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Sample records for techniques total splenectomy

  1. Splenectomy

    Science.gov (United States)

    ... with splenectomy include idiopathic thrombocytopenic purpura, polycythemia vera, thalassemia and sickle cell anemia. But splenectomy is typically performed only after other treatments have failed to reduce the symptoms of these ...

  2. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

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    Hollingsworth, Caroline L. [Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC (United States); Rice, Henry E. [Duke University Medical Center, Department of Surgery, Durham, NC (United States)

    2010-07-15

    The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality. (orig.)

  3. Evaluation of possible failure of the mononuclear phagocyte system after total splenectomy in rats

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    Marques Ruy Garcia

    2004-01-01

    Full Text Available Young and adult Wistar rats were submitted to total splenectomy and compared to animals not submitted to any surgical manipulation in order to evaluate the phagocytic function of spleen. The animals were infected with Escherichia coli labeled with technetium-99m and killed 20 minutes later. Liver, lung, spleen and a blood clot sample were taken. No significant differences were found in the percentage of bacterial radioactivity uptake in mononuclear phagocyte system (MPS organs in young and adult splenectomized rats. However, phagocytosis index by macrophages of MPS organs was smaller in splenectomized animals than in control group. Splenectomized rats were associated with a higher blood bacterial radioactivity uptake than animals of the control group (p<0.0001 due to a larger bacterial remnant in the bloodstream. This finding suggested that some failure in the MPS occurred in the absence of the spleen, demonstrating the need to develop alternative surgical techniques for total splenectomy.

  4. Prevention of overwhelming postsplenectomy infection in thalassemia patients by partial rather than total splenectomy.

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    Sheikha, Anwar K; Salih, Ziyan T; Kasnazan, Kalandar H; Khoshnaw, Mohammad K; Al-Maliki, Talal; Al-Azraqi, Tarek A; Zafer, Mubarak H

    2007-10-01

    We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure. In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication. A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years. Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.

  5. Total versus partial splenectomy in pediatric hereditary spherocytosis: A systematic review and meta-analysis.

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    Guizzetti, Leonardo

    2016-10-01

    To compare the clinical effectiveness of total splenectomy (TS) or partial splenectomy (PS) in pediatric hereditary spherocytosis, a systematic review and meta-analysis was performed (PROSPERO registration CRD42015030056). There were 14 observational studies comparing pre- and postoperative hematologic parameters. Secondary outcomes include in-hospital infections, surgical complications, symptomatic recurrence, and biliary disease. TS is more effective than PS to increase hemoglobin (3.6 g/dl vs. 2.2 g/dl) and reduce reticulocytes (12.5% vs. 6.5%) after 1 year; outcomes following PS are stable for at least 6 years. There were no cases of overwhelming postsplenectomy sepsis. A population-based patient registry is needed for long-term follow-up.

  6. A comparative study of partial vs total splenectomy in thalassemia major patients

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    Bahador Ali

    2007-01-01

    Full Text Available Background : In this study, we show the advantages of partial splenectomy (PS over total splenectomy (TS regarding the chances of overwhelming postsplenectomy sepsis (OPSI. Materials and Methods: From February 1991 to December 1999, 143 cases of β-thalassemia underwent PS. 1/3, 1/4 of the splenic tissue was preserved. One hundred and ten cases were followed for an average of 5 years. None of the patients received vaccination or prophylactic antibiotics. Pre- and postoperative hematological profiles, IgM levels, recurrence of hypersplenism and septic episodes were compared among the data of 60 cases TS; all these cases have been operated in the same hospital. Results: Hematological profile significantly increased and transfusion requirement approximately reduced to three-fold. After 3 years, 22.7% in PS and 13.3% in TS groups required the same amount of preoperative transfusion. After 5 years, these percentages were 27.3 and 18.3%, respectively. Two patients in PS and six in TS group developed signs of sepsis. Conclusion : Vaccination or prophylactic antibiotics are not necessary after PS. The risk of sepsis in PS without antibiotics is less than that in TS with antibiotics, and resplenectomy after PS is not associated with serious complications.

  7. Comparison of two minimal invasive techniques of splenectomy: Standard laparoscopy versus transumbilical multiport single-site laparoscopy with conventional instruments

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    Baris Bayraktar

    2015-01-01

    Full Text Available Background: Laparoendoscopic single-site (LESS splenectomy which is performed on small number of patients, has been introduced with better cosmetic outcome, less postoperative pain, greater patient satisfaction and faster recovery compared to standard laparoscopy. Materials and Methods : Thirty six patients were included in the study comparing standard laparoscopic splenectomy (LS, 17 patients transumbilical multiport splenectomy performed with conventional laparoscopic instruments (TUMP-LS, 19 patients. Two groups of patients were compared retrospectively by means of operation time, intra- and postoperative blood loss, perioperative complications, packed red cell and platelet requirements, lenght of hospitalization, pain scores and patient satisfaction. Results: There was no mortality in any of the groups, and no significant differences determined in operative time (P = 0,069, intraoperative blood loss (P = 0,641, patient satisfaction (P = 0,506, pain scores (P = 0,173 and the average length of hospital stay (P = 0,257. Umbilical incisions healed uneventfully and no hernia formation or wound infection was observed during follow-up period (2-34 months. There were no conversions to open surgery. Conclusions: Transumbilical multiport splenectomy performed with the conventional laparoscopic instruments is feasible and could be a logical alternative to classical laparoscopic splenectomy by combining the advantages of single access techniques and standard laparoscopy.

  8. 应用脾动脉结扎法行全腹腔镜巨脾切除术的临床研究%Clinical Research with Splenic Artery Ligation in Total Laparoscopic Massive Splenectomy

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    胡逸林; 曹庭加; 蔡逊; 李汉军; 刘颜良; 汪波

    2012-01-01

    目的:探讨应用脾动脉结扎法行全腹腔镜巨脾切除术的安全性、可行性及手术技巧.方法:将2010年1月1日至2012年1月1日因肝硬化门脉高压脾机能亢进巨脾患者随机分为腹腔镜脾切除(Laparoscopic Splenectomy,LS)组及开腹脾切除(Open Splenectomy,OS)组,比较两组的临床特征及围手术期差异.结果:LS组与OS组在性别组成、术前肝功能child分级、年龄组成及脾脏长径方面均无统计学意义.LS组手术时间比OS组略长,但无统计学意义,LS组术中出血量明显低于OS组(P<0.01),LS组术后进食、术后排气、引流管拔除及出院时间均明显早于OS组(P<0.01).结论:腹腔镜脾切除术为治疗门脉高压巨脾的一种有效、安全、可行的手术方式.%Objective: To investigate the safety, feasibility and surgical techniques with splenic artery ligation in total laparoscopic massive splenectomy. Methods: From January 1, 2010 to January 1, 2012, patients with hypertension due to cirrhosis of the liver spleen hyperfunction massive splenectomy were randomly assigned into laparoscopic splenectomy group and Open Splenectomy group. Compare the two groups in clinical characteristics and differences in the perioperative period. Results: Between the two groups, the differences in gender composition, age, child classification and the diameter in the spleen were not statistically significant. LS group operative time was slightly longer than that in the OS group, but the difference had no statistical significance. LS group blood loss was significantly lower than that in the OS group (P<0.01). The time of postoperative feeding, farting, postoperative tube remove, postopera- tive hospital stay in LS group were significantly earlier than that in the OS group (P<0.01). Conclusions: Total laparoscopic massive splenectomy is safe, feasible and effective to treatment portal hypertension.

  9. Laparoscopic Splenectomy for Splenic Hamartoma: A Case Report

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    Andrea Pisani Ceretti

    2012-01-01

    Full Text Available Hamartoma is a rare splenic benign tumor usually accidentally detected as a radiologic finding. Preoperative diagnosis poses a challenge and thus surgery becomes necessary to confirm the clinical suspicion. Laparoscopic splenectomy has gained consensus as a standard surgical procedure particularly for autoimmune hematological diseases. This former experience has allowed this technique to be extended to other splenic pathologies. Here we report a case of total laparoscopic splenectomy for a bulky splenic hamartoma in a young male patient.

  10. Total Splenectomy due to an Unexpected “Complication” after Successful Extended Laparoscopic Partial Decapsulation of a Giant Epidermoid Splenic Cyst: A Case Report

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    Michail Pitiakoudis

    2011-01-01

    Full Text Available Splenic cysts are rare entities and are classified as true cysts or pseudocysts based on the presence of an epithelial lining. Congenital nonparasitic true cysts can be epidermoid, dermoid, or endodermoid, present at a young age, and are commonly located in the upper pole of the spleen. Surgical treatment is recommended for symptomatic, large (more than 5 cm, or complicated cysts. Depending on cyst number, location, relation to hilus, and the major splenic vessels, the surgical options include aspiration, marsupialization, cystectomy, partial cystectomy (decapsulation, and partial or complete splenectomy. Laparoscopic techniques have now become the standard approach for many conditions, including the splenic cysts, with emphasis on the spleen-preserving minimally invasive operations. We present the successful extended partial laparoscopic decapsulation of a giant epidermoid splenic cyst in a young female patient that, although asymptomatic, was unfortunately followed by complete splenectomy five days later due to a misinterpreted abdominal CT suggesting splenic postoperative ischemia.

  11. Laparoscopic splenectomy using conventional instruments

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    Dalvi A

    2005-01-01

    Full Text Available INTRODUCTION : Laparoscopic splenectomy (LS is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4, 197-200 (2004], trauma [Ren et al., Surg Endosc 15(3, 324 (2001; Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4, 283-286 (2002], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45, 847-852 (2002]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. MATERIALS AND METHODS : Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. RESULTS : A total of 26 patients underwent LS. Twenty-two (85% of patients had spleen size more than 500 g (average weight being 942.55 g. Mean operative time was 214 min (45-390 min. The conversion rate was 11.5% ( n = 3. Average duration of stay was 5.65 days (3-30 days. Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. CONCLUSION : Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.

  12. Lipídios plasmáticos após esplenectomia total e parcial em cães The plasma lipids after total and partial splenectomy in dogs

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    Danilo Nagib Salomão Paulo

    2001-08-01

    Full Text Available OBJETIVO: Avaliar o efeito da esplenectomia total e parcial (hemiesplenectomia e esplenectomia subtotal no lipidograma de cães. MÉTODO: Foram operados 38 animais, adultos, machos, mestiços, com peso entre 13kg e 15kg. No pré-operatório, depois do exame clínico e jejum de 12 horas de uma dieta-padrão, foram realizados hemograma e lipidograma. Após anestesia geral com tiopental sódico os cães foram submetidos à laparotomia mediana supra e infra-umbilical. Procedeu-se no grupo 1, de sete cães, apenas à manipulação do baço (simulado; no grupo 2, de nove cães, à hemiesplenectomia cranial; no grupo 3, de nove cães, à esplenectomia subtotal, com preservação do pólo inferior do baço, após ligadura e secção dos troncos principais dos vasos esplênicos próximos ao hilo; e no grupo 4, de 13 cães, à esplenectomia total. RESULTADOS: No grupo 4 (esplenectomia total, quando comparamos os valores do lipidograma dos diferentes períodos pós-operatórios com os do pré-operatório, os nossos resultados mostraram que houve aumento significante do colesterol total em todos os períodos pós-operatórios (p 0,05 no 56º PO. O LDL aumentou significantemente no 56º PO (p BACKGROUND: The purpose of this study was to evaluate the effect of partial (hemi-splenectomy and subtotal splenectomy and total splenectomy in the dogs lipidic profile. METHOD: Thirty eight (38 mongrel male dogs, with weight varying between 13 Kg and 15 Kg were operated. After clinical evaluation and twelve hour fasting of standard diet, preoperatively hemogram and lipidic profile were evaluated. After general anaesthesia with sodium thiopental, the dogs were submitted to an upper and lower median laparotomy. Group I, seven dogs, just manipulation of the spleen (sham-control; group II, nine dogs upper hemisplenectomy; group III, nine dogs, subtotal splenectomy with preservation of inferior pole, after the ligature and section of the splenic artery and vein near the

  13. Laparoscopic splenectomy and infection

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    Seyyit Kuş

    2013-03-01

    Full Text Available Partial laparoscopic splenectomy is performed commonly in hereditary spherocytosis. Vaccination against capsulatedbacteria is essential before undergoing splenectomy. Hand-assisted laparoscopic splenectomy is known to be effectiveand convenient in the removal of a spleen larger than 20 cm in size. Laparoscopic splenectomy provides less hemorrhage,reduced surgical trauma and pain, shorter duration of hospital stay, and early recovery. Laparoscopic approachwas particularly effective in reducing the infectious complication rate compared with the open surgery. Infectious complicationsof splenectomy were observed to be wound infection, subphrenic abscess, and sometimes pulmonary infection.J Microbiol Infect Dis 2013; 3(1: 1-2Key words: Laparoscopy, splenectomy, infection

  14. Laparoscopic splenectomy for massive splenomegaly: technical aspects of initial ligation of splenic artery and extraction without hand-assisted technique.

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    Trelles, Nelson; Gagner, Michel; Pomp, Alfons; Parikh, Manish

    2008-06-01

    A 37-year-old man was referred for massive splenomegaly. In November 2005, he was diagnosed with non-Hodgkin's B-cell lymphoma in the setting of splenomegaly and thrombocytopenia. His laboratory results showed a coagulopathy owing to lupus anticoagulant. A computed tomography scan showed a 36 x 26 x 11 cm spleen and a prominent and sinuous splenic artery. The authors performed a laparoscopic splenectomy with an initial ligation of the splenic artery. The patient tolerated the procedure well and was discharged home on the fourth postoperative day in stable condition. Discussed in this paper is the safety and feasibility of the minimally invasive approach in massive splenomegaly.

