowest ranks are represented as innately polluted. ...

  3. Recommender systems

    OpenAIRE

    Lu L.; Medo M.; Yeung C.H.; Zhang Y.-C.; Zhang Z.-K.; Zhou T.

    2012-01-01

    The ongoing rapid expansion of the Internet greatly increases the necessity of effective recommender systems for filtering the abundant information. Extensive research for recommender systems is conducted by a broad range of communities including social and computer scientists, physicists, and interdisciplinary researchers. Despite substantial theoretical and practical achievements, unification and comparison of different approaches are lacking, which impedes further advances. In this article...

  4. GEOMASS system

    International Nuclear Information System (INIS)

    Ohyama, Takuya; Saegusa, Hiromitsu

    2009-03-01

    As a part of the research and development regarding characterisation of deep geological environment, the GEOMASS (GEOLOGICAL MODELLING ANALYSIS AND SIMULATION SOFTWARE) system has been developed by the Japan Atomic Energy Agency in order to carry out geological and hydrogeological modelling and groundwater flow simulation and so on. The GEOMASS system integrates a commercial geological interpretation system (EarthVision), which is used for geological modelling and visualisation, with a proprietary code for groundwater flow (FracAffinity). This integrated system allows users to make rapid improvement of models as data increases. Also, it is possible to perform more realistic groundwater flow simulation due to the capability of modelling the rock mass as a continuum with discrete hydro-structural features in the rock mass. This paper consists of 'Overview of GEOMASS system', FracAffinity Theoretical Background' and 'FracAffinity User Guide' and is edited as a GEOMASS system manual. 'Overview of GEOMASS system' describes the outline of this system. 'FracAffinity Theoretical Background' describes the information of technical background of FracAffinity software. FracAffinity User Guide' describes the structure of the FracAffinity input files, the usage of FracAffinity Interface and flow-solver. Updating of the FracAffinity has been continued as needed and FracAffinity version3.3 is the latest version at present (July 2008). (author)

  5. Systems integration (automation system). System integration (automation system)

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, K; Komori, T; Fukuma, Y; Oikawa, M [Nippon Steal Corp., Tokyo (Japan)

    1991-09-26

    This paper introduces business activities on an automation systems integration (SI) started by a company in July,1988, and describes the SI concepts. The business activities include, with the CIM (unified production carried out on computers) and AMENITY (living environment) as the mainstays, a single responsibility construction ranging from consultation on structuring optimal systems for processing and assembling industries and intelligent buildings to system design, installation and after-sales services. With an SI standing on users {prime} position taken most importantly, the business starts from a planning and consultation under close coordination. On the conceptual basis of structuring optimal systems using the ompany {prime}s affluent know-hows and tools and adapting and applying with multi-vendors, open networks, centralized and distributed systems, the business is promoted with the accumulated technologies capable of realizing artificial intelligence and neural networks in its background, and supported with highly valuable business results in the past. 10 figs., 1 tab.

  6. Creative Systems

    DEFF Research Database (Denmark)

    Manelius, Anne-Mette; Beim, Anne

    2007-01-01

    Opsamling af diskussioner på konferencen og udstillingen Creative Systems i september/oktober 2007. Konferencen og Udstillingen Creative Systems sætter fokus på systemer som en positiv drivkraft i den kreative skabelsesproces. CINARK inviterede fire internationale kapaciteter, som indenfor hver...... deres felt har beskæftiget sig med udviklingen af systemer. Kieran Timberlake, markant amerikansk tegnestue; Mark West, Professor på University of Manitoba, Canada, og pioner indenfor anvendelse af tekstilforskalling til betonstøbninger; Matilda McQuaid, Arkitekturhistoriker og kurator på udstillingen...... om Extreme Textiles på amerikanske Cooper Hewit Design Museum, samt Professor Ludger Hovestadt, ved ETH, Zürich der fokuserer på udvikling og anvendelse af logaritmiske systemtilgange. Udstillingen diskuterede ud fra deres meget forskellige arbejder, det kreative potentiale i anvendelsen af systemer...

  7. Reactive Systems

    DEFF Research Database (Denmark)

    Aceto, Luca; Ingolfsdottir, Anna; Larsen, Kim Guldstrand

    A reactive system comprises networks of computing components, achieving their goals through interaction among themselves and their environment. Thus even relatively small systems may exhibit unexpectedly complex behaviours. As moreover reactive systems are often used in safety critical systems......, the need for mathematically based formal methodology is increasingly important. There are many books that look at particular methodologies for such systems. This book offers a more balanced introduction for graduate students and describes the various approaches, their strengths and weaknesses, and when...... they are best used. Milner's CCS and its operational semantics are introduced, together with the notions of behavioural equivalences based on bisimulation techniques and with recursive extensions of Hennessy-Milner logic. In the second part of the book, the presented theories are extended to take timing issues...

  8. Upgraded RECOVER system - CASDAC system

    International Nuclear Information System (INIS)

    Yamamoto, Yoichi; Koyama, Kinji

    1992-03-01

    The CASDAC (Containment And Surveillance Data Authenticated Communication) system has been developed by JAERI for nuclear safeguards and physical protection of nuclear material. This system was designed and constructed as an upgraded RECOVER system, design concept of which was based on the original RECOVER system and also the TRANSEAVER system. Both of them were developed several years ago as a remote monitoring system for continual verification of security and safeguards status of nuclear material. The system consists of two subsystems, one of them is a Grand Command Center (GCC) subsystem and the other is a facility subsystem. Communication between the two subsystems is controlled through the international telephone line network. Therefore all communication data are encrypted to prevent access by an unauthorized person who may intend to make a falsification, or tapping. The facility subsystem has an appropriate measure that ensure data security and reliable operation under unattended mode of operator. The software of this system is designed so as to be easily used in other different types of computers. This report describes the outline of the CASDAC system and the results of its performance test. This work has been carried out in the framework of Japan Support Programme for Agency Safeguards (JASPAS) as a project, JA-1. (author)

  9. Watchdog System

    DEFF Research Database (Denmark)

    Madsen, Tanja Kidholm Osmann; Bahnsen, Chris Holmberg; Jensen, Morten Bornø

    This deliverable is part of WP4. Overall WP4 is motivated by the need for automatic systems that can ease the task of annotating massive amounts of traffic data. Concretely this deliverable is related to WP4.2 - the watchdog system. The idea with the watchdog is to develop a system that can remov...... huge chunks of video data where no events/interactions of interest are occurring and hence let a user focus on manually annotation of only the interesting stuff....

  10. Dynamical systems

    CERN Document Server

    Sternberg, Shlomo

    2010-01-01

    Celebrated mathematician Shlomo Sternberg, a pioneer in the field of dynamical systems, created this modern one-semester introduction to the subject for his classes at Harvard University. Its wide-ranging treatment covers one-dimensional dynamics, differential equations, random walks, iterated function systems, symbolic dynamics, and Markov chains. Supplementary materials offer a variety of online components, including PowerPoint lecture slides for professors and MATLAB exercises.""Even though there are many dynamical systems books on the market, this book is bound to become a classic. The the

  11. Water systems

    International Nuclear Information System (INIS)

    Riess, R.

    1980-01-01

    The present paper describes the coolant chemistry and its consequences for 1300 MWsub(e) KWU PWR plants. Some selected systems, i.e. primary heat transport system, steam water cycle and cooling water arrangements, are chosen for this description. Various aspects of coolant chemistry regarding general corrosion, selective types of corrosion and deposits on heat transfer surfaces have been discussed. The water supply systems necessary to fulfill the requirements of the coolant chemistry are discussed as well. It has been concluded that a good operating performance can only be achieved when - beside other factors - the water chemistry has been given sufficient consideration. (orig./RW)

  12. Water systems

    International Nuclear Information System (INIS)

    Riess, R.

    1981-01-01

    The present paper describes the coolant chemistry and its consequences for 1300 MWsub(e) KWU PWR plants. Some selected systems, i.e. primary heat transport system, steam water cycle and cooling water arrangements, are chosen for this description. Various aspects of coolant chemistry regarding general corrosion, selective types of corrosion and deposits on heat transfer surface have been discussed. The water supply systems necessary to fulfill the requirements of the coolant chemistry are discussed as well. It has been concluded that a good operating performance can only be achieved when - beside other factors - the water chemistry has been given sufficient consideration. (orig./RW)

  13. Imaging system

    International Nuclear Information System (INIS)

    Froggatt, R.J.

    1981-01-01

    The invention provides a two dimensional imaging system in which a pattern of radiation falling on the system is detected to give electrical signals for each of a plurality of strips across the pattern. The detection is repeated for different orientations of the strips and the whole processed by compensated back projection. For a shadow x-ray system a plurality of strip x-ray detectors are rotated on a turntable. For lower frequencies the pattern may be rotated with a Dove prism and the strips condensed to suit smaller detectors with a cylindrical lens. (author)

  14. Kaonic systems

    Directory of Open Access Journals (Sweden)

    Oset E.

    2012-12-01

    Full Text Available I make a short review of the situation of the kaonic systems, with novel information supporting the two Λ(1405 states from the K-d → nπΣ reaction. A review is made of the K¯$ar K$NN system with recent calculations converging to smaller bindings and larger widths. Novel systems involving two kaons and one nucleon or three kaons are also reported and finally a short discussion is made of the analogous state DNN for which recent studies find a large binding and a small width.

  15. The systems integration modeling system

    International Nuclear Information System (INIS)

    Danker, W.J.; Williams, J.R.

    1990-01-01

    This paper discusses the systems integration modeling system (SIMS), an analysis tool for the detailed evaluation of the structure and related performance of the Federal Waste Management System (FWMS) and its interface with waste generators. It's use for evaluations in support of system-level decisions as to FWMS configurations, the allocation, sizing, balancing and integration of functions among elements, and the establishment of system-preferred waste selection and sequencing methods and other operating strategies is presented. SIMS includes major analysis submodels which quantify the detailed characteristics of individual waste items, loaded casks and waste packages, simulate the detailed logistics of handling and processing discrete waste items and packages, and perform detailed cost evaluations

  16. ring system

    African Journals Online (AJOL)

    1,3,2-DIAZABORACYCLOALKANE. RING SYSTEM. Negussie Retta" and Robert H. Neilson. 'Department of Chemistry, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia. Department of Chemistry, Texas Christian University.

  17. Septic Systems

    Science.gov (United States)

    The web site provides guidance and technical assistance for homeowners, government officials, industry professionals, and EPA partners about how to properly develop and manage individual onsite and community cluster systems that treat domestic wastewater.

  18. Respiratory system

    Science.gov (United States)

    Bartlett, R. G., Jr.

    1973-01-01

    The general anatomy and function of the human respiratory system is summarized. Breathing movements, control of breathing, lung volumes and capacities, mechanical relations, and factors relevant to respiratory support and equipment design are discussed.

  19. Bubble systems

    CERN Document Server

    Avdeev, Alexander A

    2016-01-01

    This monograph presents a systematic analysis of bubble system mathematics, using the mechanics of two-phase systems in non-equilibrium as the scope of analysis. The author introduces the thermodynamic foundations of bubble systems, ranging from the fundamental starting points to current research challenges. This book addresses a range of topics, including description methods of multi-phase systems, boundary and initial conditions as well as coupling requirements at the phase boundary. Moreover, it presents a detailed study of the basic problems of bubble dynamics in a liquid mass: growth (dynamically and thermally controlled), collapse, bubble pulsations, bubble rise and breakup. Special emphasis is placed on bubble dynamics in turbulent flows. The analysis results are used to write integral equations governing the rate of vapor generation (condensation) in non-equilibrium flows, thus creating a basis for solving a number of practical problems. This book is the first to present a comprehensive theory of boil...

  20. Systems Biology

    Indian Academy of Sciences (India)

    IAS Admin

    study and understand the function of biological systems, particu- larly, the response of such .... understand the organisation and behaviour of prokaryotic sys- tems. ... relationship of the structure of a target molecule to its ability to bind a certain ...

  1. Bricks / Systems

    DEFF Research Database (Denmark)

    At first glance, this book may appear eclectic. It contains writings from architectural practice in a language and structure based on subjective views and experiences, combined with research contributions based on systematic design investigations of discrete computational systems. Discussions range......, and it aims to illustrate and identify new modes of working in architecture, particularly with regards to brickwork and other complex systems of modular assemblies, whether physical or digital....

  2. Expert Systems

    OpenAIRE

    Lucas, P.J.F.

    2005-01-01

    Expert systems mimic the problem-solving activity of human experts in specialized domains by capturing and representing expert knowledge. Expert systems include a knowledge base, an inference engine that derives conclusions from the knowledge, and a user interface. Knowledge may be stored as if-then rules, orusing other formalisms such as frames and predicate logic. Uncertain knowledge may be represented using certainty factors, Bayesian networks, Dempster-Shafer belief functions, or fuzzy se...

  3. Nanorobotic Systems

    Directory of Open Access Journals (Sweden)

    Lixin Dong

    2008-11-01

    Full Text Available Two strategies towards the realization of nanotechnology have been presented, i.e., top-down and bottom up. The former one is mainly based on nanofabrication and includes technologies such as nano-lithography, nano-imprint, and etching. Presently, they are still 2D fabrication processes with low resolution. The later one is an assembly-based technique. At present, it includes such items as self-assembly, dip-pen lithography, and directed self-assembly. These techniques can generate regular nano patterns in large scales. To fabricate 3D complex nano devices there are still no effective ways by so far. Here we show our effort on the development of a nano laboratory, a prototype nanomanufacturing system, based on nanorobotic manipulations. In which, we take a hybrid strategy as shown in Fig. 1. In this system, nano fabrication and nano assembly can be performed in an arbitrary order to construct nano building blocks and finally nano devices. The most important feature in this system is that the products can be fed back into the system to shrink the system part by part leading to nanorobots. Property characterization can be performed in each intermediate process. Due to the nanorobotic manipulation system, dynamic measurement can be performed rather than conventional static observations.

  4. Future of uniportal video-assisted thoracoscopic surgery-emerging technology.

    Science.gov (United States)

    Li, Zheng; Ng, Calvin S H

    2016-03-01

    Uniportal VATS poses unique difficulties to the surgeon, mainly as a consequence of operating through a small single incision. The instruments in uniportal VATS have limited movement through the small incision. In addition, the approach to the surgical operating site is unidirectional, which may restrict vision and retraction, and unavoidably suffers from instrument fencing. Recent thoracoscopic technology in the form of a wide variable angled lens has to some extent improved these shortcomings. The development of an extendable flexible thoracoscope and wireless steerable endoscope (WSE) systems can further improve the visualization for surgery and reduce or even remove fencing between endoscope and instruments. New single incision access platforms both derived from Natural orifice transluminal endoscopic surgery (NOTES) and robotic surgery approaches are on the horizon. These may allow uniportal VATS to be performed through an even smaller ultra-minimally invasive incision, with improved vision, more freedom of movement of the instruments and greater precision. However, a number of problems remain to be resolved, including provision of a stable platform and payload, applied force limitations and equipment sterilization. Advances in uniportal VATS major lung resection techniques have not only challenged the surgeon to acquire new skills and knowledge, but at the same time have rekindled the collaborative spirit between industry and clinician in developing novel equipment and technology to push the boundaries of minimally invasive surgery. These technological improvements and innovations may improve operating efficiency and safety during uniportal VATS surgery.

  5. Fiscal system analysis - contractual systems

    International Nuclear Information System (INIS)

    Kaiser, M.J.

    2006-01-01

    Production sharing contracts are one of the most popular forms of contractual system used in petroleum agreements around the world, but the manner in which the fiscal terms and contract parameters impact system measures is complicated and not well understood. The purpose of this paper is to quantify the influence of private and market uncertainty in contractual fiscal systems. A meta-modelling approach is employed that couples the results of a simulation model with regression analysis to construct numerical functionals that quantify the fiscal regime. Relationships are derived that specify how the present value, rate of return, and take statistics vary as a function of the system parameters. The deepwater Girassol field development in Angola is taken as a case study. (author)

  6. Reactor system

    International Nuclear Information System (INIS)

    Miyano, Hiroshi; Narabayashi, Naoshi.

    1990-01-01

    The represent invention concerns a reactor system with improved water injection means to a pressure vessel of a BWR type reactor. A steam pump is connected to a heat removing system pipeline, a high pressure water injection system pipeline and a low pressure water injection system pipeline for injecting water into the pressure vessel. A pump actuation pipeline is disposed being branched from a main steam pump or a steam relieaf pipeline system, through which steams are supplied to actuate the steam pump and supply cooling water into the pressure vessel thereby cooling the reactor core. The steam pump converts the heat energy into the kinetic energy and elevates the pressure of water to a level higher than the pressure of the steams supplied by way of a pressure-elevating diffuser. Cooling water can be supplied to the pressure vessel by the pressure elevation. This can surely inject cooling water into the pressure vessel upon loss of coolant accident or in a case if reactor scram is necessary, without using an additional power source. (I.N.)

  7. ARAC system

    International Nuclear Information System (INIS)

    Kelly, M.F.; Wyman, R.H.

    1975-01-01

    In spite of the remarkable safety record of the nuclear industry as a whole, recent public concern over the potential impact of the industry's accelerated growth has prompted ERDA to expand its emergency response procedures. The Atmospheric Release Advisory Capability, ARAC, is a computer communications system designed to enhance the existing emergency response capability of ERDA nuclear facilities. ARAC will add at least two new functions to this capability: centralized, real-time data acquisition and storage, and simulation of the long range atmospheric transport of hazardous materials. To perform these functions, ARAC employs four major sub-systems or facilities: the site facility, the central facility, the global weather center and the regional model. The system has been under development for the past two years at the Lawrence Livermore Laboratory of the University of California

  8. Microbiology System

    Science.gov (United States)

    1992-01-01

    Technology originating in a NASA-sponsored study of the measurement of microbial growth in zero gravity led to the development of Biomerieux Vitek, Inc.'s VITEK system. VITEK provides a physician with accurate diagnostic information and identifies the most effective medication. Test cards are employed to identify organisms and determine susceptibility to antibiotics. A photo-optical scanner scans the card and monitors changes in the growth of cells contained within the card. There are two configurations - VITEK and VITEK JR as well as VIDAS, a companion system that detects bacteria, viruses, etc. from patient specimens. The company was originally created by McDonnell Douglas, the NASA contractor.

  9. Spin systems

    CERN Document Server

    Caspers, W J

    1989-01-01

    This book is about spin systems as models for magnetic materials, especially antiferromagnetic lattices. Spin-systems are well-defined models, for which, in special cases, exact properties may be derived. These special cases are for the greater part, one- dimensional and restricted in their applicability, but they may give insight into general properties that also exist in higher dimension. This work pays special attention to qualitative differences between spin lattices of different dimensions. It also replaces the traditional picture of an (ordered) antiferromagnetic state of a Heisenberg sy

  10. Distributed systems

    CERN Document Server

    Van Steen, Maarten

    2017-01-01

    For this third edition of "Distributed Systems," the material has been thoroughly revised and extended, integrating principles and paradigms into nine chapters: 1. Introduction 2. Architectures 3. Processes 4. Communication 5. Naming 6. Coordination 7. Replication 8. Fault tolerance 9. Security A separation has been made between basic material and more specific subjects. The latter have been organized into boxed sections, which may be skipped on first reading. To assist in understanding the more algorithmic parts, example programs in Python have been included. The examples in the book leave out many details for readability, but the complete code is available through the book's Website, hosted at www.distributed-systems.net.

  11. Immune System

    Science.gov (United States)

    ... of the Immune System Print en español El sistema inmunitario Whether you're stomping through the showers ... of Use Notice of Nondiscrimination Visit the Nemours Web site. Note: All information on TeensHealth® is for ...

  12. Operating Systems

    Indian Academy of Sciences (India)

    areas in which this type is useful are multimedia, virtual reality, and advanced scientific projects such as undersea exploration and planetary rovers. Because of the expanded uses for soft real-time functionality, it is finding its way into most current operating systems, including major versions of Unix and Windows NT OS.

  13. Barrier Systems

    NARCIS (Netherlands)

    Heteren, S. van

    2015-01-01

    Barrier-system dynamics are a function of antecedent topography and substrate lithology, Relative sea-level (RSL) changes, sediment availability and type, climate, vegetation type and cover, and various aero- and hydrodynamic processes during fair-weather conditions and extreme events. Global change

  14. Systems Science

    Science.gov (United States)

    Christakis, Alexander; Hammond, Debora; Jackson, Michael; Laszlo, Alexander; Mitroff, Ian; Snowden, Dave; Troncale, Len; Carr-Chellman, Alison; Spector, J. Michael; Wilson, Brent

    2013-01-01

    Scholars representing the field of systems science were asked to identify what they considered to be the most exciting and imaginative work currently being done in their field, as well as how that work might change our understanding. The scholars included Alexander Christakis, Debora Hammond, Michael Jackson, Alexander Laszlo, Ian Mitroff, Dave…

  15. Transport system

    NARCIS (Netherlands)

    Drenth, K.F.

    1999-01-01

    The transport system comprises at least one road surface (2) and at least one vehicle (4) on wheels (6). The road surface (2) has a substantially bowl-shaped cross section and the vehicle (4) is designed so that the wheels (6) run directly on the road surface (2) while the road surface (2) acts as a

  16. Quorum Systems

    DEFF Research Database (Denmark)

    Wattenhofer, Roger; Förster, Klaus-Tycho

    2016-01-01

    What happens if a single server is no longer powerful enough to service all your customers? The obvious choice is to add more servers and to use the majority approach (e.g. Paxos, Chapter 2) to guarantee consistency. However, even if you buy one million servers, a client still has to access more ...... study the theory behind overlapping sets, known as quorum systems....

  17. System Dynamics

    Science.gov (United States)

    Morecroft, John

    System dynamics is an approach for thinking about and simulating situations and organisations of all kinds and sizes by visualising how the elements fit together, interact and change over time. This chapter, written by John Morecroft, describes modern system dynamics which retains the fundamentals developed in the 1950s by Jay W. Forrester of the MIT Sloan School of Management. It looks at feedback loops and time delays that affect system behaviour in a non-linear way, and illustrates how dynamic behaviour depends upon feedback loop structures. It also recognises improvements as part of the ongoing process of managing a situation in order to achieve goals. Significantly it recognises the importance of context, and practitioner skills. Feedback systems thinking views problems and solutions as being intertwined. The main concepts and tools: feedback structure and behaviour, causal loop diagrams, dynamics, are practically illustrated in a wide variety of contexts from a hot water shower through to a symphony orchestra and the practical application of the approach is described through several real examples of its use for strategic planning and evaluation.

  18. System Description:

    DEFF Research Database (Denmark)

    Schürmann, Carsten; Poswolsky, Adam

    2009-01-01

    Delphin is a functional programming language [Adam Poswolsky and Carsten Schürmann. Practical programming with higher-order encodings and dependent types. In European Symposium on Programming (ESOP), 2008] utilizing dependent higher-order datatypes. Delphin's two-level type-system cleanly separates...

  19. Immune System

    Science.gov (United States)

    A properly functioning immune system is essential to good health. It defends the body against infectious agents and in some cases tumor cells. Individuals with immune deficiencies resulting from genetic defects, diseases (e.g., AIDS, leukemia), or drug therapies are more suscepti...

  20. Bioenergy systems

    International Nuclear Information System (INIS)

    Mitchell, C.P.

    1997-01-01

    The objective of this paper is to demonstrate that a bioenergy system has to be considered as an integrated process in which each stage or step interacts with other steps in the overall process. There are a number of stages in the supply and conversion of woody biomass for energy. Each step in the chain has implications for the next step and for overall system efficiency. The resource can take many forms and will have varying physical and chemical characteristics which will influence the efficiency and cost of conversion. The point in the supply chain at which size and moisture content is reduced and the manner in which it is done is influential in determining feedstock delivered cost and overall system costs. To illustrate the interactions within the overall system, the influence of the nature, size and moisture content of delivered feedstocks on costs of generating electricity via thermal conversion processes is examined using a model developed to investigate the inter-relationships between the stages in the supply chain. (author)

  1. Urogenital system

    International Nuclear Information System (INIS)

    Hamm, B.; Asbach, P.; Beyersdorff, D.; Hein, P.; Zaspel, U.