  15. The THUNDERBEAT system for tissue dissection and vascular control in laparoscopic splenectomy.

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    Ceccanti, Silvia; Falconi, Ilaria; Frediani, Simone; Boscarelli, Alessandro; Catani, Marco; Cozzi, Denis A

    2017-08-01

    The advent of new energy sources for hemostasis has greatly facilitated advanced laparoscopic procedures. We describe a straightforward technique of laparoscopic splenectomy (LS) accomplished using the THUNDERBEAT™ system (TS) (Olympus Medical Systems Corp., Tokyo, Japan) as the sole means of tissue dissection and hemostasis in two patients aged 19 and 6 years, respectively. The specimens were removed intact via a Pfannenstiel incision. Total operative time was 165 and 150 min, and length of hospital stay was three and 4 d, respectively. The TS is an appealing and reliable alternative to currently available energy devices, allowing fast dissection and secure hemostasis during laparoscopic splenectomy.

  16. [Partial splenectomy in sickle cell disease].

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    Gutiérrez Díaz, A I; Svarch, E; Arencibia Núñez, A; Sabournin Ferrier, V; Machín García, S; Menendez Veitía, A; Ramón Rodriguez, L; Serrano Mirabal, J; García Peralta, T; López Martin, L G

    2015-04-01

    Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomized patients. We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomized patients selected by random sampling with similar characteristics. Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous hemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomized patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomized patients. Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomized and non-splenectomized except the greater frequency of hepatic sequestration crisis in the first group. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  17. Lipidic profile among rats submitted to total splenectomy isolated or combined with splenic autotransplant Perfil lipídico em ratos submetidos a esplenectomia total isolada ou combinada com auto-implante esplênico

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    Fernanda Correia Simões

    2007-01-01

    Full Text Available PURPOSE: To evaluate the alterations on plasmatic lipids levels among rats submitted to total splenectomy isolated or combined with splenic autotransplant receiving standard chow during the postoperative period. METHODS: Thirty Wistar rats were divided into three groups: control (C - sham-operated, total splenectomy - isolated (TS or combined with splenic autotransplantation (SA. Since the postoperative period, all animals received standard rat chow manipulated in accordance to the American Institute of Nutrition Rodents Diets (1993. The plasmatic levels of total cholesterol (TC, triglycerides (TG, high-density lipoprotein (HDL, low-density lipoprotein (LDL, very-low-density lipoprotein (VLDL, and glucose (GLUC were analyzed before the surgical procedure and after 6 and 12 weeks. RESULTS: All the animals presented significant increase of TG and VLDL levels. In relation to the other parameters there was no difference among the weeks 0 and 12 in the animals of group C. In TS group significant increase was observed in TC and GLUC levels during the experiment. In SA group TC, HDL, and GLUC levels remained unaffected while HDL levels increased. CONCLUSION: Our findings suggest that isolated total splenectomy alters lipids metabolism in rats fed with standard chow and splenic autotransplantation is effective in restoring its control.OBJETIVO: Avaliar as alterações nos níveis de lipídios plasmáticos em ratos submetidos a esplenectomia total isolada ou combinada com auto-implante esplênico, recebendo dieta padrão no período pós-operatório. MÉTODOS: Trinta ratos Wistar foram distribuídos em três grupos: controle (C - operação simulada, esplenectomia total isolada (ET ou combinada com auto-implante esplênico (AE. A partir do período pós-operatório, todos os animais receberam ração padrão, manipulada segundo o American Institute of Nutrition (1993. Os níveis plasmáticos de colesterol total (CT, triglicerídeos (TG, lipoproteína de

  18. Níveis de lípides plasmáticos em ratos submetidos à esplenectomia total, ligadura simultânea dos vasos esplênicos e à esplenectomia subtotal com preservação do pólo inferior Plasmatic lipids levels in rats after total splenectomy, simultaneous ligature of the splenic vessels and subtotal splenectomy with inferior pole preservation

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    Isabel Cristina Andreatta Lemos Paulo

    2005-10-01

    Full Text Available OBJETIVO: Verificar o efeito da esplenectomia total, da ligadura dos vasos esplênicos principais e da esplenectomia subtotal com preservação do pólo inferior, nos lípides plasmáticos de ratos alimentados com dieta-controle ou dieta acrescida com 2,5% de colesterol. MÉTODO: Foram utilizados 111 ratos Wistar, machos, pesando entre 273g e 427g, com idade aproximada de 12 semanas, assim distribuídos: Grupo 1, controle (N = 20, não operado; Grupo 2 (N = 20 submetido à manipulação do baço; Grupo 3 (N = 31 submetido à esplenectomia total; Grupo 4 (N = 20, ligadura simultânea da artéria e veia esplênicas; Grupo 5 (N = 20, esplenectomia subtotal com preservação do pólo inferior. Foram dosados os lípides plasmáticos, e os ratos foram distribuídos em dois subgrupos, de acordo com a dieta (Subgrupo A- dieta-controle; Subgrupo B - dieta acrescida com 2,5% de colesterol. Todos os animais foram submetidos à nova colheita de sangue após 90 dias do início do experimento. RESULTADOS: Os animais submetidos à esplenectomia total, independentemente do tipo de dieta, apresentaram aumento significante (p 0,05. Os animais submetidos à ligadura simultânea da artéria e veia esplênicas e à esplenectomia subtotal com preservação do pólo inferior e alimentados com dieta-controle, não apresentaram alterações nos níveis de lípides plasmáticos, exceto pelo aumento da HDL (p BACKGROUND: To verify the effect on plasmatic lipid level of rats feed with control diet and diet added with 2.5% pure cholesterol after total splenectomy, ligature of the splenic vessels and partial splenectomy with preservation of the inferior pole. METHODS: One hundred and eleven male Wistar rats weighting between 273 and 427g aged 12 weeks, were randomly divided into 5 groups. Group 1 (N = 20 control group was not submitted to surgery; Group 2 (N = 20 submitted to manipulation of the spleen; Group 3 (N = 31 total splenectomy; Group 4 (N = 20 simultaneous ligature

  19. Single-port splenectomy: Current update and controversies

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    Targarona Eduardo

    2011-01-01

    Full Text Available Multiport laparoscopic splenectomy (LS is considered the "gold standard" for the management of surgical diseases in normal or slightly enlarged spleens. The concept of minimal-invasive surgical techniques has progressed since the early 1990s from standard multiport laparoscopy to natural orifice transluminal endoscopic surgery (NOTES and, more recently, to single-port access (SPA. In this paper, we describe our technique for SPA splenectomy and provide a critical review of the current literature on SPA for splenic diseases.Preliminary results published to date indicate that the spleen can be safely removed using single-incision surgery and all the authors have unanimously endorsed the feasibility of this approach. However, available evidence is still scarce. It is based only on case reports and one small series, with a total of 17 patents and, therefore, firm conclusions cannot yet be drawn and more experience and comparative trials are needed to determine the exact role of this interesting new approach. a???5?5?

  20. Laparoscopic splenectomy for hereditary spherocytosis-preliminary report.

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    Rogulski, Robert; Adamowicz-Salach, Anna; Matysiak, Michał; Piotrowski, Dariusz; Gogolewski, Michał; Piotrowska, Anna; Roik, Danuta; Kamiński, Andrzej

    2016-06-01

    Splenectomy is considered standard surgical therapy in hereditary spherocytosis. The procedure is indicated in patients with severe anemia, recurrent hemolytic, and aplastic crises. The aim of the study was to assess treatment outcomes in patients with hereditary spherocytosis who underwent total or partial laparoscopic splenectomy. Fifteen patients aged 4-17 yr underwent laparoscopic splenectomy from 2009 to 2012. Partial and total splenectomies were performed (five and 10 children, respectively). Hematologic parameters, liver function tests, and splenic volume before and after the surgery were analyzed retrospectively. Total follow-up was 1-30 months. Hospitalization and operating time were similar in both groups. In partial splenectomy group, branches of splenic arteries gave better blood supply than short gastric vessels. In both groups, hematologic parameters were improved. Postoperative markedly elevated platelet count was maintained up to 6 months, and after that, platelet count gradually decreased to normal values. Bilirubin level was decreased in early postoperative period; however, it increased later to achieve levels lower than in preoperative period. No severe general infections were observed in both groups. Laboratory parameters (hemoglobin and bilirubin concentrations and RBC) after the surgery improved in all patients, and the effect was maintained during 12 months of follow-up. Platelet count increased significantly after the surgery and was maintained at high levels during the next 6 months. However, it returned to preoperative levels within a year after the surgery. Our study showed that partial splenectomy was not inferior to total splenectomy. However, full assessment requires longer follow-up and larger group of patients.

  1. Laparoscopic versus open splenectomy in dogs

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    Rafael Stedile

    2009-08-01

    Full Text Available In the last few years, the use of laparoscopy in veterinary medicine has expanded and consequently so was the need for studies that establish the advantages, disadvantages and possible complications of each procedure. The purpose of the current study was to describe a laparoscopic splenectomy technique and the alterations due to this access, and compare it to the open procedure in dogs. A total of 15 healthy female mongrel dogs were used, with mean weight of 17.4±2.5kg. The animals were distributed into three groups: Group IA of open splenectomy (laparotomy using double ligation of the vessels of the splenic hilum with poliglicolic acid, Group IB of open splenectomy (laparotomy with bipolar electrocoagulation of the splenic hilum, and Group II of laparoscopic access with bipolar electrocoagulation of the splenic hilum. Operative time, blood loss, size of incisions, complications during and after surgery were evaluated. Other parameters included pain scores, white blood cell (WBC counts and postoperative serum concentrations of alanine aminotransferase (ALT, alkaline phosphatase (ALP, creatine kinase (CK, C-reactive protein (CRP, glucose and cortisol. No differences were found in the evaluation of parameters between both open splenectomy techniques employed. Laparoscopic access presented significant differences (pNos últimos anos, a utilização da laparoscopia em Medicina Veterinária vem expandindo e, conseqüentemente, a necessidade de pesquisas que determinem as vantagens, desvantagens e possíveis complicações de cada procedimento. Este estudo teve como objetivo descrever uma técnica de esplenectomia laparoscópica, assim como as alterações decorrentes deste acesso, e compará-la ao procedimento convencional em cães. Foram utilizadas 15 cadelas hígidas, sem raça definida, com peso médio de 17,4 ±2,5kg. Os animais foram distribuídos em três grupos: Grupo IA de acesso convencional (por laparotomia utilizando ligadura com

  2. Application of the Radical Proximal Subtotal Gastrectomy or Total Gatrectomy and Splenectomy in Gastric Cancer with Portal Hypertension%根治性近端胃次全切或全胃切除加脾切除术在胃癌合并肝硬化门脉高压症中的应用

    Institute of Scientific and Technical Information of China (English)

    邓荣文; 李义廷; 李承良

    2011-01-01

    目的:探讨根治性近端胃次全切或全胃切+脾切除术在胃癌合并肝硬化门脉高压症患者(childA级)外科治疗中的作用.方法:回顾性分析我院10年间运用根治性近端胃次全切或全胃切+脾切除术治疗8例肝功能child A级胃癌合并肝硬化门脉高压症患者的临床资料.术前充分评估患者的肝功能、凝血机制、营养状态后积极改善,预测肿瘤切除的可能性,行根治性近端胃次全切除+脾切除3例,全胃切+脾切除术5例.结果:8例患者术后均出现不同程度的腹水,创面渗血2例,膈下感染1例.均经积极治疗后恢复,无围手术期间死亡.结论:根治性近端胃次全切或全胃切除+脾切除术应用于肝功能childA级胃癌合并肝硬化门脉高压症患者是合理的选择.%Objective: To evaluate the effect of the radical proximal subtotal gastrectomy or total gatrec-tomy +splenectomy in treating gastric cancer with portal hypertension. Method: Clinical datas of 8 patients (child A)of the radical proximal subtotal gastrectomy or total gatrectomy + splenectomy in treating gastric cancer with portal hypertension who were surgically treated in our hospital during the last 10 years were studied retrospectively. Preoperatively, a detailed examination, and improvement of their liver function, prothrom-bin time and nutritional status were aggressively made, and the possibility of tumor removal was estimated. Three patients underwent radical proximal subtotal gasterectomy and splenectomy, and five patients urderwent total gastrectomy and splenectomy. Result: All 8 patients had varying degrees of ascites. Wound oozing in 2 cases, subdiaphrogmatic abscess 1 case. All patients recovered after treatment. There were no perioperative deaths in this series. Conclusion: Radical proximal subtotal gastrectomy or total gatrectomy +splenectomy in treating gastric cancer with portal hypertension is a reasonable choice.

  3. 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.

  4. Esplenectomia vídeo-laparoscópica para púrpura trombocitopênica imune: técnica e resultados Laparoscopic splenectomy for immune thrombocytopenic purpura: technique and results of a prospective study

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    Ricardo Zorrón

    2004-08-01

    ópica é segura e efetiva, tornando-se o tratamento de escolha para PTI com indicação cirúrgica.BACKGROUND: Immune thrombocytopenic purpura (ITP is a common indication for splenectomy. In order to evaluate the results of Laparoscopic Splenectomy, 17 patients with ITP were submitted to this procedure in a prospective study. METHODS: Using three trocars through a posterior approach and simple inabsorbable ligatures, without using hemoclips and vascular stapplers, splenectomy was carried out in a prospective series of 17 patients. RESULTS: All patients were successfully managed laparoscopically, with no conversion to open surgery. Complications ocurred in three patients: one wound haematoma, one residual splenic tissue requiring reoperation, and one pancreatic pseudocyst that was treated by conservative measures. An additional fourth trocar was needed in four patients. Mean operative time was 132.9min, mean postoperative stay was 2.53 days. Intraoperative platelet transfusion was needed in two patients (11.8% and accessory spleen was detected in four (23.5%. Favourable sustained response to splenectomy was obtained in 13 patients (76.5%, with partial or no response in four (23.5%. CONCLUSION: Careful anatomical dissection technique and search for accessory tissue is needed to avoid splenosis and therapy failure. Detection of accessory spleens by this method is precise and reliable. Patients with PTI have the same remission rates of open surgery, with less complications and shortened postoperative stay. The results suggest that Laparoscopic Splenectomy is effective and safe, and has become the golden standard for the treatment of ITP with surgical indication.

  5. Pulmonary hypertension in patients with hematological disorders following splenectomy.

    Science.gov (United States)

    Meera, V; Jijina, Farah; Ghosh, Kanjaksha

    2010-03-01

    Prevalence of pulmonary arterial hypertension (PAH) was studied by Echocardiography and Doppler in 43 splenectomised patients with various disorders 1-20 years after splenectomy. PAH was detected only in thalassemia major, intermedia, hereditary sphereocytosis and myelofibrosis groups comprising a total of 21 patients. Six patients out of 21 was found to have PAH with mean pulmonary arterial pressure of 46.28 ± 28.17 mmHg. Twenty one controls having similar duration and type of disease also were assessed for PAH in this case control study 3/21 had PAH in this control group. The difference in number of patients showing pulmonary hypertension between case and control was not statistically significant (chi-square test p = 0.29-though the difference in pulmonary arterial pressure between case and control were significantly different (t-test psideroblastic anemia, extra hepatic portal hypertension, autoimmune hemolytic anemia did not show PAH after splenectomy even years after the procedure PAH following splenectomy is common after certain disorders and control patients with these diseases have tendency to develop PAH even without splenectomy. Pulmonary thromboembolism may be an important pathophysiological mechanism leading to this condition. Patients having hemolytic anemia and myelofibrosis should have regular evaluation of pulmonary arterial pressure whether he/she has been splenectomised or not. This is particularly important as availability of phosphodiesterase inhibitors like sildenafil allows one to manage these cases.

  6. Single incision laparoscopic splenectomy, technical aspects and feasibility considerations.

    Science.gov (United States)

    Cabras, Francesco; Fabrizio, Lazzara; Bracale, Umberto; Andreuccetti, Jacopo; Pignata, Giusto

    2014-12-01

    Minimally invasive techniques have been introduced to reduce morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery. The aim of the study was to present our initial clinical experience of using this technique for elective splenectomy. We carried out single access laparoscopic splenectomy (SALS) for an 8 cm cystic lesion of the spleen, involving the hilum, on a 38-year-old woman. The procedure was performed with a single-port device (4-channel) via a 2.5-cm umbilical incision. A flexible 5-mm optic and straight laparoscopic instruments were used. The operative time was 75 min. There was no blood loss. No complications were observed. The postoperative period was uneventful. Although substantial development of the instruments and skills is needed, this SALS technique appears to be feasible and safe. Nevertheless, further experience and observations are necessary.

  7. Splenectomy associated changes in IgM memory B cells in an adult spleen registry cohort.

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    Paul U Cameron

    Full Text Available Asplenic patients have a lifelong risk of overwhelming post-splenectomy infection and have been reported to have low numbers of peripheral blood IgM memory B cells. The clinical value of quantitation of memory B cells as an indicator of splenic abnormality or risk of infection has been unclear. To assess changes in B cell sub-populations after splenectomy we studied patients recruited to a spleen registry (n = 591. A subset of 209 adult asplenic or hyposplenic subjects, and normal controls (n = 140 were tested for IgM memory B cells. We also determined a changes in IgM memory B cells with time after splenectomy using the cross-sectional data from patients on the registry and b the kinetics of changes in haematological markers associated with splenectomy(n = 45. Total B cells in splenectomy patients did not differ from controls, but memory B cells, IgM memory B cells and switched B cells were significantly (p<0.001 reduced. The reduction was similar for different indications for splenectomy. Changes of asplenia in routine blood films including presence of Howell-Jolly bodies (HJB, occurred early (median 25 days and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. There was a more gradual decrease in IgM memory B cells reaching a stable level within 6 months after splenectomy. IgM memory B cells as proportion of B cells was the best discriminator between splenectomized patients and normal controls and at the optimal cut-off of 4.53, showed a true positive rate of 95% and false positive rate of 20%. In a survey of 152 registry patients stratified by IgM memory B cells around this cut-off there was no association with minor infections and no registry patients experienced OPSI during the study. Despite significant changes after splenectomy, conventional measures of IgM memory cells have limited clinical utility in this population.

  8. Laparoscopic splenectomy in patients with hereditary spherocytosis: report on 12 consecutive cases.

    Science.gov (United States)

    Vecchio, R; Intagliata, Eva; Ferla, F; Marchese, S; Cacciola, R R; Cacciola, E

    2013-12-01

    Hereditary spherocytosis is an inherited hemolytic anemia caused by a deficiency in erythrocyte membrane proteins. Removal of the spleen may reduce the intra-splenic hemolytic process of the disease and, therefore, may correct the anemia. Furthermore, it seems to decrease the levels of serum bilirubin, thus reducing the formation of gallbladder stones. Indications and timing of splenectomy, however, are still debated. Twelve patients with severe hereditary spherocytosis operated on with laparoscopic splenectomy were retrospectively reviewed. Median age at diagnosis was 13.8 years (range 8-25 years). Male to female ratio was 5/7. Indications for laparoscopic removal of the spleen included anemia unresponsive to iron supplementation in eight patients (66.6 %) with increase need for red cells transfusions, and jaundice with symptoms related to cholelitiasis in four patients (33.3 %). Laparoscopic splenectomy was associated in four cases to laparoscopic cholecystectomy. Mean operative time was 50 min (range 40-75 min) with no conversion to open surgery. Mean hospital stay ranged from 3 to 7 days. In a 16-month follow-up, no complications were recorded and a persistent correction of anemia was observed. With the advent of laparoscopic surgery, splenectomy has been performed by this mini-invasive approach in referral centers. Laparoscopic splenectomy is an effective technique, when performed in patients with hereditary spherocytosis. Low complication rate and persistent correction of the hematologic disorders can be expected after the laparoscopic splenectomy, provided that a proper technique is performed and an experienced surgical team is available.

  9. Risks and benefits of splenectomy versus no splenectomy for hereditary spherocytosis--a personal view.

    Science.gov (United States)

    Schilling, Robert F

    2009-06-01

    Splenectomy is indicated in hereditary spherocytosis to relieve symptoms due to anaemia or splenomegaly, reverse growth failure or skeletal changes due to over-robust erythropoiesis, and prevent recurrent gallstones. A life-long risk of bacterial infection has been recognised for many years as a concomitant cost of splenectomy. The scope of this risk has expanded to include a number of organisms beyond the triad of pneumococcus, meningococcus, and haemophilus influenzae. Recently, it has been demonstrated that splenectomy also confers a significant risk of delayed adverse vascular events in patients with hereditary spherocytosis, just as it does in patients undergoing splenectomy for other indications. Further, these same studies demonstrated a benefit of avoiding splenectomy: hereditary spherocytosis patients with a spleen have significantly fewer adverse vascular events than unaffected family members, probably because of the protective effect of chronic, mild anaemia. Accordingly, this review marshals the evidence favouring a conservative approach to splenectomy in spherocytosis.

  10. Efficacy and safety of splenectomy in adult autoimmune hemolytic anemia

    Science.gov (United States)

    Giudice, Valentina; Rosamilio, Rosa; Ferrara, Idalucia; Seneca, Elisa; Serio, Bianca

    2016-01-01

    Abstract Autoimmune hemolytic anemia (AIHA) is a rare hematologic disease, primarily affecting adults or children with immunodeficiency disease. First-line therapy consists of long course of steroids administration, with an early complete response rate (CRr) of 75-80%, but up to 20-30% of patients requires a second-line therapy. Rituximab is the first choice in refractory old AIHA patients, because of its safety and efficacy (early CRr at 80-90% and at 68% at 2-3 years). For this reason, splenectomy is even less chosen as second-line therapy in elderly, even though laparoscopic technique decreased complication and mortality rates. However, splenectomy can be still considered a good therapeutic option with a CRr of 81% at 35.6 months in patients older than 60 year-old, when rituximab administration cannot be performed. PMID:28352823

  11. Prognostic impact of splenectomy on advanced proximal gastric cancer with No.10 lymph node metastasis

    Institute of Scientific and Technical Information of China (English)

    HUANG Chang-ming; WANG Jia-bin; LU Hui-shan; ZHENG Chao-hui; LI Ping; XIE Jian-wei; ZHANG Xiang-fu

    2009-01-01

    Background This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum (No. 10 lymph nodes).Methods The clinical records of 216 patients with advanced proximal gastric cancer and No.10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy (splenectomy group), while 143 patients did not (spleen-preserving group). Five-year survival rates, mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.Results The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group (X~2=14.73, P 0.05).Conclusions Splenectomy is beneficial for No.10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.

  12. Comparison between single and three portal laparoscopic splenectomy in dogs

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    Khalaj Alireza

    2012-09-01

    Full Text Available Abstract Background Single incision laparoscopic surgery (SILS is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS with three portal (Conventional laparoscopic splenectomy in dogs. Mongrel dogs (n = 18, weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional. The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P  Conclusion This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional for splenectomy in dog.

  13. Splenectomy with endoscopic variceal ligation is superior to splenectomy with pericardial devascularization in treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Nan Lin; Bo Liu; Rui-Yun Xu; He-Ping Fang; Mei-Hai Deng

    2006-01-01

    AIM: To investigate the therapeutic efficacy and complications of splenectomy with endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization (i.e. Hassab's operation) in patients with portal hypertension.METHODS: A total of 103 patients with liver cirrhosis and portal hypertension were randomly selected to receive either splenectomy with EVL (n = 53, group A) or Hassab's operation (n = 50, group B).RESULTS: The portal blood flow volume, the presence of portal vein thrombosis, gastric emptying time and free portal venous pressure (FPP) before and after the operation were determined. Patients were followed up for up to 64 mo with an average of 45 mo, and the Dagradi classification of variceal veins and the grading of portal hypertension gastropathy (PHG) were evaluated.It was found that all esophageal varices were occluded or decreased to grade Ⅱ or less in both groups. There was little difference in the recurrence rate of esophageal varices (11.9% vs13.2%) and the re-bleeding rate (7.1% vs 5.3%) between groups A and B. The incidence of complications and the percentage of patients with severe PHG after the operation were significantly higher in group B (60.0% and 52.0%) than in group A (32.1%and 20.8%, P < 0.05). No patients died of operationrelated complications. There was no significant difference in gastric emptying time, FPP and portal blood flow volume between the two groups.CONCLUSION: The results suggest that splenectomy with EVL achieves similar therapeutic efficacy to that of Hassab's operation interms of the recurrence rate of esophageal varices and the re-bleeding rate, but the former results in fewer and milder complications.

  14. Splenectomy and risk of renal and perinephric abscesses: A population-based cohort study in Taiwan.

    Science.gov (United States)

    Lai, Shih-Wei; Lin, Hsien-Feng; Lin, Cheng-Li; Liao, Kuan-Fu

    2016-08-01

    Little epidemiological research is available on the relationship between splenectomy and renal and perinephric abscesses. The purpose of the study was to examine this issue in Taiwan.We conducted a population-based retrospective cohort study using the hospitalization dataset of the Taiwan National Health Insurance Program. A total of 16,426 participants aged 20 and older who were newly diagnosed with splenectomy from 1998 to 2010 were assigned to the splenectomy group, whereas 65,653 sex-matched, age-matched, and comorbidity-matched, randomly selected participants without splenectomy were assigned to the nonsplenectomy group. The incidence of renal and perinephric abscesses at the end of 2011 was measured in both groups. The multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% confidence interval (CI) for risk of renal and perinephric abscesses associated with splenectomy and other comorbidities including cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis.The overall incidence rate of renal and perinephric abscesses was 2.14-fold greater in the splenectomy group than that in the nonsplenectomy group (2.24 per 10,000 person-years vs 1.05 per 10,000 person-years, 95% CI 2.02, 2.28). After controlling for sex, age, cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis, the multivariable regression analysis demonstrated that the adjusted HR of renal and perinephric abscesses was 2.24 for the splenectomy group (95 % CI 1.30, 3.88), when compared with the nonsplenectomy group. In further analysis, the adjusted HR markedly increased to 7.69 for those comorbid with splenectomy and diabetes mellitus (95% CI 3.31, 17.9).Splenectomy is associated with renal and perinephric abscesses, particularly comorbid with diabetes mellitus. In view of its potential morbidity and mortality, clinicians should consider the possibility of renal and perinephric abscesses when

  15. A technique for pediatric total skin electron irradiation

    OpenAIRE

    Bao Qinan; Hrycushko Brian A; Dugas Joseph P; Hager Frederick H; Solberg Timothy D

    2012-01-01

    Abstract Background Total skin electron irradiation (TSEI) is a special radiotherapy technique which has generally been used for treating adult patients with mycosis fungoides. Recently, two infants presented with leukemia cutis isolated to the skin requiring TSEI. This work discusses the commissioning and quality assurance (QA) methods for implementing a modified Stanford technique using a rotating harness system to position sedated pediatric patients treated with electrons to the total skin...

  16. Ligament balancing in total knee arthroplasty—Medial stabilizing technique

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    Shuichi Matsuda

    2015-10-01

    Full Text Available Ligament balancing is one of the most important surgical techniques for successful total knee arthroplasty. It has traditionally been recommended that medial and lateral as well as flexion and extension gaps are equal. This article reviews the relevant literature and discusses the clinical importance of the aforementioned gaps. Current evidence indicates that achieving medial stability throughout the range of motion should be a high priority in ligament balancing in total knee arthroplasty. Finally, the medial stabilising surgical technique, which aims to achieve good medial stability in posterior cruciate-retaining total knee arthroplasty, is introduced.