    2007-01-01

    The book is focussed on the radiological diagnostics of diseases in the urogential system. The description of the specific diseases, the identification by modern imaging techniques, the interpretation of examinatory results and therapeutic options are systematically treated in 4 chapters: kidney and adrenal glands, urinary tract, male genitals, female genitals

  2. Mirror systems.

    Science.gov (United States)

    Fogassi, Leonardo; Ferrari, Pier Francesco

    2011-01-01

    Mirror neurons are a class of visuomotor neurons, discovered in the monkey premotor cortex and in an anatomically connected area of the inferior parietal lobule, that activate both during action execution and action observation. They constitute a circuit dedicated to match actions made by others with the internal motor representations of the observer. It has been proposed that this matching system enables individuals to understand others' behavior and motor intentions. Here we will describe the main features of mirror neurons in monkeys. Then we will present evidence of the presence of a mirror system in humans and of its involvement in several social-cognitive functions, such as imitation, intention, and emotion understanding. This system may have several implications at a cognitive level and could be linked to specific social deficits in humans such as autism. Recent investigations addressed the issue of the plasticity of the mirror neuron system in both monkeys and humans, suggesting also their possible use in rehabilitation. WIREs Cogn Sci 2011 2 22-38 DOI: 10.1002/wcs.89 For further resources related to this article, please visit the WIREs website. Copyright © 2010 John Wiley & Sons, Ltd.

  3. Systemic Planning

    DEFF Research Database (Denmark)

    Leleur, Steen

    This book presents principles and methodology for planning in a complex world. It sets out a so-called systemic approach to planning, among other things, by applying “hard” and “soft” methodologies and methods in combination. The book is written for Ph.D and graduate students in engineering...

  4. Energy systems

    International Nuclear Information System (INIS)

    Haefele, W.

    1974-01-01

    Up to the present the production, transmission and distribution of energy has been considered mostly as a fragmented problem; at best only subsystems have been considered. Today the scale of energy utilization is increasing rapidly, and correspondingly, the reliance of societies on energy. Such strong quantitative increases influence the qualitative nature of energy utilization in most of its aspects. Resources, reserves, reliability and environment are among the key words that may characterize the change in the nature of the energy utilization problem. Energy can no longer be considered an isolated technical and economical problem, rather it is embedded in the ecosphere and the society-technology complex. Restraints and boundary conditions have to be taken into account with the same degree of attention as in traditional technical problems, for example a steam turbine. This results in a strong degree of interweaving. Further, the purpose of providing energy becomes more visible, that is, to make survival possible in a civilized and highly populated world on a finite globe. Because of such interweaving and finiteness it is felt that energy should be considered as a system and therefore the term 'energy systems' is used. The production of energy is only one component of such a system; the handling of energy and the embedding of energy into the global and social complex in terms of ecology, economy, risks and resources are of similar importance. he systems approach to the energy problem needs more explanation. This paper is meant to give an outline of the underlying problems and it is hoped that by so doing the wide range of sometimes confusing voices about energy can be better understood. Such confusion starts already with the term 'energy crisis'. Is there an energy crisis or not? Much future work is required to tackle the problems of energy systems. This paper can only marginally help in that respect. But it is hoped that it will help understand the scope of the

  5. Energy systems

    Energy Technology Data Exchange (ETDEWEB)

    Haefele, W [Nuclear Research Centre, Applied Systems Analysis and Reactor Physics, Karlsruhe (Germany); International Institute for Applied Systems Analysis, Laxenburg (Austria)

    1974-07-01

    Up to the present the production, transmission and distribution of energy has been considered mostly as a fragmented problem; at best only subsystems have been considered. Today the scale of energy utilization is increasing rapidly, and correspondingly, the reliance of societies on energy. Such strong quantitative increases influence the qualitative nature of energy utilization in most of its aspects. Resources, reserves, reliability and environment are among the key words that may characterize the change in the nature of the energy utilization problem. Energy can no longer be considered an isolated technical and economical problem, rather it is embedded in the ecosphere and the society-technology complex. Restraints and boundary conditions have to be taken into account with the same degree of attention as in traditional technical problems, for example a steam turbine. This results in a strong degree of interweaving. Further, the purpose of providing energy becomes more visible, that is, to make survival possible in a civilized and highly populated world on a finite globe. Because of such interweaving and finiteness it is felt that energy should be considered as a system and therefore the term 'energy systems' is used. The production of energy is only one component of such a system; the handling of energy and the embedding of energy into the global and social complex in terms of ecology, economy, risks and resources are of similar importance. he systems approach to the energy problem needs more explanation. This paper is meant to give an outline of the underlying problems and it is hoped that by so doing the wide range of sometimes confusing voices about energy can be better understood. Such confusion starts already with the term 'energy crisis'. Is there an energy crisis or not? Much future work is required to tackle the problems of energy systems. This paper can only marginally help in that respect. But it is hoped that it will help understand the scope of the

  6. TUBO system

    International Nuclear Information System (INIS)

    Barbosa, H.J.C.; Guerreiro, J.N.C.; Toledo, E.M.

    1980-01-01

    Proceedings recently incorporated to TUBO system like the seismic analysis and the stress verification acccording to ASME-Boiler Rule and Pressure Vessel Code-section III are presented. The seismic analysis comprehend the consideration of uniform motion of the support, its multiple excitation, and the attainment of the spectral response for both cases. The module for stress verification uses stresses resulting fromthe combination of the loads specified by the user, in the automatic verification of permissible stresses for the pipings class 1 and 2, based on criteria NB-3650 and NC-3650 of ASME. The implementation of these proceedings in the TUBO system are discussed and a numerical example that covers the different phases of a stress analysis in a piping is presented [pt

  7. Solar Systems

    Science.gov (United States)

    1979-01-01

    The solar collectors shown are elements of domestic solar hot water systems produced by Solar One Ltd., Virginia Beach, Virginia. Design of these systems benefited from technical expertise provided Solar One by NASA's Langley Research Center. The company obtained a NASA technical support package describing the d e sign and operation of solar heating equipment in NASA's Tech House, a demonstration project in which aerospace and commercial building technology are combined in an energy- efficient home. Solar One received further assistance through personal contact with Langley solar experts. The company reports that the technical information provided by NASA influenced Solar One's panel design, its selection of a long-life panel coating which increases solar collection efficiency, and the method adopted for protecting solar collectors from freezing conditions.

  8. Bilateral system. The ABACC system

    International Nuclear Information System (INIS)

    Nicolas, Ruben O.

    2001-01-01

    After relating the antecedents of the creation of the Brazilian-Argentine Agency for the Accounting and Control of Nuclear Materials (ABACC), the paper describes the common system of accounting and control set up by Argentina and Brazil. The organization of ABACC is also outlined

  9. Physical system requirements: Overall system

    International Nuclear Information System (INIS)

    1992-01-01

    The Nuclear Waste Policy Act (NWPA) of 1982 assigned to the Department of Energy (DOE) the responsibility for managing the disposal of spent nuclear fuel and high-level radioactive waste and established the Office of Civilian Radioactive Waste Management (OCRWM) for that purpose. The Secretary of Energy, in his November 1989 report to Congress (DOE/RW-0247), announced three new initiatives for conduct of the Civilian Radioactive Waste Management (CRWM) program. One of these initiatives was to establish improved management structure and procedures. In response, OCRWM performed a management study and the Direct subsequently issued the Management Systems Improvement Strategy (MSIS) on August 10, 1990, calling for a rigorous implementation of systems engineering principles with a special emphasis on functional analysis. This approach establishes a framework for integrating the program management efforts with the technical requirements analysis into a single, unified, and consistent program. The functional analysis approach recognizes that just the facilities and equipment comprising the physical waste management system must perform certain functions, so must certain programmatic and management functions be performed within the program in order to successfully bring the physical system into being

  10. Security system

    Science.gov (United States)

    Baumann, Mark J.; Kuca, Michal; Aragon, Mona L.

    2016-02-02

    A security system includes a structure having a structural surface. The structure is sized to contain an asset therein and configured to provide a forceful breaching delay. The structure has an opening formed therein to permit predetermined access to the asset contained within the structure. The structure includes intrusion detection features within or associated with the structure that are activated in response to at least a partial breach of the structure.

  11. Cardiovascular system

    International Nuclear Information System (INIS)

    Soulen, R.L.; Grosh, J.

    1984-01-01

    Invasive cardiovascular diagnostic procedures involve a finite risk and therefore can be recommended only when the benefit appears to exceed the risk by a substantial margin. The risk/benefit ratio varies not only with the procedure concerned but with the status of the vascular system, concomitant diseases, and the risks of both the suspected illness and its treatment. The risks inherent in the procedures per se are detailed in the sections to follow

  12. Priority Systems

    OpenAIRE

    Gössler , Gregor; Sifakis , Joseph

    2004-01-01

    Projet POP_ART; We present a framework for the incremental construction of deadlock-free systems meeting given safety properties. The framework borrows concepts and basic results from the controller synthesis paradigm by considering a step in the construction process as a controller synthesis problem. We show that priorities are expressive enough to represent restrictions induced by deadlock-free controllers preserving safety properties. We define a correspondence between such restrictions an...

  13. Imaging system

    International Nuclear Information System (INIS)

    Rushbrooke, J.G.; Ansorge, R.E.

    1987-01-01

    A moving object such as a container on a conveyor belt is imaged by an optical system onto a charge coupled device array in which the lines of the array are arranged perpendicular to the direction of motion of the object. The speed of movement of the object is sensed to generate electrical signals which are processed to provide shift signals enabling the shifting of data row to row in the array in synchronism with the movement of the container. The electrical charge associated with a given point on the array is transferred from one line to the other until it appears at the last line of the array, from which it is read out in known manner in conjunction with all other electrical charges associated with the row of charge coupled devices in the last line of the array. Due to the integrating effect achieved, the aperture of the imaging system can be much smaller than otherwise would be required, and/or the level of light illumination can be reduced. The imaging system can be applied to X-ray inspection devices, aerial surveillance or scanning of moving documents in copying processes. (author)

  14. Braking system

    Science.gov (United States)

    Norgren, D.U.

    1982-09-23

    A balanced braking system comprising a plurality of braking assemblies located about a member to be braked. Each of the braking assemblies consists of a spring biased piston of a first material fitted into a body of a different material which has a greater contraction upon cooling than the piston material. The piston is provided with a recessed head portion over which is positioned a diaphragm and forming a space therebetween to which is connected a pressurized fluid supply. The diaphragm is controlled by the fluid in the space to contact or withdraw from the member to be braked. A cooling means causes the body within which the piston is fitted to contract more than the piston, producing a tight shrink fit therebetween. The braking system is particularly applicable for selectively braking an arbor of an electron microscope which immobilizes, for example, a vertically adjustable low temperature specimen holder during observation. The system provides balanced braking forces which can be easily removed and re-established with minimal disturbance to arbor location.

  15. Protecting information in systems of systems

    NARCIS (Netherlands)

    Trivellato, D.

    2012-01-01

    Systems of systems are coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. The component systems of a system of systems often belong to different security domains, which are governed by different authorities (hereafter called parties). Furthermore, systems

  16. Transportability

    Science.gov (United States)

    2013-04-25

    and dump trucks are exceptions and may be tested at a curb weight or weight less than the gross weight. Consult with SDDCTEA for these types of...will be provided by a hydraulic actuator system. Accomplish the provision loading for the durations specified in MIL-STD-209K. Measure the loads...to flight testing. (b) Once rigged, attach the sling set apex to the cargo hook of a mobile or overhead crane and hoist the item from the ground

  17. CSIR in aerospace: An engine for future industrial growth

    CSIR Research Space (South Africa)

    Naidoo, Kavendra

    2017-10-01

    Full Text Available for industry impact 3 A brief summary of previous and current activities in SA aerospace Argos-II Airborne Observation System SumbandilaSat Satellite 4 RAVIN Light Aircraft JS1 Championship Glider Sling Light Sport Aircraft AIRBUS SUPPLIER... BOEING SUPPLIER SAAB Light Fighter Aircraft Airbus Military Transport Agusta Military Helicopter A brief summary of previous and current activities in SA aerospace A-Darter Short Range Air to Air Missile 5 Test flight centre Alkantpan...

  18. 10th international conference on ground control in mining - proceedings

    International Nuclear Information System (INIS)

    Peng, S.S.