  17. Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy

    Institute of Scientific and Technical Information of China (English)

    LIU Ying-bin; ZHANG Zhi-ping; WU Xiang-song; FEI Xiao-zhou; QUAN Zhi-wei; Li Song-gang; LI Ji-yu; CAO Li-ping; PENG Shu-you; KONG Ying; WANG Xuan; WANG Jian-wei; LI Jiang-tao; WANG Yong; CHEN Yan; CHEN De-qing; WENG Wei-hong

    2008-01-01

    Background It is well known that conventional splenectomy,which requires careful handling and ligation of tissue of the splenic hilum,can easily cause complications such as splenic fever and pancreatic fistula.Here,we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy.Methods We retrospectively compared and analyzed the complications,postoperative hospital stay,operative time,and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007.The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle.In addition,we analyzed the relationship between size of the spleen and occurrence of complications.Results The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively).In addition,there was no significant difference in operative time and volume of blood loss between two groups.The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications.Conclusions These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula,and shorten the postoperative hospital stay,especially in the patients with a large spleen.So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy.

  18. A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction.

    Science.gov (United States)

    Takase, Yoshiaki; Tomizawa, Naoki; Enokida, Yasuaki; Shiraishi, Takuya; Katoh, Ryuji; Suto, Yujin; Sato, Hiroaki; Muroya, Ken; Kurosaki, Ryo; Kobayashi, Katsumi; Arakawa, Kazuhisa; Ando, Tatsumasa; Takesyohi, Izumi

    2016-12-01

    A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

  19. Comparision and Analysis of Complications of Orthotopic Splenectomy and Traditional Splenectomy in Portal Hypertension%门脉高压症原位脾切除术与传统脾切除术并发症比较分析

    Institute of Scientific and Technical Information of China (English)

    宿宝栋; 郭连明; 丁维宝; 杜福田

    2015-01-01

    目的 通过回顾性研究,比较分析原位脾切除术与传统脾切除术在治疗肝硬化门脉高压症中的出血量等并发症情况,提供一定临床指导意义. 方法 回顾潍坊市人民医院肝胆外科2003~2013年因肝硬化门脉高压症行单纯脾切除病例,共98例,按照手术方式分为原位脾切除组46例,传统脾切除组52例,统计手术中出血、输血等并发症情况,进行统计学分析比较. 结果原位脾切除组及传统脾切除组出血量分别为(281.63±109.30)ml,(422.45±153.00)ml,P<0.05;原位脾切除组0例发生胰瘘,传统脾切除组5例(9.61%)发生胰瘘,P<0.05;原位脾切除组中11例(31.42%)输血,传统脾切除中27例(51.92%)输血,P<0. 05. 结论 较传统脾切除术,原位脾切除术可减少手术中的出血量及手术输血,且术后胰瘘等并发症的发生率明显低于传统脾切除术. 对于肝硬化门脉高压症患者,原位脾切除术较传统脾切除术更具优势.%Objective To compare and analyse hemorrhage and complications of orthotopic splenectomy and traditional splenec-tomy by retrospective study .Methods Collected and looked up the illness records of hepatobiliary surgery of Weifang people 's hospital from 2003 to 2013 which was diagnosed Hepatic Cirrhosis ( HC) and Portal Hypertension ( PH) and picking the records merely had splenectomy . The total records were 98 cases and were divided into two groups ,according to different surgery methods .The orthotopic splenectomy group had 46 records,and the traditional splenectomy group had 52 records.Obtained the clinical data and did statistical analysis .Results The blood loss of the orthotopic splenectomy group and the traditional splenectomy group were (281.63±109.30)ml and (422.45±153.00)ml (P<0.05).The orthotopic splenectomy group had no pancreatic fistula and the traditional splenectomy group had 5(9.61%),P<0.05.The orthotopic splenectomy group had 11(31.42%) need transfusion and the traditional

  20. Laparoscopic splenectomy: the latest technical evaluation

    Institute of Scientific and Technical Information of China (English)

    Min Tan; Chao-Xu Zheng; Zhi-Mian Wu; Guo-Tai Chen; Liu-Hua Chen; Zhen-Xian Zhao

    2003-01-01

    AIM: To introduce our latest innovation on technical manipulation of laparoscopic splenectomy.METHODS: Under general anesthesia and carbon dioxide (CO2) pneumoperitoneum, 86 cases of laparoscopic splenectomy (LS) were performed. The patients were placed in three different operative positions: 7 cases in the lithotomic position, 31 cases in the right recumbent position and 48cases in the right lateral position. An ultrasonic scissors was used to dissect the pancreaticosplenic ligament, the splenocolicum ligament, lienorenal ligament and the lienophrenic ligament, respectively. Lastly, the gastrosplenic ligament and short gastric vessels were dissected. The splenic artery and vein were resected at splenic hilum with EndoGIA. The impact of different operative positions, spleen size and other events during the operation were studied.RESULTS: The laparoscopic splenectomy was successfully performed on all 86 patients from August 1997 to August 2002. No operative complications, such as peritoneal cavity infection, massive bleeding after operation and adjacent organs injured were observed. There was no death related to the operation. The study showed that different operative positions could significantly influence the manipulation of LS. The right lateral position had more advantages than the lithotomic position and the right recumbent position in LS.CONCLUSION: Most cases of LS could be accomplishedsuccessfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.

  1. Thrombocytosis following splenectomy: with or without additional organ resection.

    Science.gov (United States)

    Oida, Takatsugu; Kano, Hisao; Mimatsu, Kenji; Kawasaki, Atsushi; Kuboi, Youichi; Fukino, Nobutada; Kida, Kazutoshi; Amano, Sadao

    2012-06-01

    Splenectomy is one of the main causes of reactive thrombocytosis. In most cases, thrombocytosis found incidentally is harmless and resolves spontaneously; however, extreme thrombocytosis may result in thrombotic events such as acute myocardial infarction, mesenteric vein thrombosis and pulmonary embolism. Thus, there are no clear indications for determining which patients with reactive thrombocytosis require treatment. In this study, we evaluated reactive thrombocytosis that developed after splenectomy with or without additional organ resection. We retrospectively studied 70 patients who underwent splenectomy. These patients were divided into 2 groups: the only splenectomy group (group A) and the splenectomy with additional organ resection group (group B). Both the platelet count at 1 week and 1 month after the operation (pthrombocytosis at 1 week and 1 month (pthrombocytosis without any platelet reduction therapy and there was no postoperative thrombosis. Splenectomy often results in reactive thrombocytosis; however, platelet reduction therapy is not required for treating postsplenectomy reactive thrombocytosis.

  2. Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

    Directory of Open Access Journals (Sweden)

    Frederico R. Romero

    2007-02-01

    Full Text Available OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. RESULTS: Mean total operative time was 5.2 (range 3.5 - 8 hours: 84.5 (range 62 - 110 minutes for the gastric dissection, 56 (range 28 - 80 minutes for the gastric suturing, and 170.6 (range 70 to 200 minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. CONCLUSIONS: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.

  3. BACTERIAL INFECTIONS FOLLOWING SPLENECTOMY FOR MALIGNANT AND NONMALIGNANT HEMATOLOGIC DISEASES

    Directory of Open Access Journals (Sweden)

    Giuseppe Leone

    2015-10-01

    Full Text Available Splenectomy, while often necessary in otherwise healthy patients after major trauma, find its primary indication for patients with an underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP, Autoimmune Hemolytic Anemia (AIHA, Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infection found in splenectomized patients

  4. A technique for pediatric total skin electron irradiation

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    Bao Qinan

    2012-03-01

    Full Text Available Abstract Background Total skin electron irradiation (TSEI is a special radiotherapy technique which has generally been used for treating adult patients with mycosis fungoides. Recently, two infants presented with leukemia cutis isolated to the skin requiring TSEI. This work discusses the commissioning and quality assurance (QA methods for implementing a modified Stanford technique using a rotating harness system to position sedated pediatric patients treated with electrons to the total skin. Methods and Results Commissioning of pediatric TSEI consisted of absolute calibration, measurement of dosimetric parameters, and subsequent verification in a pediatric patient sized cylindrical phantom using radiographic film and optically stimulated luminance (OSL dosimeters. The depth of dose penetration under TSEI treatment condition was evaluated using radiographic film sandwiched in the phantom and demonstrated a 2 cm penetration depth with the maximum dose located at the phantom surface. Dosimetry measurements on the cylindrical phantom and in-vivo measurements from the patients suggested that, the factor relating the skin and calibration point doses (i.e., the B-factor was larger for the pediatric TSEI treatments as compared to adult TSEI treatments. Custom made equipment, including a rotating plate and harness, was fabricated and added to a standard total body irradiation stand and tested to facilitate patient setup under sedated condition. A pediatric TSEI QA program, consisting of daily output, energy, flatness, and symmetry measurements as well as in-vivo dosimetry verification for the first cycle was developed. With a long interval between pediatric TSEI cases, absolute dosimetry was also repeated as part of the QA program. In-vivo dosimetry for the first two infants showed that a dose of ± 10% of the prescription dose can be achieved over the entire patient body. Conclusion Though pediatric leukemia cutis and the subsequent need for TSEI are

  5. Total Robotic Biliopancreatic Diversion with Duodenal Switch Technique.

    Science.gov (United States)

    Antanavicius, Gintaras; Mohammed, Ricardo; Van Houtte, Olivier

    2016-12-31

    The use of robotic bariatric surgery has increased significantly since its advent in 1999. Its utility and safety has been demonstrated in the literature for all bariatric procedures, including most recently the biliopancreatic diversion with duodenal switch (BPDDS). The robotic-assisted biliopancreatic diversion with duodenal switch (RBPDDS) was first described by Sudan et al. in 2007 with the use of the robot primarily for the duodeno-ileal anastomosis, then in 2015, the same authors described 59 cases of totally RBPDDS using the robot for the most of the operation, but still utilizing laparoscopic staplers. Robotic staplers were introduced recently and it became possible to utilize robot throughout the entire procedure without relying on stapling performed by an assistant. Described here is the technique of a total RBPDDS utilizing robotic staplers.

  6. 完全腹腔镜脾切除贲门周围血管离断术处理门静脉高压症的临床应用%Clinical treatment of portal hypertension with total laparoscopic splenectomy and periesophagogastric devascularization

    Institute of Scientific and Technical Information of China (English)

    王文斌; 闫长青; 吕海涛; 周泽高; 刘学青; 李秋生; 秦建章; 刘建华

    2015-01-01

    Objective To evaluate the safety and effectiveness of laparoscopic splenectomy and periesophagogastric devascularization.Methods From September 2013 to April 2015,36 patients with cirrhosis and portal hypertension, secondary hypersplenism, and bleeding from the upper alimentary tract were operated in the Second Hospital of Hebei Medical University.Results Operation on the 36 patients were successful without a single conversion from laparoscopic to open surgery.The operative duration varied from 3.0 to 4.5 hours, and the bleeding volume were between 60 to 1 500 ml.The fart was resumed between 24 to 72 hours after operation.There were no serous complications.The duration of hospitalization was 8-15 days (mean =12 days).The follow-up of 20 patients from 1 month to 18 months after surgery indicated that hypersplenism was virtually corrected, no hepatic encephalopathy was found, and no hematemesis and melena occurred.Conclusion Total laparoscopic splenectomy and periesophagogastric devascularization are safe and effective, providing a new alternative choice to treat portal hypertension and bleeding from the upper digestive tract.%目的 探讨腹腔镜脾切除贲门周围血管离断术的安全性和有效性.方法 2013年9月至2015年4月我们对36例肝硬化门静脉高压症患者进行了腹腔镜脾切除和贲门周围血管离断术,回顾性分析其临床资料.结果 36例患者手术均获成功.无一例中转开腹手术,手术时间3.0~4.5 h,出血量60~1 500 ml,术后24 h~3 d肛门恢复排气,无严重并发症发生,术后住院8~15 d,平均12d.术后对20例随访1个月~1.5年,脾功能亢进基本纠正,无肝性脑病,未再发生呕血或黑便.结论 腹腔镜脾切除贲门周围血管离断术安全、有效,为临床处理门静脉高压症提供了一种新的治疗选择.

  7. Electronic compensation technique to deliver a total body dose

    Science.gov (United States)

    Lakeman, Tara E.

    Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient's immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has been conventionally used to compensate for the varying thickness throughout the body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Method: Treatment plans utilizing the electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two pair of parallel opposed fields. One pair of large fields is used to encompass the majority of the patient's anatomy. The other pair are very small open fields focused only on the thin bottom portion of the patient's anatomy, which requires much less radiation than the rest of the body to reach 100% of the prescribed dose. A desirable fluence pattern was manually painted within each of the larger fields for each patient to provide a more uniform distribution. Results: Dose-volume histograms (DVH) were calculated for evaluating the electronic compensation technique. In the electronically compensated plans, the maximum body doses calculated from the DVH were reduced from the conventionally-compensated plans by an average of 15%, indicating a more uniform dose. The mean body doses calculated from the electronically compensated DVH remained comparable to that of the conventionally-compensated plans, indicating an accurate delivery of the prescription dose using electronic compensation. All calculated monitor units were within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not increase the beam on time beyond clinically acceptable limits while it can substantially reduce the compensator setup

  8. [Impact of splenectomy and/or distal pancreatectomy in the prognosis of the proximal gastric cancer].

    Science.gov (United States)

    Mori Gonzales, Edmundo; Celis, Juan; Ruiz, Eloy; Payet, Eduardo; Berrospi, Francisco; Chavez, Iván; Young, Frank; Luque, Carlos; Montes, Jaime

    2012-01-01

    Identify prognostic factors associated to total or proximal gastrectomy with or without splenectomy and / or distal pancreatectomy in patient with proximal gastric cancer. Evaluate the frequency of lymph node metastasis to the hilum and splenic artery, postoperative morbidity and mortality and the impact of lymphadenectomy of group 10 and 11 on long term survival. We performed an observational, descriptive, longitudinal and retrospective study analyzing patients with diagnostic of proximal third gastric adenocarcinoma subjected to total or proximal gastrectomy with or without splenectomy or distal pancreatectomy in the service of Abdomen of the Instituto Nacional de Enfermedades Neoplásicas between 1990 and 2005. Overall survival for each of the groups was calculated using the Kaplan-Meier method, prognostic factors were evaluated using univariate and multivariate analysis. We studied 219 patients with proximal third gastric adenocarcinoma (cardias and bottom), of wich, according to inclusion criteria, only qualify 129 (N=129): 22 (17.1%) were treated by gastrectomy alone, 79 (61.2%) gastrectomy associated witch splenectomy and 28 (21.7%) gastrectomy with distal pancreatosplenectomy, constituting three treatment groups. We compared the survival of each group and each factor analyzed, determining the following prognostic factors: lymph node metastasis (N2-N3), degree of differentiation, undifferentiated tumors and Borrmann III and IV tumors. Neither splenectomy or distal pancreatectosplenectomy improved survival compared to the gastrectomy alone. The morbidity and mortality was higher in patients with more aggressive but more aggressive surgery without significant value. The number of nodes removed in patients who had pancreatosplenectomy and /or splenectomy was higher, however, had no impact on survival at 5 years.

  9. Chronic total occlusions — Current techniques and future directions

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    George Touma

    2015-06-01

    Full Text Available Chronic total occlusions (CTOs of coronary arteries represent a common and significant challenge to interventional cardiology. Medical therapy is often regarded as an adequate long term strategy in the management of these lesions with surgical intervention for refractory symptoms. Extensive collateralisation is used as a marker of distal coronary perfusion, further reinforcing non-invasive strategies. This together with relatively low percutaneous success rates outside of specialised centres has meant that rates of percutaneous intervention have remained low. Increasing evidence suggests that CTOs are not a benign entity. Further, symptom control and quality of life improve significantly with successful percutaneous revascularisation. Both factors have reignited interest in percutaneous modalities. The Japanese have been pioneers in the field of CTO intervention although their success rates have been difficult to replicate. New techniques and equipment developed in North America offer an alternative to the Japanese approach. These techniques focus on time, radiation and contrast minimisation. This review will assess the histopathology of CTO and shifting paradigms in CTO treatment strategies.

  10. Total lymphoid irradiation in the Wistar rat: technique and dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Hoogenhout, J.; Kazem, I.; de Jong, J.

    1983-01-01

    The technical and dosimetric aspects of total lymphoid irradiation (TLI) in the Wistar rat were evaluated as part of a set-up to develop a new model for tumor xenotransplantation. Information obtained from anatomical dissections, radionuclide imaging of the spleen, lymphography and chromolymphography was used to standardize the localization portals cut out in a lead plate. The two portals encompassed the lymphoid tissue above and below the diaphragm. A specially designed masonite phantom was used to measure the dose distribution in the simulated target volumes. Ionization chamber dosimetery, thermoluminescence dosimetry and film densitometry were used for measuring exposure and absorbed dose. Irradiation was performed with 250 kV X rays (HVL 3.1 mm Cu). The dose rate was regulated by adjusting the treatment distance. The dose inhomogeneity measured in the target volumes varied between 80-100%. The side scatter dose to non target tissues under the shielded area between the two portals ranged between 20-30%. The technique and dosimetry of total lymphoid irradiation in Wistar rats are now standardized and validated and pave the way for tumor xenotransplantation experiments.

  11. Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma

    Institute of Scientific and Technical Information of China (English)

    Rajko Milosevic; Milena Todorovic; Bela Balint; Miodrag Jevtic; Miodrag Krstic; Elizabeta Ristanovic; Nebojsa Antonijevic; Mirjana Pavlovic; Maja Perunicic; Milan Petrovic; Biljana Mihaljevic

    2009-01-01

    AIM:To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS).METHODS:A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined.Splenectomy plus chemotherapy was applied in 20 patients,while splenectomy as a single treatment-option was performed in 10 patients.Prognostic factor and overall survival rate were analyzed.RESULTS:Complete remission (CR) was achieved in 20 (66.7%),partial remission (PR) in seven (23.3%),and lethal outcome due to disease progression occurred in three (10.0%) patients.Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank=0.056,P>0.05).Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions,as measured by computerized tomography and ultra-sound (t=2.558,P=0.018).Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244,P 0.05) effects on the OS.The expression of other antigens (immunohistochemistry) also had no effect on survival-rate,as measured by a χ2 test (P > 0.05).CONCLUSION:Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration;however,a larger controlled clinical study is required to confirm our findings.

  12. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Directory of Open Access Journals (Sweden)

    Srikanth G

    2011-01-01

    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  13. Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation

    Institute of Scientific and Technical Information of China (English)

    XU Wei-li; LI Suo-lin; WANG Yan; SHI Bao-jun; LI Meng; LI Ying-chao; ZHONG Zhi-yong; LI Zhen-dong

    2009-01-01

    Background Laparoscopic splenectomy (LS) is currently the standard approach for resection of a normal-sized spleen.However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging (CDFI) in splenic vessel anatomy and evaluated its value for LS.Methods Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size (CDFI group). In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed (non-CDFI group). Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student's ttest.Results All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the

  14. Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura : only splenectomy induces a complete remission

    NARCIS (Netherlands)

    Louwes, H; Vellenga, E; Houwerzijl, EJ; de Wolf, JTM

    2001-01-01

    Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous disease, whereby it is unclear if and in which way prednisone and splenectomy affect the platelet kinetics leading to a complete remission. To determine the effects of prednisone and splenectomy on the mean platelet life (MPL) and platelet

  15. Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype

    Directory of Open Access Journals (Sweden)

    Motomura Takashi

    2012-11-01

    Full Text Available Abstract Background IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined. Methods Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group and 90 who did not (non-Spx group were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15 and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen. Results Sustained virological response (SVR rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3% and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P 3/μl vs 168.7 × 103/μl, P Conclusions IL28B genetic variants correlated with response to PEG-IFN/RBV following splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype.

  16. Modified techniques of heterotopic total small intestinal transplantation in rats

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ting Wu; Jie-Shou Li; Xiao-Fei Zhao; Wen Zhuang; Xie-Lin Feng

    2002-01-01

    AIM: To establish a successful model of heterotopictotal small intestinal transplantation (SIT) in rats inorder to reduce the complications and increase thesurvival rate.METHODS: A total of 196 Wistar rats underwentheterotopic SIT with microsurgical technique. Technicalmodifications included shortening fasting time andsupplying energy before surgery, administering optimalvolume of crystalloid fluid to the donor and recipientduring surgical procedures, reducing mechanical andischemic injuries to donor intestine, revascularizingsmall intestinal graft with a combination ofconventional aorta to aorta anastomosis and a cuffedportal vein to left renal vein anastomosis which resultedin an acceptably short warm ischemic time, and alsoan adequate blood supply and drainage of the graft.RESULTS: The average time for the donor surgery was86min±20min, the mean operative time for therecipient was 115min±20min and warm ischemia timewas shortened to 40min±5min. There was a shorterrevascularizing time of the graft, the abdominal aorta(AA) to AA anastomosis being 21min±10min, and thecuffed portal vein (PV) to the renal vein anastomosisbeing 5min±5min.The one-week survival rate of 98 ratswith SIT was 88.78% (87/98), without thrombosis andstenosis of anastomosis. The longest survival time ofrecipient rats was more than 389 days after SIT, therats were maintaining normal weight, with perfectintestinal function and intact intestinal histology.CONCLUSION: These modified techniques for SIT wouldremarkably reduce the complications and improve survival rate in rats, which provided a potentially more consistent and practical model for experimental andclinical studies.

  17. An overwhelming post-splenectomy infection (OPSI

    Directory of Open Access Journals (Sweden)

    Elbadawi O

    2012-09-01

    Full Text Available We present the case of a 25 year old man who had a splenectomy five years previously following a road traffic accident (RTA. He presented to our A&E department one evening with fever and upper abdominal pain associated with nausea and vomiting. Clinical examination was unremarkable. Initial investigations revealed only pyuria. He was treated symptomatically along with parenteral antibiotic and admitted to the general medical ward. Within few hours he deteriorated rapidly with septic shock, multi-organ failure, disseminated intravascular coagulation (DIC and eventually cardio-respiratory arrest. Despite all resuscitative measures he died within few hours of admission. Splenectomized patients are prone to develop severe infection, including sepsis and meningitis, due to OPSI, or overwhelming post-splenectomy infection. Presentation may be mild, but the course is rapid and the prognosis is very poor, even in young people. It is important that splenectomized patients receive vaccines according to guidelines, take antibiotic prophylaxis and are educated to seek medical attention at the earliest sign of even minor infections.

  18. Splenectomy normalizes hematocrit in murine polycythemia vera.

    Directory of Open Access Journals (Sweden)

    Jan-Rung Mo

    Full Text Available Splenic enlargement (splenomegaly develops in numerous disease states, although a specific pathogenic role for the spleen has rarely been described. In polycythemia vera (PV, an activating mutation in Janus kinase 2 (JAK2(V617 induces splenomegaly and an increase in hematocrit. Splenectomy is sparingly performed in patients with PV, however, due to surgical complications. Thus, the role of the spleen in the pathogenesis of human PV remains unknown. We specifically tested the role of the spleen in the pathogenesis of PV by performing either sham (SH or splenectomy (SPL surgeries in a murine model of JAK2(V617F-driven PV. Compared to SH-operated mice, which rapidly develop high hematocrits after JAK2(V617F transplantation, SPL mice completely fail to develop this phenotype. Disease burden (JAK2(V617 is equivalent in the bone marrow of SH and SPL mice, however, and both groups develop fibrosis and osteosclerosis. If SPL is performed after PV is established, hematocrit rapidly declines to normal even though myelofibrosis and osteosclerosis again develop independently in the bone marrow. In contrast, SPL only blunts hematocrit elevation in secondary, erythropoietin-induced polycythemia. We conclude that the spleen is required for an elevated hematocrit in murine, JAK2(V617F-driven PV, and propose that this phenotype of PV may require a specific interaction between mutant cells and the spleen.

  19. Electron tomography based on a total variation minimization reconstruction technique

    Energy Technology Data Exchange (ETDEWEB)

    Goris, B., E-mail: bart.goris@ua.ac.be [EMAT, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp (Belgium); Van den Broek, W. [EMAT, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp (Belgium); Batenburg, K.J. [Centrum Wiskunde and Informatica, Science Park 123, NL-1098XG Amsterdam (Netherlands); Vision Lab, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk (Belgium); Heidari Mezerji, H.; Bals, S. [EMAT, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp (Belgium)

    2012-02-15

    The 3D reconstruction of a tilt series for electron tomography is mostly carried out using the weighted backprojection (WBP) algorithm or using one of the iterative algorithms such as the simultaneous iterative reconstruction technique (SIRT). However, it is known that these reconstruction algorithms cannot compensate for the missing wedge. Here, we apply a new reconstruction algorithm for electron tomography, which is based on compressive sensing. This is a field in image processing specialized in finding a sparse solution or a solution with a sparse gradient to a set of ill-posed linear equations. Therefore, it can be applied to electron tomography where the reconstructed objects often have a sparse gradient at the nanoscale. Using a combination of different simulated and experimental datasets, it is shown that missing wedge artefacts are reduced in the final reconstruction. Moreover, it seems that the reconstructed datasets have a higher fidelity and are easier to segment in comparison to reconstructions obtained by more conventional iterative algorithms. -- Highlights: Black-Right-Pointing-Pointer A reconstruction algorithm for electron tomography is investigated based on total variation minimization. Black-Right-Pointing-Pointer Missing wedge artefacts are reduced by this algorithm. Black-Right-Pointing-Pointer The reconstruction is easier to segment. Black-Right-Pointing-Pointer More reliable quantitative information can be obtained.

  20. Inter-technique validation of tropospheric slant total delays

    Science.gov (United States)

    Kačmařík, Michal; Douša, Jan; Dick, Galina; Zus, Florian; Brenot, Hugues; Möller, Gregor; Pottiaux, Eric; Kapłon, Jan; Hordyniec, Paweł; Václavovic, Pavel; Morel, Laurent

    2017-06-01

    An extensive validation of line-of-sight tropospheric slant total delays (STD) from Global Navigation Satellite Systems (GNSS), ray tracing in numerical weather prediction model (NWM) fields and microwave water vapour radiometer (WVR) is presented. Ten GNSS reference stations, including collocated sites, and almost 2 months of data from 2013, including severe weather events were used for comparison. Seven institutions delivered their STDs based on GNSS observations processed using 5 software programs and 11 strategies enabling to compare rather different solutions and to assess the impact of several aspects of the processing strategy. STDs from NWM ray tracing came from three institutions using three different NWMs and ray-tracing software. Inter-techniques evaluations demonstrated a good mutual agreement of various GNSS STD solutions compared to NWM and WVR STDs. The mean bias among GNSS solutions not considering post-fit residuals in STDs was -0.6 mm for STDs scaled in the zenith direction and the mean standard deviation was 3.7 mm. Standard deviations of comparisons between GNSS and NWM ray-tracing solutions were typically 10 mm ± 2 mm (scaled in the zenith direction), depending on the NWM model and the GNSS station. Comparing GNSS versus WVR STDs reached standard deviations of 12 mm ± 2 mm also scaled in the zenith direction. Impacts of raw GNSS post-fit residuals and cleaned residuals on optimal reconstructing of GNSS STDs were evaluated at inter-technique comparison and for GNSS at collocated sites. The use of raw post-fit residuals is not generally recommended as they might contain strong systematic effects, as demonstrated in the case of station LDB0. Simplified STDs reconstructed only from estimated GNSS tropospheric parameters, i.e. without applying post-fit residuals, performed the best in all the comparisons; however, it obviously missed part of tropospheric signals due to non-linear temporal and spatial variations in the troposphere. Although the

  1. Laparoscopic Partial Splenectomy for Giant Hemangioma Misdiagnosed as Splenic Cyst: a Case Report

    Institute of Scientific and Technical Information of China (English)

    Jin Wang; Jian-chun Yu; Wei-ming Kang; Zhi-qiang Ma

    2010-01-01

    @@ ALTHOUGH unusual, hemangioma is the most common type of primary splenic neoplasm.1 Usually, splenic hemangioma appears as solid mass, but sometimes it presents cystic corn-ponent as well, which is difficult to discriminate from some other lesions, such as abscess, simple cyst, parasitic cyst, and lymphangioma.2 Preoperative diagnosis of splenic hemangioma mainly depends on imaging study (e.g. Ultra-sonography, CT, MRI). As the laparoscopic technique de-velops, laparoscopic splenectomy is becoming the standard treatment for benign tumor of the spleen. Compared with that procedure, laparoscopic partial splenectomy (LPS) has some unique advantages except for higher requirements for surgical skills. We described in this report a successful LPS in a patient who was misdiagnosed as splenic cyst initially.