    1991-01-01

    36 papers are presented covering topics that include longwall pillar design, assessment of underground structural design, load and convergence measurements in longwall faces, shield strata interaction, longwall shield recovery, roof control in longwall mining, anchor resin system, thrust bolting, roof bolts, cable slings, roof support in retreat mining, coal bump prediction, delineation of abandoned workings, stability of coal mine openings, mining under rivers, rock strength determination, subsidence prediction and measurement, drag picks, measuring roof convergence, and finite element modelling of subsidence

  19. Dynamical systems

    CERN Document Server

    Birkhoff, George D

    1927-01-01

    His research in dynamics constitutes the middle period of Birkhoff's scientific career, that of maturity and greatest power. -Yearbook of the American Philosophical Society The author's great book€¦is well known to all, and the diverse active modern developments in mathematics which have been inspired by this volume bear the most eloquent testimony to its quality and influence. -Zentralblatt MATH In 1927, G. D. Birkhoff wrote a remarkable treatise on the theory of dynamical systems that would inspire many later mathematicians to do great work. To a large extent, Birkhoff was writing about his o

  20. Nuclear systems

    CERN Document Server

    Todreas, Neil E

    2011-01-01

    Principal Characteristics of Power ReactorsIntroductionPower CyclesPrimary Coolant SystemsReactor CoresFuel AssembliesAdvanced Water- and Gas-Cooled Reactors (Generation III And III+)Advanced Thermal and Fast Neutron Spectrum Reactors (Generation IV)ReferencesProblemsThermal Design Principles and ApplicationIntroductionOverall Plant Characteristics Influenced by Thermal Hydraulic ConsiderationsEnergy Production and Transfer ParametersThermal Design LimitsThermal Design MarginFigures of Merit for Core Thermal PerformanceThe Inverted Fuel ArrayThe Equivalent Annulus ApproximationReferencesProble

  1. Videobasierte Systeme

    Science.gov (United States)

    Knoll, Peter

    Videosensoren spielen für Fahrerassistenz systeme eine zentrale Rolle, da sie die Interpretation visueller Informationen (Objektklassifikation) gezielt unterstützen. Im Heckbereich kann die Video sensorik in der einfachsten Variante die ultraschallbasierte Einparkhilfe bei Einpark- und Rangiervorgängen unterstützen. Beim Nachtsichtsystem NightVision wird das mit Infrarotlicht angestrahlte Umfeld vor dem Fahrzeug mit einer Frontkamera aufgenommen und im Fahrzeugcockpit auf einem Display dem Fahrer angezeigt (s. Nachtsichtsysteme). Andere Fahrerassistenzsysteme verarbeiten die Videosignale und generieren daraus gezielt Informationen, die für eigenständige Funktionen (z. B. Spurverlassenswarner) oder aber als Zusatzinformation für andere Funktionen ausgewertet werden (Sensordatenfusion).

  2. Relaxation System

    Science.gov (United States)

    1987-01-01

    Environ Corporation's relaxation system is built around a body lounge, a kind of super easy chair that incorporates sensory devices. Computer controlled enclosure provides filtered ionized air to create a feeling of invigoration, enhanced by mood changing aromas. Occupant is also surrounded by multidimensional audio and the lighting is programmed to change colors, patterns, and intensity periodically. These and other sensory stimulators are designed to provide an environment in which the learning process is stimulated, because research has proven that while an individual is in a deep state of relaxation, the mind is more receptive to new information.

  3. Bearing system

    Science.gov (United States)

    Kapich, Davorin D.

    1987-01-01

    A bearing system includes backup bearings for supporting a rotating shaft upon failure of primary bearings. In the preferred embodiment, the backup bearings are rolling element bearings having their rolling elements disposed out of contact with their associated respective inner races during normal functioning of the primary bearings. Displacement detection sensors are provided for detecting displacement of the shaft upon failure of the primary bearings. Upon detection of the failure of the primary bearings, the rolling elements and inner races of the backup bearings are brought into mutual contact by axial displacement of the shaft.

  4. Propulsion Systems

    Science.gov (United States)

    2011-03-31

    stand.    CV CS x dAvvdVov dt d F   (18-1) Where  denotes density and vx is the velocity in the x-direction. The first term on the...by  but to avoid confusion with  from Eqs. 18-7 to 10, it is denoted k in this formula . Ru is the universal gas constant (8.314472 J/mol K), pe is...Russian Federation Used on Phobos spacecraft as main engines 74 1.03 NTO/ UDMH 13.73-19.61 316-325 Orbital Maneuvering System 1 Aerojet Shuttle

  5. Expert Systems: What Is an Expert System?

    Science.gov (United States)

    Duval, Beverly K.; Main, Linda

    1994-01-01

    Describes expert systems and discusses their use in libraries. Highlights include parts of an expert system; expert system shells; an example of how to build an expert system; a bibliography of 34 sources of information on expert systems in libraries; and a list of 10 expert system shells used in libraries. (Contains five references.) (LRW)

  6. System analysis and design

    International Nuclear Information System (INIS)

    Son, Seung Hui

    2004-02-01

    This book deals with information technology and business process, information system architecture, methods of system development, plan on system development like problem analysis and feasibility analysis, cases for system development, comprehension of analysis of users demands, analysis of users demands using traditional analysis, users demands analysis using integrated information system architecture, system design using integrated information system architecture, system implementation, and system maintenance.

  7. Posting system

    International Nuclear Information System (INIS)

    Hackney, S.

    1983-01-01

    A system for posting hazardous materials into and out of an enclosure, such as a glovebox, through a port in a wall of the enclosure. The port is normally closed by a door which cooperates with a removable end closure, on a container or the like when the latter is presented to and secured at the port. The container is secured in position at the port by means of a rotatable coupling ring. A single interlock ensures that the door cannot be opened in the absence of a container at the port and also that the container cannot be removed from the port when the door is open. In place of the container, a glove secured to a rigid sleeve may be used to enable the operator to perform a work function within the glovebox. (author)

  8. hydrothermal systems

    Directory of Open Access Journals (Sweden)

    L. Bayón

    2002-01-01

    Full Text Available In this paper, we revise the classical formulation of the problem depriving it of the concepts that are superfluous from the mathematical point of view. We observe that a number of power stations can be substituted by a single one that behaves equivalently to the entire set. Proceeding in this way, we obtain a variational formulation in its purest sense (without restrictions. This formulation allows us to employ the theory of calculus of variations to the highest degree. We then calculate the equivalent minimizer in the case where the cost functions are second-order polynomials. We prove that the equivalent minimizer is a second-order polynomial with piece-wise constant coefficients. Moreover, it belongs to the class C1. Finally, we present various examples prompted by real systems and perform the proposed algorithms using Mathematica.

  9. Nonlinear systems

    CERN Document Server

    Palmero, Faustino; Lemos, M; Sánchez-Rey, Bernardo; Casado-Pascual, Jesús

    2018-01-01

    This book presents an overview of the most recent advances in nonlinear science. It provides a unified view of nonlinear properties in many different systems and highlights many  new developments. While volume 1 concentrates on mathematical theory and computational techniques and challenges, which are essential for the study of nonlinear science, this second volume deals with nonlinear excitations in several fields. These excitations can be localized and transport energy and matter in the form of breathers, solitons, kinks or quodons with very different characteristics, which are discussed in the book. They can also transport electric charge, in which case they are known as polarobreathers or solectrons. Nonlinear excitations can influence function and structure in biology, as for example, protein folding. In crystals and other condensed matter, they can modify transport properties, reaction kinetics and interact with defects. There are also engineering applications in electric lattices, Josephson junction a...

  10. Posting system

    International Nuclear Information System (INIS)

    Jones, E.L.

    1983-01-01

    A posting system for the movement of equipment, such as a manipulator, into and out of an enclosure e.g. a cell or glovebox, for toxic or radioactive materials has the manipulator arranged within a collapsible bellows-like container with an end of the container cooperating with a port entry to the enclosure. The collapsible container isolates the manipulator from the environment outside the enclosure and allows the manipulator to enter and leave the contaminated enclosure without breach of the containment. A particular construction of cell for use with radioactive material is described, having a thick wall of shielding material such as concrete provided with a door normally closed by a Pb shutter and having a cylindrical gamma shield block located over the shutter on the exterior of the wall. (author)

  11. Systems engineering simplified

    CERN Document Server

    Cloutier, Robert; Bone, Mary Alice

    2015-01-01

    IntroductionOverviewDiscussion of Common TerminologyThe Case for Systems EngineeringA Brief History of Systems EngineeringSystem ExamplesSummaryThe System Life CycleManaging System Development-The Vee ModelSystem ProductionSystem Utilization and SupportSystem Retirement and DisposalOther Systems Engineering Development ModelsSpiral ModelAgile Model for Systems EngineeringSystem of InterestAbstraction and DecompositionIntegrationDeveloping and Managing RequirementsCyclone Requiremen

  12. NJOY system

    International Nuclear Information System (INIS)

    Gil, Choong Sup; Kim, Jung Do

    1998-01-01

    The NJOY Nuclear Data Processing System is used to convert evaluated nuclear data in ENDF format into forms useful for applications. The NJOY code is a modular computer code designed to read evaluated data in ENDF format, transform the data in various ways, and output the results as libraries designed to be used in various applications. The modules are essentially independent programs, and they communicate with each other using input and output files, plus a very few common variables. The NJOY code can work with neutrons, photons, and charged particles. The evaluated nuclear data are reconstructed to pointwise cross sections from ENDF resonance parameters and interpolation schemes. The pointwise data can be Doppler broadened to the temperatures requested by users. The data in unresolved energy range can be computed to effective self-shielded pointwise cross sections. The cross sections and scattering matrices for free or bound scatterers in the thermal energy range are able to be produced. The self-shielded multigroup cross sections, group-to-group scattering matrices, photon-production matrices, and charged-particle cross sections from pointwise data can be generated for various application codes

  13. Chem systems

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports that world styrene demand, paced by a near doubling of combined requirements in East Asia and Oceania, could reach 19.3 million metric tons by 2000, an average growth rate of 3.7%/year. So concludes Chem Systems Inc., Tarrytown, N.Y., in a study of world styrene markets through the end of the century. Pacific Rim styrene production and consumption throughout the 1990s are predicted to make up increasingly larger shares of world markets, while demand and production lag in the U.S. and western Europe. Demand and capacity in other parts of the world will grow in real terms, increasing combined market shares only slightly. Most of the increase will be driven by demand in East Asia and Oceania, where consumption by century's end is expected to increase 4.48 million metric tons from 2.25 million tons in 1991. Meantime, Japan's styrene demand in 2000 is projected at 2.64 million tons, a 500,000 ton increase from 1991 demand but a net market loss of 1.9%

  14. System safety education focused on system management

    Science.gov (United States)

    Grose, V. L.

    1971-01-01

    System safety is defined and characteristics of the system are outlined. Some of the principle characteristics include role of humans in hazard analysis, clear language for input and output, system interdependence, self containment, and parallel analysis of elements.

  15. Systems Biology and Health Systems Complexity in;

    NARCIS (Netherlands)

    Donald Combs, C.; Barham, S.R.; Sloot, P.M.A.

    2016-01-01

    Systems biology addresses interactions in biological systems at different scales of biological organization, from the molecular to the cellular, organ, organism, societal, and ecosystem levels. This chapter expands on the concept of systems biology, explores its implications for individual patients

  16. Airport Information Retrieval System (AIRS) System Design

    Science.gov (United States)

    1974-07-01

    This report presents the system design for a prototype air traffic flow control automation system developed for the FAA's Systems Command Center. The design was directed toward the immediate automation of airport data for use in traffic load predicti...

  17. Recent technological advancements in laparoscopic surgical instruments

    Science.gov (United States)

    Subido, Edwin D. C.; Pacis, Danica Mitch M.; Bugtai, Nilo T.

    2018-02-01

    Laparoscopy was a progressive step to advancing surgical procedures as it minimised the scars left on the body after surgery, compared to traditional open surgery. Many years later, single-incision laparoscopic surgery (SILS) was created where, instead of having multiple incisions, only one incision is made or multiple small incisions in one location. SILS, or laparoendoscopic single-site surgery (LESS), may produce lesser scars but drawbacks for the surgeons are still present. This paper aims to present related literature of the recent technological developments in laparoscopic tools and procedure particularly in the vision system, handheld instruments. Tech advances in LESS will also be shown. Furthermore, this review intends to give an update on what has been going on in the surgical robot market and state which companies are interested and are developing robotic systems for commercial use to challenge Intuitive Surgical's da Vinci Surgical System that currently dominates the market.

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

    Science.gov (United States)

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

    2016-06-01

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

  19. System specifications for the NDS Dictionary System

    International Nuclear Information System (INIS)

    Attree, P.M.; Smith, P.M.

    1979-09-01

    The NDS Dictionary System is a computerized system for maintaining and distributing the EXFOR dictionaries and for preparing internal versions of these dictionaries for use in the NDS EXFOR System and other NDS systems. This document is an internal manual for the system specifications of the NDS Dictionary System. It includes flow charts, system and program summaries, input and output specifications and file and record descriptions. This manual is updated from time to time when system modifications are made; this is the version of January 1979

  20. Safety requirements and feedback of commonly used material handling equipment

    International Nuclear Information System (INIS)

    Pathak, M.K.

    2009-01-01

    Different types of cranes, hoists, chain pulley blocks are the most commonly used material handling equipment in industry along with attachments like chains, wire rope slings, d-shackles, etc. These equipment are used at work for transferring loads from one place to another and attachments are used for anchoring, fixing or supporting the load. Selection of the correct equipment, identification of the equipment planning of material handling operation, examination/testing of the equipment, education and training of the persons engaged in operation of the material handling equipment can reduce the risks to safety of people in workplace. Different safety systems like boom angle indicator, overload tripping device, limit switches, etc. should be available in the cranes for their safe use. Safety requirement for safe operation of material handling equipment with emphasis on different cranes and attachments particularly wire rope slings and chain slings have been brought out in this paper. An attempt has also been made to bring out common nature of deficiencies observed during regulatory inspection carried out by AERB. (author)

  1. Quality management system

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Mu Sung

    2009-08-15

    This book deals with ISO9001 quality management system which includes summary of this system such as classification of quality, principle of quality management, and definition, requirement and procedure of quality management system, introduction of ISO9001 system like model of ISO9001 quality management system, ISO certificate system, structure of ISO9001 standard, requirement of ISO9001 quality management system, process approach and documentation of system, propel cases of ISO9001 quality management system.

  2. Quality management system

    International Nuclear Information System (INIS)

    Lee, Mu Sung

    2009-08-01

    This book deals with ISO9001 quality management system which includes summary of this system such as classification of quality, principle of quality management, and definition, requirement and procedure of quality management system, introduction of ISO9001 system like model of ISO9001 quality management system, ISO certificate system, structure of ISO9001 standard, requirement of ISO9001 quality management system, process approach and documentation of system, propel cases of ISO9001 quality management system.

  3. Protecting Information in Systems of Systems

    NARCIS (Netherlands)

    Trivellato, Daniel; Zannone, Nicola; Etalle, Sandro

    2011-01-01

    Systems of Systems (SoS) are dynamic, distributed coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, the SoS paradigm has a strong impact on system interoperability and on the

  4. A security framework for systems of systems

    NARCIS (Netherlands)

    Trivellato, D.; Zannone, N.; Etalle, S.

    2011-01-01

    Systems of systems consist of a wide variety of dynamic, distributed coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, this new paradigm has a strong impact on system

  5. A Security Framework for Systems of Systems

    NARCIS (Netherlands)

    Trivellato, Daniel; Zannone, Nicola; Etalle, Sandro

    2011-01-01

    Systems of systems consist of a wide variety of dynamic, distributed coalitions of autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, this new paradigm has a strong impact on system

  6. Systems theory of interconnected port contact systems

    NARCIS (Netherlands)

    Eberard, D.; Maschke, B.M.; Schaft, A.J. van der

    2005-01-01

    Port-based network modeling of a large class of complex physical systems leads to dynamical systems known as port-Hamiltonian systems. The key ingredient of any port-Hamiltonian system is a power-conserving interconnection structure (mathematically formalized by the geometric notion of a Dirac

  7. Digital processing data communication systems (bus systems)

    International Nuclear Information System (INIS)

    Fleck, K.

    1980-01-01

    After an introduction to the technology of digital processing data communication systems there are the following chapters: digital communication of processing data in automation technology, the technology of biserial communication, the implementaiton of a bus system, the data transmission of the TDC-2000 system of Honeywell's and the process bus CS 275 in the automation system TELEPERM M of Siemens AG. (WB) [de

  8. Networked control of microgrid system of systems

    Science.gov (United States)

    Mahmoud, Magdi S.; Rahman, Mohamed Saif Ur; AL-Sunni, Fouad M.

    2016-08-01

    The microgrid has made its mark in distributed generation and has attracted widespread research. However, microgrid is a complex system which needs to be viewed from an intelligent system of systems perspective. In this paper, a network control system of systems is designed for the islanded microgrid system consisting of three distributed generation units as three subsystems supplying a load. The controller stabilises the microgrid system in the presence of communication infractions such as packet dropouts and delays. Simulation results are included to elucidate the effectiveness of the proposed control strategy.

  9. D0 Cryo System Control System Autodialer

    Energy Technology Data Exchange (ETDEWEB)

    Urbin, J.; /Fermilab

    1990-04-17

    The DO cryogenic system is controlled by a TI565-PLC based control system. This allows the system to be unmanned when in steady state operation. System experts will need to be contacted when system parameters exceed normal operating points and reach alarm setpoints. The labwide FIRUS system provides one alarm monitor and communication link. An autodialer provides a second and more flexible alarm monitor and communication link. The autodialer monitors contact points in the control system and after receiving indication of an alarm accesses a list of experts which it calls until it receives an acknowledgement. There are several manufacturers and distributors of autodialer systems. This EN explains the search process the DO cryo group used to fmd an autodialer system that fit the cryo system's needs and includes information and specs for the unit we chose.

  10. Superspeed Maglev system Transrapid. System decription

    Energy Technology Data Exchange (ETDEWEB)

    Miller, L [Thyssen Henschel AG,, Maglev Transportation Technology, Muenchen (Germany)

    1996-12-31

    The superspeed maglev system Transrapid is a track-bound transportation system for passengern and priority freight transport. The transrapid trainsets are composed of self-sufficient vehicle section coupled together. The superspeed maglev system Transrapid is capable of revenue operation at speeds of 100 to 500 km/h. Besides the description of the system concept and system characteristics safety and availability are discussed. (HW)

  11. System design specification Brayton Isotope Power System (BIPS) Flight System (FS), and Ground Demonstration System (GDS)

    International Nuclear Information System (INIS)

    1976-01-01

    The system design specification for ground demonstration, development, and flight qualification of a Brayton Isotope Power System (BIPS) is presented. The requirements for both a BIPS conceptual Flight System (FS) and a Ground Demonstration System (GDS) are defined

  12. The Sit & Stand chair. A revolutionary advance in adaptive seating systems.

    Science.gov (United States)

    Galumbeck, Michael H; Buschbacher, Ralph M; Wilder, Robert P; Winters, Kathryne L; Hudson, Mary Anne; Edlich, Richard F

    2004-01-01

    A major factor governing independence for the elderly and persons with disabilities is the ability to stand from a chair. Factors such as pain, reduced joint range of motion, stiffness, and muscle weakness frequently limit the ability to stand. Sit-to-stand position is even further reduced in patients whose hands and shoulders are afflicted with rheumatoid arthritis. When achieving a sit-to-stand position in the elderly and persons with disabilities, there is considerable risk of the individual falling and sustaining bone fracture. The purposes of this scientific report are to achieve the following goals: (1) to provide a narrative discussion of the senior author's contributions to furniture manufacturing as well as his successful patent application for the SIT & STAND chair, (2) to describe the steps involved in the development of the SIT & STAND prototype, and (3) to examine the performance of the SIT & STAND chair in assisting the elderly or persons with disabilities in achieving a sit-to-stand position. The invention of the SIT & STAND chair by the senior author, Michael Galumbeck, was a culmination of his lifelong interest in adaptive seating systems. His electrically operated chair has the unique ability to assist the occupant to achieve safely a sit-to-stand position. The rear portion of his chair remains in a fixed position to support the buttocks of the user during mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned in a more posterior position firmly on the floor. Using its actuator, the height that the chair rises will vary with the length of the legs of the occupant. Using the drawing program Solid Works (Solid Works, Concord, Massachusetts), drawings of the chair were made. To visualize the operation and performance of the chair, separate drawings were made in the lateral position. The prototype of the SIT & STAND chair was manufactured with an electric actuator that

  13. Situation awareness with systems of systems

    CERN Document Server

    Tretmans, Jan; Borth, Michael

    2013-01-01

    This book discusses various aspects, challenges, and solutions for developing systems-of-systems for situation awareness, using applications in the domain of maritime safety and security.  Topics include advanced, multi-objective visualization methods for situation awareness, stochastic outlier selection, rule-based anomaly detection, an ontology-based event model for semantic reasoning, new methods for semi-automatic generation of adapters bridging communication gaps, security policies for systems-of-systems, trust assessment, and methods to deal with the dynamics of systems-of-systems in run-time monitoring, testing, and diagnosis. Architectural considerations for designing information-centric systems-of-systems such as situation awareness systems, and an integrated demonstrator implementing many of the investigated aspects, complete the book.

  14. System specifications for the NDS EXFOR System

    International Nuclear Information System (INIS)

    Attree, P.M.; Smith, P.M.

    1979-07-01

    EXFOR is the agreed exchange format for the magnetic-tape exchange of nuclear reaction data between national and international nuclear data centres for the benefit of nuclear data users in all countries. The NDS EXFOR System is a computerized system for the storage and retrieval of EXFOR information compiled or received by the IAEA. This document is an internal manual for the system specifications of the NDS EXFOR System. It includes flow charts, system and program summaries, input and output specifications and file and record descriptions. The manual is updated from time to time when system modifications are made

  15. System specifications for the NDS EXFOR System

    Energy Technology Data Exchange (ETDEWEB)

    Attree, P M; Smith, P M

    1982-06-01

    EXFOR is the agreed exchange format for the magnetic-tape exchange of nuclear reaction data between national and international nuclear data centers for the benefit of nuclear data users in all countries. The NDS EXFOR System is a computerized system for the storage and retrieval of EXFOR information compiled or received of the IAEA. This document is an internal manual for the system specifications of the NDS EXFOR System. It includes flow charts, system and program summaries, input and output specifications and file and record descriptions. The manual is updated from time to time when system modifications are made; the first version was issued in July 1979. (author)

  16. Computer System Design System-on-Chip

    CERN Document Server

    Flynn, Michael J

    2011-01-01

    The next generation of computer system designers will be less concerned about details of processors and memories, and more concerned about the elements of a system tailored to particular applications. These designers will have a fundamental knowledge of processors and other elements in the system, but the success of their design will depend on the skills in making system-level tradeoffs that optimize the cost, performance and other attributes to meet application requirements. This book provides a new treatment of computer system design, particularly for System-on-Chip (SOC), which addresses th

  17. Medline Plus

    Full Text Available ... Hospital, Norfolk, VA, 3/25/2009) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser ... Hospital, Greenville, SC, 04/10/2013) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser ...

  18. Medline Plus

    Full Text Available ... Springs, Coral Springs, FL, 3/31/2014) Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling ... Springs, Coral Springs, FL, 3/31/2014) Erectile Dysfunction Simultaneous Inflatable Penile Prosthesis (IPP) and Male Sling ...

  19. Smart electromechanical systems the central nervous system

    CERN Document Server

    Kurbanov, Vugar

    2017-01-01

    This book describes approaches to solving the problems of developing the central nervous system of robots (CNSR) based on smart electromechanical systems (SEMS) modules, principles of construction of the various modules of the central nervous system and variants of mathematical software CNSR in control systems for intelligent robots. It presents the latest advances in theory and practice at the Russian Academy of Sciences. Developers of intelligent robots to solve modern problems in robotics are increasingly addressing the use of the bionic approach to create robots that mimic the complexity and adaptability of biological systems. These have smart electromechanical system (SEMS), which are used in various cyber-physical systems (CPhS), and allow the functions of calculation, control, communications, information storage, monitoring, measurement and control of parameters and environmental parameters to be integrated. The behavior of such systems is based on the information received from the central nervous syst...

  20. Multiobjective Collaborative Optimization of Systems of Systems

    National Research Council Canada - National Science Library

    Wolf, Robert A

    2005-01-01

    ...; in other words an inefficient design of the system of systems. This thesis examines the simultaneous design of several ships using the sea base concept as an example application of a network of ships working together...

  1. Situation Awareness with Systems of Systems

    NARCIS (Netherlands)

    Laar, P. van de; Tretmans, J.; Borth, M.