  2. Esplenectomia laparoscópica Laparoscopic splenectomy

    Directory of Open Access Journals (Sweden)

    Julio Cezar Uili Coelho

    2004-06-01

    Full Text Available OBJETIVO: O objetivo do presente estudo é avaliar a segurança e as complicações relacionadas à esplenectomia laparoscópica. MÉTODO: Análise retrospectiva dos pacientes submetidos à esplenectomia laparoscópica entre janeiro de 1998 e março de 2003. RESULTADOS: Trinta e cinco pacientes (22 mulheres e 13 homens foram submetidos a esplenectomia laparoscópica. As indicações cirúrgicas para esplenectomia foram: púrpura trombocitopênica idiopática (29 pacientes, linfoma (3, anemia hemolítica (2 e esferocitose (1. O tamanho médio do baço foi de 12cm (entre 7 e 27cm e o peso médio 262gr (entre 30 e 1850gr. Baço acessório foi encontrado em seis pacientes (17%. O tempo cirúrgico médio foi de 195 minutos (entre 120 e 270 minutos. Houve três casos (8% de sangramento intra-operatório, resultando em dois casos de conversão. Outros dois casos de conversão ocorreram por espaço inadequado em pacientes com baço gigante, 24 e 27cm. Complicações pós-operatórias ocorreram em três pacientes (8%. O tempo médio de internação hospitalar foi de 1,7 dia (entre 1 e 7dias. CONCLUSÕES: A esplenectomia laparoscópica é segura e está associada à baixa taxa de complicações e curto período de hospitalização. Fatores limitantes são a experiência do cirurgião, obesidade do paciente e esplenomegalia.BACKGROUND: To evaluate the feasibility and complications of laparoscopic splenectomy. METHODS: Retrospective assessment of medical records of the patients who underwent laparoscopic splenectomy from January of 1998 to March of 2003. RESULTS: Thirty-five patients (22 female, 13 male underwent laparoscopic splenectomy. The indications were: idiopathic thrombocytopenic purpura (29 patients, lymphoma (3, hemolytic anemia (2, spherocytosis (1. The mean size of the spleen was 12cm (from 7cm to 27cm, and the mean weight was 262gr (from 30gr to 1850gr. Accessory spleen was found in six patients. The mean operative time was 195min (form 120 to

  3. Effect of splenectomy on liver cirrhosis and related surgical issues

    Directory of Open Access Journals (Sweden)

    KONG Degang

    2016-12-01

    Full Text Available Patients with liver fibrosis and cirrhosis experience certain changes in spleen morphology and function, and there is always a controversy over whether to perform splenectomy in patients with liver cirrhosis. As a surgical treatment of recurrent portal hypertension complicated by esophagogastric variceal bleeding, splenectomy can reduce portal venous pressure, reduce the possibility of gastrointestinal bleeding, and correct the reduced white blood cell count and platelet count. It can also protect the liver by improving liver function, promoting regeneration of hepatocytes, and inhibiting the progression of liver fibrosis. With reference to available clinical and laboratory data, this article reviews the effect of splenectomy on the cirrhotic liver and related issues such as selection of surgical procedures and prevention and treatment of postoperative complications, in order to promote splenectomy in patients with liver cirrhosis.

  4. Splenectomy for hematologic disease. The UCLA experience with 306 patients.

    Science.gov (United States)

    Musser, G; Lazar, G; Hocking, W; Busuttil, R W

    1984-07-01

    Between 1956 and 1981, 306 splenectomies for hematologic diseases were performed at the UCLA Medical Center. Of these operations, more than 75% were performed for therapeutic reasons to control anemia, thrombocytopenia, neutropenia, or painful symptoms of splenomegaly. Of the 65 patients who had idiopathic thrombocytopenic purpura, 77% showed an excellent response, and of the 39 patients who had hereditary spherocytosis, 90% responded. Other diseases with predictably good response rates were autoimmune hemolytic anemias, Felty's syndrome, and hairy cell leukemia. Forty patients with Hodgkin's disease had splenectomies for diagnostic purposes the last 10 years. The overall morbidity and mortality were 24% and 6%, respectively, the most common complications being pneumonia, wound infections, and local postoperative bleeding, and the most common cause of death being sepsis. The review supports the thesis that in carefully selected patients, therapeutic splenectomy can have desirable palliative effects and that diagnostic splenectomy has a sufficiently low risk to warrant its consideration in patients with Hodgkin's disease.

  5. Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

    Science.gov (United States)

    Gross, Christopher E; Neumann, Julie A; Godin, Jonathan A; DeOrio, James K

    2016-04-01

    Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

  6. Total Ossiculoplasty: Advantages of Two-Point Stabilization Technique

    Directory of Open Access Journals (Sweden)

    Leonard Berenholz

    2012-01-01

    Full Text Available Objective. Evaluate a porous polyethylene prosthesis with two-point stabilization in total ossiculoplasty. This approach utilizes a lateral as well as a medial graft to stabilize a total ossicular prosthesis (TOP. Study Design. Retrospective cohort review of total ossiculoplasty. Methods. All patients who underwent total ossiculoplasty during the years 2004–2007 were included in the study group. Only five patients (10% had primary surgery whereas 45 (90% underwent revision surgery. Cartilage grafts covering the prosthesis (Sheehy, Xomed laterally were used in all patients with areolar tissue being used for medial stabilization at the stapes footplate. Follow-up examination and audiometrics were performed a mean of 8.1 months following surgery. Results. The percentage of patients closing their ABG to within 10 dB was 44% with 66% closing their ABG to within 20 dB. The mean four-frequency hearing gain was 15.7 dB. The mean postoperative ABG was 15.7 dB. Conclusion. Audiometric results following total ossiculoplasty surgery using two-point stabilization exceeded results from the otologic literature. Proper two-point fixation with areolar tissue and stabilization utilizing cartilage were the keys to achieving a relatively high percentage of success in chronic ear disease in this sample.

  7. Our clinical experience on laparoscopic splenectomy: Outcomes of 38 patients

    Directory of Open Access Journals (Sweden)

    Zübeyir Bozdağ

    2015-12-01

    Full Text Available Objective: Laparoscopic splenectomy has gained widespread acceptance in the treatment of hematological diseases in recent years. In this study, we aimed to present the outcomes of the patients who underwent laparoscopic splenectomy. Methods: Between 2012 and 2015, the data of 38 patients, who underwent laparoscopic splenectomy for hematological diseases at our clinic, were evaluated retrospectively. Results: 15 males and 23 females patients were underwent laparoscopic splenectomy, and the average age was 33.9 ± 12.9 years. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP in 34 patients, and hereditary spherocytosis in 4 patients. During the surgical exploration, accessory spleen was detected in 7 patients, and removed. Laparoscopic cholecystectomy was performed at the same session in 2 hereditary spherocytosis patients who had stones in the gallbladder. One patient was converted to the open surgery due to the bleeding which was eliminated the exposure during the dissection. At the postoperative period, we observed atelectasis in one patient, and wound fat necrosis in one patient. In addition, thrombocytosis was observed in one patient. Hematological treatment was continued because of persistent refractory thrombocytopenia in two patients, and temporary thrombocytopenia in four patients. An accessory spleen was detected with splenic scintigraphy in one of these patients at the postoperative period. The average hospitalization time was 2.6 ± 0.7 days. Conclusion: Laparoscopic splenectomy for hematological diseases may be considered as first-line therapy with less hospital stay and morbidity.

  8. Total Dose Hardness Assurance. Volume I. Identification of Techniques.

    Science.gov (United States)

    1980-02-01

    under Contract F29601-78-C-0022. The project officer for the Air Force was Mr. Roe J. Maier. The program manager and principal investigator for BDM was...Assurance Techniques," AFWL-TR-73-134, 3 Volumes, January 1974. 44. Bruncke, W. C. et al. " Tecniques for Screening Bipolar Transistor Degradation Due to

  9. Evaluation of Tricuspid Regurgitant Jet Velocity in Thalassemia Patients with Splenectomy

    Directory of Open Access Journals (Sweden)

    Nikparvar

    2015-02-01

    Full Text Available Background β-thalassemia is an inherited disorder of β-globin biosynthesis. Dysfunction in hemoglobin chain production, ineffective erythropoiesis, and hemolysis occur in β-thalassemia. Pulmonary arterial hypertension (PAH is increasingly detected in patients with β-thalassemia, and splenectomy which decreases the need for blood transfusion increases the pulmonary artery pressure (PAP. Objectives This study aimed to assess the PAP in patients with β-thalassemia (male or female and major or intermedia who had undergone splenectomy. Methods A total of 137 patients suffering from β-thalassemia were evaluated during the study. All subjects were referred for cardiac evaluation. Clinical history, presence of cardiac symptoms, and previous splenectomy were noted. Standard M-mode, 2D, and Doppler echocardiographic examinations were performed for all subjects. Patients with a tricuspid regurgitant jet velocity (TRV ≥ 2.5 m/s were considered at risk for PAH. Results Average age of the patients was 21.15 ± 6.68 years. No significant difference was observed in the PAP between the 2 groups of thalassemia major and intermedia and also the 2 sex groups. Indeed, 6.6% of the patients had an increased PAP. The significant finding of the study was that the patients who had had splenectomy were significantly at an increased risk of PAH (P = 0.046. Conclusions The etiology of PAH in thalassemia is multifactorial such as inflammatory mediators. Also, the absence of the spleen plays an important role in developing a high TRV and PAH.

  10. Postoperative outcomes after open splenec-tomy versus laparoscopic splenectomy in cirrhotic patients:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Khaled Al-raimi; Shu-Sen Zheng

    2016-01-01

    BACKGROUND: Laparoscopic splenectomy is considered the gold standard for resecting normal-to-moderately bigger spleens in benign conditions, and in addition could be tried for patients with malignant splenic disorders. However, the safety of laparoscopic splenectomy in patients with hyper-splenism is not well-known. This study aimed to investigate the efficacy and safety of laparoscopic splenectomy for pa-tients with hypersplenism secondary to liver cirrhosis by com-paring with the open splenectomy. DATA SOURCES: Several databases were searched to identify comparative studies fulfilling the predefined selection criteria from January 2000 to June 2015. The subsequent key words were utilized for browsing “laparoscopy” or “laparoscopic”,“open”, “splenectomy”, and “liver cirrhosis”. Studies evaluat-ing laparoscopic and open splenectomy for patients with liver cirrhosis were incorporated. Two evaluators personally strained the title and abstract of each publication. Citations with contemplated compliance within our eligibility criteria underwent compressed review. Meta-analysis was carried out according to the recommendations of the Cochrane Collabo-ration software (review manager 5.1). RESULTS: Seven studies containing 509 patients were included. Compared with the open splenectomy group, patients in the laparoscopic splenectomy group had significantly less intraop-erative blood loss (MD=210.30; 95% CI: 11.28-409.32; P=0.04), longer operative time (MD=-31.58; 95% CI: -53.34--9.82; P=0.004), shorter duration of postoperative hospital stay (MD=3.41;95% CI: 2.39-4.43; P CONCLUSION: Hypersplenism secondary to cirrhosis and portal hypertension should not be a contraindication for lapa-roscopic splenectomy.

  11. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Koning, G G; Wetterslev, J; van Laarhoven, C J H M

    2013-01-01

    Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared...

  12. Cluster Studies of Chemisorption Using Total Energy Techniques.

    Science.gov (United States)

    Wander, Adrian

    Available from UMI in association with The British Library. Requires signed TDF. Chapter 1 introduces the topic. Chapter 2 contains a discussion of ab initio quantum chemistry techniques and in particular the self consistent Hartree-Fock equations. Section 2.2 discusses the Hartree -Fock equations and their matrix form the Roothaan-Hall equations. Section 2.3 deals with the important question of the choice of a basis set for molecular calculations and in section 2.4 we move on to present a brief review of the GAMESS SCF MO package. Finally, section 2.5 deals with methods of moving beyond HF theory by including electron -electron correlation effects. Chapters 3, 4 and 5 deal with applications of the ab initio method to real systems. Chapter 3 details calculations performed on the formate and methoxy radicals on the Cu(100) surface, while chapter 4 looks at the controversial topic of the low temperature structure of oxygen on Cu(110). Finally, chapter 5 considers the effects of atomic oxygen chemisorption on the Si(100)(2 times 1) reconstructed surface. While the preceding three chapters highlight the virtues of ab initio methods, chapter 6 points out some of their vices and in particular the severe demands they make on computational resources. Alternative semi-empirical techniques are then introduced in the form of the extended Huckel and ASED methods. In particular, we discuss the role of charge self consistency in semi-empirical techniques and show that in contrast to other methods, it has little effect on the quality of results produced using the ASED method. Finally, we conclude in chapter 7 by reviewing the thesis and suggesting possible future developments to this work, both in terms of interesting systems to investigate and new directions in which the theory could be developed. (Abstract shortened with permission of author.).