    2013-01-01

    This book discusses various aspects, challenges, and solutions for developing systems-of-systems for situation awareness, using applications in the domain of maritime safety and security. Topics include advanced, multi-objective visualization methods for situation awareness, stochastic outlier

  2. Linking Political Systems and War Systems

    DEFF Research Database (Denmark)

    Harste, Gorm

    2009-01-01

    Decisive parts of the Western political system have demonstrated a seemingly surprising misinterpretation of military might. As Madelaine Albright has suggested, the mighty perceived themselves as "almighty". Political power seems to have invested in instrumental coercive power relations and found...... military coercion to be the appropriate mean. Using the system theory and the theory of systemic risks displayed by the German sociologist Niklas Luhmann the article demonstrates how military systems due to their own autonomy and autopoiesis do not fit into the idea of political government....... The Clausewitzian ideal of a political system that could continue its power games by means of war was moderated by Clausewitz' own analysis of "friction". How can a political system be so blind towards the possibilities of another system? What are the risks of systemic blind spots? The argument of the paper...

  3. Designing information systems

    CERN Document Server

    Blethyn, Stanley G

    2014-01-01

    Designing Information Systems focuses on the processes, methodologies, and approaches involved in designing information systems. The book first describes systems, management and control, and how to design information systems. Discussions focus on documents produced from the functional construction function, users, operators, analysts, programmers and others, process management and control, levels of management, open systems, design of management information systems, and business system description, partitioning, and leveling. The text then takes a look at functional specification and functiona

  4. Cognitive Medical Multiagent Systems

    OpenAIRE

    Barna Iantovics

    2010-01-01

    The development of efficient and flexible agent-based medical diagnosis systems represents a recent research direction. Medical multiagent systems may improve the efficiency of traditionally developed medical computational systems, like the medical expert systems. In our previous researches, a novel cooperative medical diagnosis multiagent system called CMDS (Contract Net Based Medical Diagnosis System) was proposed. CMDS system can solve flexibly a large variety of medical diagnosis problems...

  5. Non linear system become linear system

    Directory of Open Access Journals (Sweden)

    Petre Bucur

    2007-01-01

    Full Text Available The present paper refers to the theory and the practice of the systems regarding non-linear systems and their applications. We aimed the integration of these systems to elaborate their response as well as to highlight some outstanding features.

  6. System Design of the SWRL Financial System.

    Science.gov (United States)

    Ikeda, Masumi

    To produce various management and accounting reports in order to maintain control of SWRL (Southwest Regional Laboratory) operational and financial activities, a computer-based SWRL financial system was developed. The system design is outlined, and various types of system inputs described. The kinds of management and accounting reports generated…

  7. Triggering system innovation in agricultural innovation systems

    NARCIS (Netherlands)

    Turner, James A.; Williams, Tracy; Nicholas, Graeme; Foote, Jeff; Rijswijk, Kelly; Barnard, Tim; Beechener, Sam; Horita, Akiko

    2017-01-01

    This article describes a process for stimulating engagement among change agents to develop a shared understanding of systemic problems in the agricultural innovation system (AIS), challenge prevalent institutional logics and identify actions they might undertake to stimulate system innovation.

  8. Port contact systems for irreversible thermodynamical systems

    NARCIS (Netherlands)

    Eberard, D.; Maschke, B.M.; Schaft, A.J. van der

    2005-01-01

    In this paper we propose a definition of control contact systems, generalizing input-output Hamiltonian systems, to cope with models arising from irreversible Thermodynamics. We exhibit a particular subclass of these systems, called conservative, that leaves invariant some Legendre submanifold (the

  9. Modeling learning technology systems as business systems

    NARCIS (Netherlands)

    Avgeriou, Paris; Retalis, Symeon; Papaspyrou, Nikolaos

    2003-01-01

    The design of Learning Technology Systems, and the Software Systems that support them, is largely conducted on an intuitive, ad hoc basis, thus resulting in inefficient systems that defectively support the learning process. There is now justifiable, increasing effort in formalizing the engineering

  10. General Systems Theory and Instructional Systems Design.

    Science.gov (United States)

    Salisbury, David F.

    1990-01-01

    Describes basic concepts in the field of general systems theory (GST) and identifies commonalities that exist between GST and instructional systems design (ISD). Models and diagrams that depict system elements in ISD are presented, and two matrices that show how GST has been used in ISD literature are included. (11 references) (LRW)

  11. Expert systems in process control systems

    International Nuclear Information System (INIS)

    Wittig, T.

    1987-01-01

    To illustrate where the fundamental difference between expert systems in classical diagnosis and in industrial control lie, the work of process control instrumentation is used as an example for the job of expert systems. Starting from the general process of problem-solving, two classes of expert systems can be defined accordingly. (orig.) [de

  12. Expert Systems for auditing management information systems

    Directory of Open Access Journals (Sweden)

    Gheroghe Popescu

    2007-05-01

    Full Text Available Expert systems are built with the help of: specialised programming languages or expert system generators (shell. But this structure was reached after tens of years of work and research, because expert systems are nothing but pragmatic capitalisation of the results of research carried out in artificial intelligence and theory of knowledge.

  13. Psychology of system design

    CERN Document Server

    Meister, D

    2014-01-01

    This is a book about systems, including: systems in which humans control machines; systems in which humans interact with humans and the machine component is relatively unimportant; systems which are heavily computerized and those that are not; and governmental, industrial, military and social systems. The book deals with both traditional systems like farming, fishing and the military, and with systems just now tentatively emerging, like the expert and the interactive computer system. The emphasis is on the system concept and its implications for analysis, design and evaluation of these many di

  14. Biomedical signals and systems

    CERN Document Server

    Tranquillo, Joseph V

    2013-01-01

    Biomedical Signals and Systems is meant to accompany a one-semester undergraduate signals and systems course. It may also serve as a quick-start for graduate students or faculty interested in how signals and systems techniques can be applied to living systems. The biological nature of the examples allows for systems thinking to be applied to electrical, mechanical, fluid, chemical, thermal and even optical systems. Each chapter focuses on a topic from classic signals and systems theory: System block diagrams, mathematical models, transforms, stability, feedback, system response, control, time

  15. Operating System Security

    CERN Document Server

    Jaeger, Trent

    2008-01-01

    Operating systems provide the fundamental mechanisms for securing computer processing. Since the 1960s, operating systems designers have explored how to build "secure" operating systems - operating systems whose mechanisms protect the system against a motivated adversary. Recently, the importance of ensuring such security has become a mainstream issue for all operating systems. In this book, we examine past research that outlines the requirements for a secure operating system and research that implements example systems that aim for such requirements. For system designs that aimed to

  16. Systems Measures of Water Distribution System Resilience

    Energy Technology Data Exchange (ETDEWEB)

    Klise, Katherine A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Murray, Regan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Walker, La Tonya Nicole [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-01-01

    Resilience is a concept that is being used increasingly to refer to the capacity of infrastructure systems to be prepared for and able to respond effectively and rapidly to hazardous events. In Section 2 of this report, drinking water hazards, resilience literature, and available resilience tools are presented. Broader definitions, attributes and methods for measuring resilience are presented in Section 3. In Section 4, quantitative systems performance measures for water distribution systems are presented. Finally, in Section 5, the performance measures and their relevance to measuring the resilience of water systems to hazards is discussed along with needed improvements to water distribution system modeling tools.

  17. Manager's assistant systems for space system planning

    Science.gov (United States)

    Bewley, William L.; Burnard, Robert; Edwards, Gary E.; Shoop, James

    1992-01-01

    This paper describes a class of knowledge-based 'assistant' systems for space system planning. Derived from technology produced for the DARPA/USAF Pilot's Associate program, these assistant systems help the human planner by doing the bookkeeping to maintain plan data and executing the procedures and heuristics currently used by the human planner to define, assess, diagnose, and revise plans. Intelligent systems for Space Station Freedom assembly sequence planning and Advanced Launch System modeling will be presented as examples. Ongoing NASA-funded work on a framework supporting the development of such tools will also be described.

  18. Lighting system with thermal management system

    Science.gov (United States)

    Arik, Mehmet; Weaver, Stanton; Stecher, Thomas; Seeley, Charles; Kuenzler, Glenn; Wolfe, Jr., Charles; Utturkar, Yogen; Sharma, Rajdeep; Prabhakaran, Satish; Icoz, Tunc

    2013-05-07

    Lighting systems having unique configurations are provided. For instance, the lighting system may include a light source, a thermal management system and driver electronics, each contained within a housing structure. The light source is configured to provide illumination visible through an opening in the housing structure. The thermal management system is configured to provide an air flow, such as a unidirectional air flow, through the housing structure in order to cool the light source. The driver electronics are configured to provide power to each of the light source and the thermal management system.

  19. EPICS based DAQ system

    International Nuclear Information System (INIS)

    Cheng Weixing; Chen Yongzhong; Zhou Weimin; Ye Kairong; Liu Dekang

    2002-01-01

    EPICS is the most popular developing platform to build control system and beam diagnostic system in modern physics experiment facilities. An EPICS based data acquisition system was built in Redhat 6.2 operation system. The system is successfully used in the beam position monitor mapping, it improves the mapping process a lot

  20. Autonomous photovoltaic lighting system

    OpenAIRE

    Hafez, Ahmed A. A.; Montesinos Miracle, Daniel; Sudrià Andreu, Antoni

    2012-01-01

    This paper introduces a comparison between the conventional and Photovoltaic (PV) lighting systems. A simple sizing procedure for a PV stand-alone system was advised. The paper also proposes a novel PV lighting system. The proposed system is simple, compact and reliable. The system operation was investigated by thoroughly mathematical and simulation work.

  1. FFTF control system experience

    International Nuclear Information System (INIS)

    Warrick, R.P.

    1981-01-01

    The FFTF control systems provide control equipment for safe and efficient operation of the plant. For convenience, these systems will be divided into three parts for discussions: (1) Plant Protection System (PPS); (2) Plant Control System (PCS); and (3) General Observations. Performance of each of these systems is discussed

  2. Automatic control systems engineering

    International Nuclear Information System (INIS)

    Shin, Yun Gi

    2004-01-01

    This book gives descriptions of automatic control for electrical electronics, which indicates history of automatic control, Laplace transform, block diagram and signal flow diagram, electrometer, linearization of system, space of situation, state space analysis of electric system, sensor, hydro controlling system, stability, time response of linear dynamic system, conception of root locus, procedure to draw root locus, frequency response, and design of control system.

  3. MEA vacuum system

    International Nuclear Information System (INIS)

    Stroo, R.; Schwebke, H.; Heine, E.

    1984-01-01

    This report describes construction and operation of the MEA vacuum system of NIKHEF (Netherlands). First, the klystron vacuum system, beam transport system, diode pump and a triode pump are described. Next, the isolation valve and the fast valves of the vacuum system are considered. Measuring instruments, vacuum system commands and messages of failures are treated in the last chapter. (G.J.P.)

  4. From systems biology to systems biomedicine.

    Science.gov (United States)

    Antony, Paul M A; Balling, Rudi; Vlassis, Nikos

    2012-08-01

    Systems Biology is about combining theory, technology, and targeted experiments in a way that drives not only data accumulation but knowledge as well. The challenge in Systems Biomedicine is to furthermore translate mechanistic insights in biological systems to clinical application, with the central aim of improving patients' quality of life. The challenge is to find theoretically well-chosen models for the contextually correct and intelligible representation of multi-scale biological systems. In this review, we discuss the current state of Systems Biology, highlight the emergence of Systems Biomedicine, and highlight some of the topics and views that we think are important for the efficient application of Systems Theory in Biomedicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Mapping biological systems to network systems

    CERN Document Server

    Rathore, Heena

    2016-01-01

    The book presents the challenges inherent in the paradigm shift of network systems from static to highly dynamic distributed systems – it proposes solutions that the symbiotic nature of biological systems can provide into altering networking systems to adapt to these changes. The author discuss how biological systems – which have the inherent capabilities of evolving, self-organizing, self-repairing and flourishing with time – are inspiring researchers to take opportunities from the biology domain and map them with the problems faced in network domain. The book revolves around the central idea of bio-inspired systems -- it begins by exploring why biology and computer network research are such a natural match. This is followed by presenting a broad overview of biologically inspired research in network systems -- it is classified by the biological field that inspired each topic and by the area of networking in which that topic lies. Each case elucidates how biological concepts have been most successfully ...

  6. Environmental Management System

    Science.gov (United States)

    Goals Recycling Green Purchasing Pollution Prevention Reusing Water Resources Environmental Management Stewardship » Environmental Protection » Environmental Management System Environmental Management System An Environmental Management System is a systematic method for assessing mission activities, determining the

  7. System floorplanning optimization

    KAUST Repository

    Browning, David W.; Elansary, Ayman; Shalaby, Mohamed

    2012-01-01

    Notebook and Laptop Original Equipment Manufacturers (OEMs) place great emphasis on creating unique system designs to differentiate themselves in the mobile market. These systems are developed from the 'outside in' with the focus on how the system

  8. Connected motorcycle system performance.

    Science.gov (United States)

    2016-01-15

    This project characterized the performance of Connected Vehicle Systems (CVS) on motorcycles based on two key components: global positioning and wireless communication systems. Considering that Global Positioning System (GPS) and 5.9 GHz Dedicated Sh...