  13. Applying total quality management techniques to improve software development.

    Science.gov (United States)

    Mezher, T; Assem Abdul Malak, M; el-Medawar, H

    1998-01-01

    Total Quality Management (TQM) is a new management philosophy and a set of guiding principles that represent the basis of a continuously improving organization. This paper sheds light on the application of TQM concepts for software development. A fieldwork study was conducted on a Lebanese software development firm and its customers to determine the major problems affecting the organization's operation and to assess the level of adoption of TQM concepts. Detailed questionnaires were prepared and handed out to the firm's managers, programmers, and customers. The results of the study indicate many deficiencies in applying TQM concepts, especially in the areas of planning, defining customer requirements, teamwork, relationship with suppliers, and adopting standards and performance measures. One of the major consequences of these deficiencies is considerably increased programming errors and delays in delivery. Recommendations on achieving quality are discussed.

  14. Splenic cysts: a new approach to partial splenectomy--case report and review of the literature.

    Science.gov (United States)

    Yavorski, C C; Greason, K L; Egan, M C

    1998-08-01

    Cysts of the spleen are rare entities and can be classified as either primary or secondary depending on the presence of a true epithelial lining. We report such a case in a young woman who presented with a symptomatic primary splenic cyst that was located in the lower pole of the spleen. We performed a partial splenectomy using a TA-90 stapler. The stapler provided excellent hemostasis and represents a convenient and safe technique for a resection. We recommend employment of this technique when faced with a similar case.

  15. [Chronic pulmonary thromboembolism revealing beta-thalassemia intermedia after splenectomy].

    Science.gov (United States)

    Pierre, B; Maillot, F; Casset-Sedon, D; Regina, S; Sitbon, O; Cosnay, P

    2006-12-01

    The clinical expression of beta-thalassemia intermedia is variable and complications are more frequent than in the minor form. Thromboembolism risk increase after splenectomy. Few cases of the type of complications are reported. A man was admitted for beta-thalassemia intermedia with moderate chronic hemolysis anemia, complicated by chronic pulmonary thromboembolism and liver iron overload. Post-traumatic splenectomy probably increase the risk of this two complications. The patient's respiratory status improved following bosentan therapy without worsening his hepatopathy. The present study also notes that thromboembolism complications can be an indicator of beta thalassemia and interrogate about the risk and the benefit of splenectomy in the treatment of beta-thalassemia intermedia.

  16. Optimization of the skin total irradiation technique with electrons; Optimizacion de la tecnica de irradiacion cutanea total con electrons

    Energy Technology Data Exchange (ETDEWEB)

    Reggio, F. [Universidad Central de Venezuela, Caracas (Venezuela). Escuela de Fisica; Davila, J. [Instituto Medico La Floresta, Caracas (Venezuela). Unidad de Radioterapia Oncologica GURVE

    2004-07-01

    The Total Skin Electron Irradiation (TSEI) is one of the special techniques of radiotherapy, and it allows achieving an effective Mycosis Fungoides (MF) control. The general objective of this research was to reduce the dose variations on patients surface with MF treated with the TSEI used in La Floresta Medical Institute Radiation Unit, Caracas, Venezuela. The first step was a dosimetry evaluation of the initial technique. According with these results, we proposed several modifications, which produced a great improvement about dose uniformity on the patients skin, and at the same time simplify the initial technique. (author)

  17. Kinetics of small lymphocytes in normal and nude mice after splenectomy

    DEFF Research Database (Denmark)

    Hougen, H P; Hansen, F; Jensen, E K

    1977-01-01

    Autoradiography and various quantitations on lymphoid tissues have been used to evaluate the kinetics of small lymphocytes in normal (+/nu or +/+) and congenitally athymic nude (nu/nu) NMRI mice 1 month after splenectomy or sham-splenectomy. The results indicate that splenectomy causes depressed...

  18. Implementation of the phenomenon of total reflection for total reflection X-Ray fluorescence spectrometry technique simulation

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcio H. dos; Anjos, Marcelino J. dos; Oliveira, Luis F. de, E-mail: marciohsantos2010@gmail.com, E-mail: bmarcelin@uerj.br, E-mail: clfolive@uerj.br [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Programa de Pos-Graduacao em Fisica; Albuquerque, Marcelo P. de, E-mail: mpalbuquer@gmail.com [Centro Brasileiro de Pesquisas Fisicas (CBPF), Rio de Janeiro, RJ (Brazil). Coordenacao de Atividades Tecnicas

    2015-07-01

    Within the scientific research field, X-ray fluorescence spectrometry is a basic technique for chemical analysis of materials, allowing recognition and study of the elemental nature of a particular sample. With this technique, the researcher uses different devices such as X-ray tubes, radioactive sources, monochromators crystals, capillaries, slits and waveguides, Si-Li detectors and scintillators. Furthermore, one can provide these elements with different arrangements in order to obtain a better configuration. One of the X-ray fluorescence spectrometry variants is the total reflection X-ray fluorescence spectrometry. It is based on the optical phenomenon of total reflection observed when a radiation beam impinges on a surface below a critical angle. Two important characteristics of this technique are to minimize the generation of background derived from the reflector support and allow the radiation interaction with very thin samples (thickness between 100 nm and 15 μm). The goal of the paper is to show the computational modeling of the physical phenomenon of total reflection that enables the implementation of total reflection X-ray fluorescence spectrometry technique through the simulator developed at Institute of Physics of the University of the State of Rio de Janeiro with parallel and distributed processing features. The simulator at hand is already available for implementation of energy dispersive X-ray fluorescence spectrometry. Through it, they are shown three simulations, each based on a particular apparatus: a set of reflectors, a capillary and a waveguide with lucite reflectors. (author)

  19. Combined total body X-ray irradiation and total skin electron beam radiotherapy with an improved technique for mycosis fungoides

    Energy Technology Data Exchange (ETDEWEB)

    Halberg, F.E.; Fu, K.K.; Weaver, K.A.; Zackheim, H.S.; Epstein, E.H. Jr.; Wintroub, B.U.

    1989-08-01

    Twelve consecutive patients with advanced stage mycosis fungoides (MF) were treated with combined total body X ray irradiation (TBI) and total skin electron beam radiotherapy (EBRT). Six had generalized plaque disease and dermatopathic nodes, three had tumor stage disease and node biopsy positive for mycosis fungoides, and three had erythroderma/Sezary syndrome. The treatment regimen consisted of split course total body X ray irradiation, given in twice weekly 15 cGy fractions to 75 cGy, then total skin electron beam radiation therapy given in once weekly 400 cGy fractions to a total dose of 2400 cGy. Underdosed areas and areas of greatest initial involvement were boosted 400 cGy twice weekly for an additional 1200 cGy. This was followed by a second course of total body X ray irradiation, to a total dose of 150 cGy. The total skin electron beam radiotherapy technique is a modification of an established six position EBRT technique for mycosis fungoides. Measurements to characterize the beam with and without a lexan scattering plate, demonstrated that the combination of no-plate beams produced better dose uniformity with a much higher dose rate. This improved technique is particularly advantageous for elderly and/or frail patients. Nine (75%) of the 12 patients achieved complete response (CR). The other three had significant improvement with greater than 80% clearing of their disease and resolution of symptoms. All six patients with generalized plaque disease achieved complete response and remained free of disease from 2 to 16 months. Two of three node positive patients also achieved complete response; one, with massive biopsy-documented mycosis fungoides nodal disease and deep open tumors, remained relapse-free over 2 years. Only one of the three patients with erythroderma/Sezary syndrome achieved a complete response, which was short lived.

  20. Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children

    Directory of Open Access Journals (Sweden)

    Pal Kamalesh

    2010-01-01

    Full Text Available Aim : Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS. Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods : Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1-4, left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm, and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results : There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3-4 days. Conclusion : CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.

  1. Laparoscopic Splenectomy for Hairy Cell Leukemia in Pregnancy

    Directory of Open Access Journals (Sweden)

    Beni Adegoke Adeniji

    2010-01-01

    Conclusion. Hairy cell leukemia is a clonal B-Cell malignancy, for which there is very limited experience worldwide for its management when it occurs during pregnancy. Laparoscopic splenectomy should be considered as a therapeutic option, even with a significantly enlarged spleen, in order to avoid the risks of fetal exposure to chemotherapeutic agents. Unique considerations relating to pregnancy are highlighted.

  2. Successful rescue of refractory, severe antibody mediated rejection with splenectomy.

    Science.gov (United States)

    Kaplan, Bruce; Gangemi, Antonio; Thielke, James; Oberholzer, José; Sankary, Howard; Benedetti, Enrico

    2007-01-15

    Antibody-mediated rejection (AMR) commonly occurs after transplantation of ABO-incompatible and sensitized renal transplant. Treatment regimens commonly include a combination of plasmapheresis (PL) and intravenous immunoglobulin (IVIG). However, some cases of AMR remain refractory to treatment. We report a case series of four patients with AMR refractory to standard therapy (ST) who resolved after splenectomy. Four living donor kidney transplant recipients were diagnosed with AMR. Two patients were ABO incompatible, one was cross-match positive and one had no obvious predisposing factors. After failure of therapy with corticosteroids, PL, IVIG, Thymoglobulin, and Rituximab (three patients) or Campath (one patient), AMR was treated with laparoscopic splenectomy. After an average of 11 days of ST, laparoscopic splenectomy was performed for rescue. The urinary output improved immediately in all patients, serum creatinine levels decreased within 48 hr, and ABO titers fell in the ABO-incompatible patient and the cross-match became negative in the two sensitized patients. Splenectomy may play a role in the treatment of AMR refractory to ST.

  3. Role of splenectomy for immune thrombocytopenic purpura (ITP) in ...

    African Journals Online (AJOL)

    105, No. 5. Immune thrombocytopenia (ITP) is an autoimmune disorder ... ART era and its role in HIV-associated ITP in the current era of ART needs to be ... in B lymphocytes and has been studied in treatment-resistant ITP, but has .... Definition of hepatitis B-positive ... The median age at splenectomy was 33 years. (IQR 22 ...

  4. Laparoscopic Splenectomy for Traumatic Splenic Injury after Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    Salim Abunnaja

    2012-09-01

    Full Text Available Colonoscopy is a widespread diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. Splenic rupture following colonoscopy is rarely encountered and is most likely secondary to traction on the splenocolic ligament. Exploratory laparotomy and splenectomy is the most commonly employed therapeutic intervention for this injury reported in the literature. We present the case of a patient with this potentially fatal complication who was treated successfully at our institution. To our knowledge it is the first report in the literature of laparoscopic splenectomy as a successful minimally invasive treatment of splenic rupture following colonoscopy. The patient was a 62-year-old female who underwent screening colonoscopy with polypectomies at the cecum, descending colon and rectum. Immediately following the procedure she developed abdominal pain and had a syncopal episode. Clinical, laboratory and imaging findings were suggestive of hemoperitoneum and a ruptured spleen. A diagnostic laparoscopy was emergently performed and revealed a grade IV splenic laceration and hemoperitoneum. Laparoscopic splenectomy was completed safely and effectively. The patient’s postoperative recovery was uneventful. We conclude that splenic rupture after colonoscopy is a rare but dangerous complication. A high index of suspicion is required to recognize it early. Awareness of this potential complication can lead to optimal patient outcome. Laparoscopic splenectomy may be a feasible treatment option.

  5. [Advances in Pathogenesis and Related Clinical Research of Thromboembolism in Patients with Thalassemia after Splenectomy].

    Science.gov (United States)

    Sun, Na; Cheng, Peng; Deng, Dong-Hong

    2016-06-01

    Thalassemia is the most common human hereditary hemolytic anemia. Due to splenomegaly and hypersp-lenism, splenectomy can be used as a means of treatment for thalassemia. Various complications following splenectomy, however, especially thromboembolic complications are remarkable. This review summarizes the incidence, clinical manifestations and development time of thromboembolism. The pathogenesis of thromboembolism after splenectomy in thalassemia, such as abnormal platelet number and function, changes in red cell membrane, endothelial cell damage, dysfunction of other procoagulant and anticoagulant factors, and local factors associated with splenectomy are elaborated and the trategies to prevent and treat the thromboembolic events in thalassemia after splenectomy, including the attention to risk factors associated with splenectomy, a reassessment of splenectomy, regular blood transfusion to reduce the ratio of abnormal red blood cells, treatment with anticoagulant and antiplatelet drugs, application of hydroxyurea and stem cell transplantation are discussed.

  6. Successful Splenectomy for Hypersplenism in Wilson’s Disease: A Single Center Experience from China

    Science.gov (United States)

    Chen, Huai-Zhen; Wu, Yun-Hu; Fang, Xiang; Zhang, Jing; Wang, Zhen; Han, Yong-Sheng; Wang, Yu

    2015-01-01

    Splenomegaly and pancytopenia are common in Wilson’s disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson’s Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients

  7. Successful Splenectomy for Hypersplenism in Wilson's Disease: A Single Center Experience from China.

    Directory of Open Access Journals (Sweden)

    Liang-Yong Li

    Full Text Available Splenomegaly and pancytopenia are common in Wilson's disease (WD and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS. All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson's Disease Rating Scale (UWDRS showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most

  8. Splenectomy Correlates With Increased Risk of Pyogenic Liver Abscess: A Nationwide Cohort Study in Taiwan

    Directory of Open Access Journals (Sweden)

    Shih-Wei Lai

    2015-09-01

    Full Text Available Objectives: Little is known about the risk of pyogenic liver abscess in patients with splenectomy. We explored the relationship between splenectomy and pyogenic liver abscess in Taiwan. Methods: We conducted a nationwide cohort analysis using the hospitalization dataset of the Taiwan National Health Insurance Program. We included 17 779 subjects aged 20–84 years who underwent splenectomy in 1998 to 2010 (splenectomy group and 70 855 randomly selected subjects without splenectomy (non-splenectomy group. Both groups were matched by sex, age, other comorbidities, and hospitalization year of receiving splenectomy. The incidence of pyogenic liver abscess at the end of 2011 was measured. The multivariable Cox proportional hazard regression model was used to estimate the hazard ratios and 95% confidence intervals for pyogenic liver abscess associated with splenectomy and other comorbidities. Results: The overall incidence rate was 3.75-fold higher in the splenectomy group than that in the non-splenectomy group (2.15 vs 0.57 per 1000 person-years; 95% confidence interval, 3.57–3.94. After controlling for potential confounding factors, the adjusted hazard ratio of pyogenic liver abscess was 3.89 in subjects with splenectomy (95% confidence interval, 3.20–4.72 when compared with subjects without splenectomy. In further analysis, the hazard ratio markedly increased to 14.34 for those with splenectomy and having any of the assessed comorbidities, including alcoholism, biliary stone, chronic kidney disease, chronic liver diseases, and diabetes mellitus (95% confidence interval, 10.61–19.39. Conclusions: Patients with splenectomy are at an increased risk of developing pyogenic liver abscess, particularly when they have comorbid conditions.