  9. Antiskid braking system

    Science.gov (United States)

    Pazdera, J. S.

    1974-01-01

    Published report describes analytical development and simulation of braking system. System prevents wheels from skidding when brakes are applied, significantly reducing stopping distance. Report also presents computer simulation study on system as applied to aircraft.

  10. Bridge Management Systems

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    In this paper bridge management systems are discussed with special emphasis on management systems for reinforced concrete bridges. Management systems for prestressed concrete bridges, steel bridges, or composite bridges can be developed in a similar way....

  11. TWRSview system requirements specification

    International Nuclear Information System (INIS)

    Caldwell, J.A.; Lee, A.K.

    1995-12-01

    This document provides the system requirements specification for the TWRSview software system. The TWRSview software system is being developed to integrate electronic data supporting the development of the TWRS technical baseline

  12. Calo trigger acquisition system

    CERN Multimedia

    Franchini, Matteo

    2016-01-01

    Calo trigger acquisition system - Evolution of the acquisition system from a multiple boards system (upper, orange cables) to a single board one (below, light blue cables) where all the channels are collected in a single board.

  13. Lungs and Respiratory System

    Science.gov (United States)

    ... Videos for Educators Search English Español Lungs and Respiratory System KidsHealth / For Parents / Lungs and Respiratory System ... ll have taken at least 600 million breaths. Respiratory System Basics All of this breathing couldn't ...

  14. The Trinity System

    Energy Technology Data Exchange (ETDEWEB)

    Archer, Billy Joe [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vigil, Benny Manuel [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-01-13

    This paper describes the Trinity system, the first ASC Advanced Technology System (ATS-1). We describe the Trinity procurement timeline, the ASC computing strategy, the Trinity specific mission needs, and the Trinity system specifications.

  15. Pneumatic transfer systems

    International Nuclear Information System (INIS)

    Bichler, H.; Boeck, H.; Hammer, J.; Buchtela, K.

    1988-11-01

    A pneumatic transfer system for research reactors, including a sample changer system and to be used for neutron activation analysis, is described. The system can be obtained commercially from the Atominstitut. 2 figs. (qui)

  16. Immune System Quiz

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Quiz: Immune System KidsHealth / For Kids / Quiz: Immune System Print How much do you know about your immune system? Find out by taking this quiz! About Us ...

  17. System floorplanning optimization

    KAUST Repository

    Browning, David W.; Ansary, Ayman M. El; Shalaby, Mohamed

    2013-01-01

    Notebook and Laptop Original Equipment Manufacturers (OEMs) place great emphasis on creating unique system designs to differentiate themselves in the mobile market. These systems are developed from the 'outside in' with the focus on how the system

  18. Autonomic Nervous System Disorders

    Science.gov (United States)

    Your autonomic nervous system is the part of your nervous system that controls involuntary actions, such as the beating of your heart ... breathing and swallowing Erectile dysfunction in men Autonomic nervous system disorders can occur alone or as the result ...

  19. Central Nervous System Vasculitis

    Science.gov (United States)

    ... of Vasculitis / Central Nervous System (CNS) Vasculitis Central Nervous System (CNS) Vasculitis Swap out your current Facebook Profile ... Facebook personal page. Replace with this image. Central nervous system (CNS) vasculitis is inflammation of blood vessel walls ...

  20. Wind energy systems

    Science.gov (United States)

    Stewart, H. J.

    1978-01-01

    A discussion on wind energy systems involved with the DOE wind energy program is presented. Some of the problems associated with wind energy systems are discussed. The cost, efficiency, and structural design of wind energy systems are analyzed.

  1. System Software 7 Macintosh

    CERN Multimedia

    1991-01-01

    System 7 is a single-user graphical user interface-based operating system for Macintosh computers and was part of the classic Mac OS line of operating systems. It was introduced on May 13, 1991, by Apple Computer. It succeeded System 6, and was the main Macintosh operating system until it was succeeded by Mac OS 8 in 1997. Features added with the System 7 release included virtual memory, personal file sharing, QuickTime, QuickDraw 3D, and an improved user interface. This is the first real major evolution of the Macintosh system, bringing a significant improvement in the user interface, improved stability and many new features such as the ability to use multiple applications at the same time. "System 7" is the last operating system name of the Macintosh that contains the word "system". Macintosh operating systems were later called "Mac OS" (for Macintosh Operating System).

  2. Marketing reporting system

    OpenAIRE

    Hanić Hasan M.

    2004-01-01

    The main components of a developed and good organized marketing information system are: internal reporting system, marketing reporting system, market research system and analytical marketing system. Marketing reporting system provides data and information about changes in business and micro marketing environment. This component of MIS ensures that marketing managers are up-to-date with what is going on, and to be informed about changes in company marketing environment.

  3. Marketing reporting system

    Directory of Open Access Journals (Sweden)

    Hanić Hasan M.

    2004-01-01

    Full Text Available The main components of a developed and good organized marketing information system are: internal reporting system, marketing reporting system, market research system and analytical marketing system. Marketing reporting system provides data and information about changes in business and micro marketing environment. This component of MIS ensures that marketing managers are up-to-date with what is going on, and to be informed about changes in company marketing environment.

  4. Propulsion Systems Panel deliberations

    Science.gov (United States)

    Bianca, Carmelo J.; Miner, Robert; Johnston, Lawrence M.; Bruce, R.; Dennies, Daniel P.; Dickenson, W.; Dreshfield, Robert; Karakulko, Walt; Mcgaw, Mike; Munafo, Paul M.

    1993-01-01

    The Propulsion Systems Panel was established because of the specialized nature of many of the materials and structures technology issues related to propulsion systems. This panel was co-chaired by Carmelo Bianca, MSFC, and Bob Miner, LeRC. Because of the diverse range of missions anticipated for the Space Transportation program, three distinct propulsion system types were identified in the workshop planning process: liquid propulsion systems, solid propulsion systems and nuclear electric/nuclear thermal propulsion systems.

  5. Small test SDHW systems

    DEFF Research Database (Denmark)

    Vejen, Niels Kristian

    1999-01-01

    Three small test SDHW systems was tested in a laboratory test facility.The three SDHW systems where all based on the low flow principe and a mantle tank but the design of the systems where different.......Three small test SDHW systems was tested in a laboratory test facility.The three SDHW systems where all based on the low flow principe and a mantle tank but the design of the systems where different....

  6. Battery systems engineering

    CERN Document Server

    Rahn, Christopher D

    2012-01-01

    A complete all-in-one reference on the important interdisciplinary topic of Battery Systems Engineering Focusing on the interdisciplinary area of battery systems engineering, this book provides the background, models, solution techniques, and systems theory that are necessary for the development of advanced battery management systems. It covers the topic from the perspective of basic electrochemistry as well as systems engineering topics and provides a basis for battery modeling for system engineering of electric and hybrid electric vehicle platforms. This original

  7. Gas transfer system

    International Nuclear Information System (INIS)

    Oberlin, J.C.; Frick, G.; Kempfer, C.; North, C.

    1988-09-01

    The state of work on the Vivitron gas transfer system and the system functions are summarized. The system has to: evacuate the Vivitron reservoir; transfer gas from storage tanks to the Vivitron; recirculate gas during operation; transfer gas from the Vivitron to storage tanks; and assure air input. The system is now being installed. Leak alarms are given by SF6 detectors, which set off a system of forced ventilation. Another system continuously monitors the amount of SF6 in the tanks [fr

  8. Cognitive Medical Multiagent Systems

    Directory of Open Access Journals (Sweden)

    Barna Iantovics

    2010-01-01

    Full Text Available The development of efficient and flexible agent-based medical diagnosis systems represents a recent research direction. Medical multiagent systems may improve the efficiency of traditionally developed medical computational systems, like the medical expert systems. In our previous researches, a novel cooperative medical diagnosis multiagent system called CMDS (Contract Net Based Medical Diagnosis System was proposed. CMDS system can solve flexibly a large variety of medical diagnosis problems. This paper analyses the increased intelligence of the CMDS system, which motivates its use for different medical problem’s solving.

  9. Airports Geographic Information System -

    Data.gov (United States)

    Department of Transportation — The Airports Geographic Information System maintains the airport and aeronautical data required to meet the demands of the Next Generation National Airspace System....

  10. Aeronautical Information System -

    Data.gov (United States)

    Department of Transportation — The Aeronautical Information System (AIS) is a leased weather automated system that provides a means of collecting and distributing aeronautical weather information...

  11. Credit Management System

    Data.gov (United States)

    US Agency for International Development — Credit Management System. Outsourced Internet-based application. CMS stores and processes data related to USAID credit programs. The system provides information...

  12. Control system design method

    Science.gov (United States)

    Wilson, David G [Tijeras, NM; Robinett, III, Rush D.

    2012-02-21

    A control system design method and concomitant control system comprising representing a physical apparatus to be controlled as a Hamiltonian system, determining elements of the Hamiltonian system representation which are power generators, power dissipators, and power storage devices, analyzing stability and performance of the Hamiltonian system based on the results of the determining step and determining necessary and sufficient conditions for stability of the Hamiltonian system, creating a stable control system based on the results of the analyzing step, and employing the resulting control system to control the physical apparatus.

  13. Neural Systems Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — As part of the Electrical and Computer Engineering Department and The Institute for System Research, the Neural Systems Laboratory studies the functionality of the...

  14. Integrated Systems Health Management for Intelligent Systems

    Science.gov (United States)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  15. System Analysis and Risk Assessment (SARA) system

    International Nuclear Information System (INIS)

    Krantz, E.A.; Russell, K.D.; Stewart, H.D.; Van Siclen, V.S.

    1986-01-01

    Utilization of Probabilistic Risk Assessment (PRA) related information in the day-to-day operation of plant systems has, in the past, been impracticable due to the size of the computers needed to run PRA codes. This paper discusses a microcomputer-based database system which can greatly enhance the capability of operators or regulators to incorporate PRA methodologies into their routine decision making. This system is called the System Analysis and Risk Assessment (SARA) system. SARA was developed by EG and G Idaho, Inc. at the Idaho National Engineering Laboratory to facilitate the study of frequency and consequence analyses of accident sequences from a large number of light water reactors (LWRs) in this country. This information is being amassed by several studies sponsored by the United States Nuclear Regulatory Commission (USNRC). To meet the need of portability and accessibility, and to perform the variety of calculations necessary, it was felt that a microcomputer-based system would be most suitable

  16. Systems engineering for very large systems

    Science.gov (United States)

    Lewkowicz, Paul E.

    Very large integrated systems have always posed special problems for engineers. Whether they are power generation systems, computer networks or space vehicles, whenever there are multiple interfaces, complex technologies or just demanding customers, the challenges are unique. 'Systems engineering' has evolved as a discipline in order to meet these challenges by providing a structured, top-down design and development methodology for the engineer. This paper attempts to define the general class of problems requiring the complete systems engineering treatment and to show how systems engineering can be utilized to improve customer satisfaction and profit ability. Specifically, this work will focus on a design methodology for the largest of systems, not necessarily in terms of physical size, but in terms of complexity and interconnectivity.

  17. Epilogue: Systems Approaches and Systems Practice

    Science.gov (United States)

    Reynolds, Martin; Holwell, Sue

    Each of the five systems approaches discussed in this volume: system dynamics (SD), the viable systems model (VSM), strategic options development and analysis (SODA), soft systems methodology (SSM) and critical systems heuristics (CSH) has a pedigree. Not in the sense of the sometimes absurd spectacle of animals paraded at dog shows. Rather, their pedigree derives from their systems foundations, their capacity to evolve and their flexibility in use. None of the five approaches has developed out of use in restricted and controlled contexts of either low or high levels of complicatedness. Neither has any one of them evolved as a consequence of being applied only to situations with either presumed stakeholder agreement on purpose, or courteous disagreement amongst stakeholders, or stakeholder coercion. The compilation is not a celebration of abstract ‘methodologies', but of theoretically robust approaches that have a genuine pedigree in practice.

  18. Systems analysis of a security alarm system

    International Nuclear Information System (INIS)

    Schiff, A.

    1975-01-01

    When the Lawrence Livermore Laboratory found that its security alarm system was causing more false alarms and maintenance costs than LLL felt was tolerable, a systems analysis was undertaken to determine what should be done about the situation. This report contains an analysis of security alarm systems in general and ends with a review of the existing Security Alarm Control Console (SACC) and recommendations for its improvement, growth and change. (U.S.)

  19. Precision digital control systems

    Science.gov (United States)

    Vyskub, V. G.; Rozov, B. S.; Savelev, V. I.

    This book is concerned with the characteristics of digital control systems of great accuracy. A classification of such systems is considered along with aspects of stabilization, programmable control applications, digital tracking systems and servomechanisms, and precision systems for the control of a scanning laser beam. Other topics explored are related to systems of proportional control, linear devices and methods for increasing precision, approaches for further decreasing the response time in the case of high-speed operation, possibilities for the implementation of a logical control law, and methods for the study of precision digital control systems. A description is presented of precision automatic control systems which make use of electronic computers, taking into account the existing possibilities for an employment of computers in automatic control systems, approaches and studies required for including a computer in such control systems, and an analysis of the structure of automatic control systems with computers. Attention is also given to functional blocks in the considered systems.

  20. L-system fractals

    CERN Document Server

    Mishra, Jibitesh

    2007-01-01

    The book covers all the fundamental aspects of generating fractals through L-system. Also it provides insight to various researches in this area for generating fractals through L-system approach & estimating dimensions. Also it discusses various applications of L-system fractals. Key Features: - Fractals generated from L-System including hybrid fractals - Dimension calculation for L-system fractals - Images & codes for L-system fractals - Research directions in the area of L-system fractals - Usage of various freely downloadable tools in this area - Fractals generated from L-System including hybrid fractals- Dimension calculation for L-system fractals- Images & codes for L-system fractals- Research directions in the area of L-system fractals- Usage of various freely downloadable tools in this area

  1. Power system protection 2 systems and methods

    CERN Document Server

    1995-01-01

    The worldwide growth in demand for electricity has forced the pace of developments in electrical power system design to meet consumer needs for reliable, secure and cheap supplies. Power system protection, as a technology essential to high quality supply, is widely recognised as a specialism of growing and often critical importance, in which power system needs and technological progress have combined to result in rapid developments in policy and practice in recent years. In the United Kingdom, the need for appropriate training in power system protection was recognised in the early 1960s with t

  2. Hot Spot Removal System: System description

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-09-01

    Hazardous wastes contaminated with radionuclides, chemicals, and explosives exist across the Department of Energy complex and need to be remediated due to environmental concerns. Currently, an opportunity is being developed to dramatically reduce remediation costs and to assist in the acceleration of schedules associated with these wastes by deploying a Hot Spot Removal System. Removing the hot spot from the waste site will remove risk driver(s) and enable another, more cost effective process/option/remedial alternative (i.e., capping) to be applied to the remainder of the site. The Hot Spot Removal System consists of a suite of technologies that will be utilized to locate and remove source terms. Components of the system can also be used in a variety of other cleanup activities. This Hot Spot Removal System Description document presents technologies that were considered for possible inclusion in the Hot Spot Removal System, technologies made available to the Hot Spot Removal System, industrial interest in the Hot Spot Removal System`s subsystems, the schedule required for the Hot Spot Removal System, the evaluation of the relevant technologies, and the recommendations for equipment and technologies as stated in the Plan section.

  3. Unmanned Aerial System, New System Manning Prediction

    National Research Council Canada - National Science Library

    Hunn, Bruce P

    2006-01-01

    .... System safety and effectiveness, training, contractor operations and working conditions were evaluated for current UASs, including Hunter, Shadow, Predator, Improved Gnat, and to a lesser degree...

  4. Site systems engineering: Systems engineering management plan

    Energy Technology Data Exchange (ETDEWEB)

    Grygiel, M.L. [Westinghouse Hanford Co., Richland, WA (United States)

    1996-05-03

    The Site Systems Engineering Management Plan (SEMP) is the Westinghouse Hanford Company (WHC) implementation document for the Hanford Site Systems Engineering Policy, (RLPD 430.1) and Systems Engineering Criteria Document and Implementing Directive, (RLID 430.1). These documents define the US Department of Energy (DOE), Richland Operations Office (RL) processes and products to be used at Hanford to implement the systems engineering process at the site level. This SEMP describes the products being provided by the site systems engineering activity in fiscal year (FY) 1996 and the associated schedule. It also includes the procedural approach being taken by the site level systems engineering activity in the development of these products and the intended uses for the products in the integrated planning process in response to the DOE policy and implementing directives. The scope of the systems engineering process is to define a set of activities and products to be used at the site level during FY 1996 or until the successful Project Hanford Management Contractor (PHMC) is onsite as a result of contract award from Request For Proposal DE-RP06-96RL13200. Following installation of the new contractor, a long-term set of systems engineering procedures and products will be defined for management of the Hanford Project. The extent to which each project applies the systems engineering process and the specific tools used are determined by the project`s management.

  5. Hot Spot Removal System: System description

    International Nuclear Information System (INIS)

    1997-09-01

    Hazardous wastes contaminated with radionuclides, chemicals, and explosives exist across the Department of Energy complex and need to be remediated due to environmental concerns. Currently, an opportunity is being developed to dramatically reduce remediation costs and to assist in the acceleration of schedules associated with these wastes by deploying a Hot Spot Removal System. Removing the hot spot from the waste site will remove risk driver(s) and enable another, more cost effective process/option/remedial alternative (i.e., capping) to be applied to the remainder of the site. The Hot Spot Removal System consists of a suite of technologies that will be utilized to locate and remove source terms. Components of the system can also be used in a variety of other cleanup activities. This Hot Spot Removal System Description document presents technologies that were considered for possible inclusion in the Hot Spot Removal System, technologies made available to the Hot Spot Removal System, industrial interest in the Hot Spot Removal System''s subsystems, the schedule required for the Hot Spot Removal System, the evaluation of the relevant technologies, and the recommendations for equipment and technologies as stated in the Plan section

  6. Systems integration of business systems. Business system ni kanshite

    Energy Technology Data Exchange (ETDEWEB)

    Furukawa, H [Nippon Steel Corp., Tokyo (Japan)

    1991-09-26

    System integration (SI) is defined as combining hardwares and softwares as the infrastructures with know-hows for their use comprehensively to respond to high-level needs of users. This paper reports the features of an SI being developed by a company (E Company), its concept on the systematized development methodology, and the conceptual models. With the primary policy placed on creative integration standing on customers positions, the SI concept comprises three parts of models for evaluations as seen from the customers, evaluations as seen from the E Company, and the development object systems to link both parts. The third part is further consisted of several lower hierarchies including a customer controlled system hierarchy (this enables customers to control the system through visualization, for example, and includes three logic models (multiple solution selection, optimal solution under restricted conditions, and numerical solution)). 2 refs., 9 figs.

  7. CDMA systems capacity engineering

    CERN Document Server

    Kim, Kiseon

    2004-01-01

    This new hands-on resource tackles capacity planning and engineering issues that are crucial to optimizing wireless communication systems performance. Going beyond the system physical level and investigating CDMA system capacity at the service level, this volume is the single-source for engineering and analyzing systems capacity and resources.

  8. Smart SDHW systems

    DEFF Research Database (Denmark)

    Andersen, Elsa

    2000-01-01

    The aim of the project is to develop smart solar domestic hot water (SDHW) systems. A smart SDHW is a system in which the domestic water can bee heated both by solar collectors and by an auxiliary energy supply system. The auxiliary energy supply system heats up the hot-water tank from the top an...

  9. Information Systems Security Audit

    OpenAIRE

    Gheorghe Popescu; Veronica Adriana Popescu; Cristina Raluca Popescu

    2007-01-01

    The article covers:Defining an information system; benefits obtained by introducing new information technologies; IT management;Defining prerequisites, analysis, design, implementation of IS; Information security management system; aspects regarding IS security policy; Conceptual model of a security system; Auditing information security systems and network infrastructure security.

  10. Medical imaging systems

    Science.gov (United States)

    Frangioni, John V

    2013-06-25

    A medical imaging system provides simultaneous rendering of visible light and diagnostic or functional images. The system may be portable, and may include adapters for connecting various light sources and cameras in open surgical environments or laparascopic or endoscopic environments. A user interface provides control over the functionality of the integrated imaging system. In one embodiment, the system provides a tool for surgical pathology.

  11. Evolution of ERP systems

    NARCIS (Netherlands)

    Wortmann, J.C.; Bititci, U.S.; Carrie, A.S.

    1998-01-01

    This paper describes the development of ERP systems over time. It explores both the functionality and the technology of ERP-systems. It explains the increased importance of ERP systems in practice. The paper also addresses the difficulties encountered in implementing ERP systems in real life. Modern

  12. Digital processing data communication systems (bus systems). Digitale Prozessdaten-Kommunikations-Systeme (Bus Systeme)

    Energy Technology Data Exchange (ETDEWEB)

    Fleck, K

    1980-01-01

    After an introduction to the technology of digital processing data communication systems there are the following chapters: digital communication of processing data in automation technology, the technology of biserial communication, the implementaiton of a bus system, the data transmission of the TDC-2000 system of Honeywell's and the process bus CS 275 in the automation system TELEPERM M of Siemens AG.

  13. EUCLID ARCHIVE SYSTEM PROTOTYPE

    NARCIS (Netherlands)

    Belikov, Andrey; Williams, Owen; Droge, Bob; Tsyganov, Andrey; Boxhoorn, Danny; McFarland, John; Verdoes Kleijn, Gijs; Valentijn, E; Altieri, Bruno; Dabin, Christophe; Pasian, F.; Osuna, Pedro; Soille, P.; Marchetti, P.G.

    2014-01-01

    The Euclid Archive System prototype is a functional information system which is used to address the numerous challenges in the development of fully functional data processing system for Euclid. The prototype must support the highly distributed nature of the Euclid Science Ground System, with Science

  14. Product Service Systems

    DEFF Research Database (Denmark)

    Departing from Product Development models based on physical artefacts. Moving towards integrated Product Development and System Operations models suited Product/Service-systems......Departing from Product Development models based on physical artefacts. Moving towards integrated Product Development and System Operations models suited Product/Service-systems...

  15. Biogas plant control system

    International Nuclear Information System (INIS)

    Balasevicius, L.; Dervinis, G.; Macerauskas, V.

    2002-01-01

    This paper presents intelligent control system for the pig farm biogas production process. The system uses a fuzzy logic models based on knowledge of experts and operators. Four fuzzy models are introduced. The adequacy of fuzzy models is verified using real data and MATLAB simulation. Proposed expert system is implemented into traditional SCADA system for biogas process prediction and failure analyzing. (authors)

  16. System Performance and Testing

    NARCIS (Netherlands)

    Frei, U.; Oversloot, H.

    2004-01-01

    This chapter compares and contrasts the system performance of two widely used solar thermal systems using testing and simulation programs. Solar thermal systems are used in many countries for heating domestically used water. In addition to the simple thermosiphon systems, better designed pumped

  17. Hybrid intelligent engineering systems

    CERN Document Server

    Jain, L C; Adelaide, Australia University of

    1997-01-01

    This book on hybrid intelligent engineering systems is unique, in the sense that it presents the integration of expert systems, neural networks, fuzzy systems, genetic algorithms, and chaos engineering. It shows that these new techniques enhance the capabilities of one another. A number of hybrid systems for solving engineering problems are presented.

  18. ERP–systems

    OpenAIRE

    Shustova I.

    2016-01-01

    In this work, we analyzed the existing ERP–systems of foreign and domestic manufacturers. Popular ERP–systems in the Republic of Belarus were considered. The leading ERP-systems in the domestic market and their features were described in detail. Finally, we described the steps that must be taken to select the most suitable ERP-system for a particular company.

  19. Business advertisements management system

    OpenAIRE

    Rekel, Ernest

    2017-01-01

    Business Advertisements Management System The main goal of the project was to create a business advertisements management system, where users could easily create and find business advertisements. To accomplish this goal exist- ing systems were analyzed as well as their limitations. The end result is a working system which is able to store and proccess huge amount of data.

  20. Functional System Dynamics

    OpenAIRE

    Ligterink, N.E.

    2007-01-01

    Functional system dynamics is the analysis, modelling, and simulation of continuous systems usually described by partial differential equations. From the infinite degrees of freedom of such systems only a finite number of relevant variables have to be chosen for a practical model description. The proper input and output of the system are an important part of the relevant variables.