  9. The Thoratec system implanted as a modified total artificial heart: the Bad Oeynhausen technique.

    Science.gov (United States)

    Arusoglu, Latif; Reiss, Nils; Morshuis, Michiel; Schoenbrodt, Michael; Hakim-Meibodi, Kavous; Gummert, Jan

    2010-12-01

    The CardioWest™ total artificial heart (SynCardia Systems, Tuscon, AZ, USA) is the only FDA-approved total artificial heart determined as a bridge to human heart transplantation for patients dying of biventricular heart failure. Implantation provides immediate hemodynamic restoration and clinical stabilization, leading to end-organ recovery and thus eventually allowing cardiac transplantation. Occasionally, implantation of a total artificial heart is not feasible for anatomical reasons. For this patient group, we have developed an alternative technique using the paracorporeal Thoratec biventricular support system (Thoratec, Pleasanton, CA, USA) as a modified total artificial heart. A detailed description of the implantation technique is presented.

  10. Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Xiao-Zhong Jiang; Shao-Yong Zhao; Hong Luo; Bin Huang; Chang-Song Wang; Lei Chen; You-Jiang Tao

    2009-01-01

    AIM: To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension.METHODS: From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnection (LSD) were performed on 28 patients with cirrhosis, bleeding due to portal hypertension, and secondary hypersplenism. Success was achieved in 26 patients.Demographic, intraoperative, and postoperative variables of the patients were compared.RESULTS: Success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but two patients (7.14%) who required open splenectomy and azygoportal devascularization (OSD). The operation time was significantly longer in patients undergoing LSD than in those undergoing OSD (235± 36 min vs 178 ±47 min, P < 0.05). The estimated intraoperative blood loss was much more in patients receiving OSD than in those receiving LSD (420 ± 50 mL vs 200 ±30 mL, P < 0.01). The proportion of patients undergoing laparoscopic and open splenectomy and azygoportal disconnection who received transfusion of packed red blood cells during or after the operation was 23.08%and 38.46%, respectively ( P < 0.05). The time of first oral intake was faster in patients after LSD than in those after OSD (1.5 ± 0.7 d vs 3.5 ± 1.6 d, P < 0.05). The hospital stay of patients after LSD was shorter than that of patients after OSD (6.5 ± 2.3 d vs 11.7 ± 4.5 d, P <0.05). The pain requiring medication was less severe in patients after LSD than in those after OSD (7.69% vs 73.08%, P < 0.001). The overall complication rate was lower in patients after LSD than in those after OSD (19.23% vs 42.31%, P < 0.05).CONCLUSION: Laparoscopic splenectomy and azygoportal disconnection are the feasible, effective, and safe surgical procedure, and are advantageous over minimally invasive surgery for bleeding portal hypertension and hypersplenism.

  11. Laparoscopic splenectomy in children with benign hematological diseases: Leaving nothing behind policy

    Directory of Open Access Journals (Sweden)

    Mohammad Gharieb Khirallah

    2016-01-01

    Full Text Available Context: Laparoscopic splenectomy (LS is considered the standard approach for the treatment of children with nonmalignant hematological diseases due to the advances in the minimal invasive surgery over the conventional splenectomy (CS. Different techniques are involved in the operation to secure the hilum. Aim: The use of (Ligasure™ is a safe, effective, less time consuming and with less complications rate. Materials and Methods: Sixty children (33 with thalassemia, 20 with immune thrombocytopenic purpura [ITP] and seven with spherocytosis were operated during the period from June 2007 to December 2014. These children had undergone LS using (Ligasure™. Three ports were used in small-sized spleens while four ports were used in large spleens. Results: There were 60 children (37 girls and 23 boys with a mean age of 10.2 years had LS using Ligasure™ with mean operative time of 85 min for cases of ITP and 120 min for other cases. There was no mortality. Two cases were converted to CS. Conclusions: Use of Ligasure™ alone was safe, less time consuming with less complications rates.

  12. Total cysto-prostatectomy: Technique description and results in 2 dogs.

    Science.gov (United States)

    Bacon, Nicholas; Souza, Carlos H de M; Franz, Sarah

    2016-02-01

    We describe a novel technique for total cysto-prostatectomy, followed by uretero-urethral anastomosis in 2 dogs. The technique was successful and was performed without pubic osteotomy. Post-operative urinary tract infections may be a potentially serious event.

  13. Operative technique for insertion of a totally implantable system for venous access.

    Science.gov (United States)

    Sterchi, J M; Fulks, D; Cruz, J; Paschold, E

    1986-10-01

    A totally implantable venous access device is described and a step by step technique for implanting the device is given. Among 203 patients in whom the technique has been used, thrombosis of the subclavian or jugular vein has occurred in only three. There have been no pulmonary complications, and only three devices have been removed because of infection.

  14. Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

    Institute of Scientific and Technical Information of China (English)

    Mao-Qiang Wang; Han-Ying Lin; Li-Ping Guo; Feng-Yong Liu; Feng Duan; Zhi-Jun Wang

    2009-01-01

    AIM: To present a series of cases with symptomatic acute extensive portal vein (PV) and superior mesenteric vein (SMV) thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS: A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis.The mean age of the patients was 41.2 years. After access to the portal system via the transjugular approach, pigtail catheter fragmentation of clots,local urokinase injection, and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge. RESULTS: Technical success was achieved in all 6 patients. Clinical improvement was seen in these patients within 12-24 h of the procedure. No complications were observed. The 6 patients were discharged 6-14 d (8 ± 2.5 d) after admission. The mean duration of follow-up after hospital discharge was 40 ± 16.5 mo. Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV, and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period .CONCLUSION: Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

  15. Laparoscopic Splenectomy for Hairy Cell Leukemia in Pregnancy

    OpenAIRE

    2010-01-01

    Objective. We present a successful case of laparoscopic splenectomy for a massively enlarged spleen at 25 weeks of gestation for hairy cell leukemia in pregnancy in a woman with initial hemoglobin of 4.3 gm/dl and platelet count of 18,000/mm3. Study Design. Case report. Results. This report provides an approach to management that may be applicable in those cases where thrombocytopenia or other clinical imperatives preclude delaying treatment till after pregnancy. Conclusion. Hairy ce...

  16. Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni.

    Directory of Open Access Journals (Sweden)

    Luiz Arthur Calheiros Leite

    Full Text Available Schistosomiasis mansoni is a chronic liver disease, in which some patients (5-10% progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved. Splenectomy is a validated procedure to reduce portal hypertension following digestive bleeding. Here, we evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients.Forty-five patients who had undergone splenectomy surgery were assessed by laboratory analyses and ultrasound examination and compared to a non-operated group (n = 55. Blood samples were obtained for liver function tests, platelet count and prothrombin time. Coagulation factors (II, VII, VIII, IX and X, protein C and antithrombin IIa, plasminogen activator inhibitor-1 were measured by routine photometric, chromogenic or enzyme-linked immunosorbent assays, while hyperfibrinolysis was defined by plasminogen activator inhibitor-1 levels. Both groups had similar age, gender and pattern of periportal fibrosis. Splenectomized patients showed significant reductions in portal vein diameter, alkaline phosphatase and bilirubin levels compared to non-operated patients, while for coagulation factors there were significant improvement in prothrombin, partial thromboplastin times and higher levels of factor VII, VIII, IX, X, protein C and plasminogen activator inhibitor-1.This study shows that the decrease of flow pressure in portal circulation after splenectomy restores the capacity of hepatocyte synthesis, especially on the factor VII and protein C levels, and these findings suggest that portal hypertension in patients with hepatosplenic schistosomiasis influences liver functioning and the blood coagulation status.

  17. Kinetics of small lymphocytes in normal and nude mice after splenectomy

    DEFF Research Database (Denmark)

    Hougen, H P; Hansen, F; Jensen, E K;

    1977-01-01

    Autoradiography and various quantitations on lymphoid tissues have been used to evaluate the kinetics of small lymphocytes in normal (+/nu or +/+) and congenitally athymic nude (nu/nu) NMRI mice 1 month after splenectomy or sham-splenectomy. The results indicate that splenectomy causes depressed ......, are released from the lympho-myeloid organs in compensation for the loss of long-lived, thymus-derived cells....

  18. Response of chronic myelogenous leukemia patients to COAP-splenectomy. A Southwest Oncology Group study.

    Science.gov (United States)

    Hester, J P; Waddell, C C; Coltman, C A; Morrison, F S; Stephens, R L; Balcerzak, S P; Baker, L H; Chen, T T

    1984-11-01

    Eighty-seven patients from 18 institutions with a confirmed diagnosis of chronic myelogenous leukemia were registered on a Southwest Oncology Group protocol for multiagent induction and single-agent maintenance chemotherapy, with randomization to an immunotherapy arm. Elective surgical splenectomy was performed for 42 patients at the completion of 3 months of induction therapy. Final analysis of the study revealed statistically significant survival advantages were correlated with age, splenectomy, the absence of hepatic leukemic infiltrate at the time of splenectomy, and race.

  19. An Automated Size Recognition Technique for Acetabular Implant in Total Hip Replacement

    CERN Document Server

    Shapi'i, Azrulhizam; Hasan, Mohammad Khatim; Kassim, Abdul Yazid Mohd; 10.5121/ijcsit.2011.3218

    2011-01-01

    Preoperative templating in Total Hip Replacement (THR) is a method to estimate the optimal size and position of the implant. Today, observational (manual) size recognition techniques are still used to find a suitable implant for the patient. Therefore, a digital and automated technique should be developed so that the implant size recognition process can be effectively implemented. For this purpose, we have introduced the new technique for acetabular implant size recognition in THR preoperative planning based on the diameter of acetabulum size. This technique enables the surgeon to recognise a digital acetabular implant size automatically. Ten randomly selected X-rays of unidentified patients were used to test the accuracy and utility of an automated implant size recognition technique. Based on the testing result, the new technique yielded very close results to those obtained by the observational method in nine studies (90%).

  20. Moderate hypothermia technique for chronic implantation of a total artificial heart in calves.

    Science.gov (United States)

    Karimov, Jamshid H; Grady, Patrick; Sinkewich, Martin; Sunagawa, Gengo; Dessoffy, Raymond; Byram, Nicole; Moazami, Nader; Fukamachi, Kiyotaka

    2017-02-25

    The benefit of whole-body hypothermia in preventing ischemic injury during cardiac surgical operations is well documented. However, application of hypothermia during in vivo total artificial heart implantation has not become widespread because of limited understanding of the proper techniques and restrictions implied by constitutional and physiological characteristics specific to each animal model. Similarly, the literature on hypothermic set-up in total artificial heart implantation has also been limited. Herein we present our experience using hypothermia in bovine models implanted with the Cleveland Clinic continuous-flow total artificial heart.

  1. Information Landscaping: Information Mapping, Charting, Querying and Reporting Techniques for Total Quality Knowledge Management.

    Science.gov (United States)

    Tsai, Bor-sheng

    2003-01-01

    Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…

  2. Total Physical Response: A Technique for Teaching All Skills in Spanish.

    Science.gov (United States)

    Glisan, Eileen W.

    1986-01-01

    Presents a strategy for using an expanded version of Total Physical Response (TPR) as one tool for teaching listening, speaking, reading, and writing in Spanish. Variations of TPR are suggested for the purpose of implementing the technique within the foreign language curriculum. (Author/CB)

  3. Total intravenous anaesthesia. A technique based on alphaxalone/alphadolone and pentazocine.

    Science.gov (United States)

    Jago, R H; Restall, J

    1977-10-01

    Two hundred and eight patients were anaesthetised using incremental doses of intravenous alphaxalone/alphadolone (Althesin). Analgesia was provided by supplements of pentazocine, which also helped eliminate the excessive movements associated with pure Althesin anaesthesia. This is a total intravenous technique and consequently eliminates the problem of atmospheric pollution. It provides adequate anaesthesia for most minor surgical procedures.

  4. Information Landscaping: Information Mapping, Charting, Querying and Reporting Techniques for Total Quality Knowledge Management.

    Science.gov (United States)

    Tsai, Bor-sheng

    2003-01-01

    Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…

  5. Whole-body irradiation technique: physical aspects; Tecnica de irradiacion corporal total: aspectos fisicos

    Energy Technology Data Exchange (ETDEWEB)

    Venencia, D.; Bustos, S.; Zunino, S. [Instituto Privado de Radioterapia. Obispo Oro 425. Cordoba 5000 (Argentina)

    1998-12-31

    The objective of this work has been to implement a Total body irradiation technique that fulfill the following conditions: simplicity, repeatability, fast and comfortable positioning for the patient, homogeneity of the dose between 10-15 %, short times of treatments and In vivo dosimetric verifications. (Author)

  6. Totally robot-assisted biliary pancreatic diversion with duodenal switch: single dock technique and technical outcomes.

    Science.gov (United States)

    Sudan, Ranjan; Podolsky, Erica

    2015-01-01

    The biliopancreatic diversion with duodenal switch (BPD/DS) requires operating in three different abdominal quadrants. Previous techniques have used either two docks or a hybrid technique in which the robot is used only to suture the duodeno-ileal anastomosis, while the rest of the operation was performed laparoscopically. Recently, a modification in technique has allowed all operative steps to be completed robotically with a single dock. The operative technique and its technical results are described. Operative technique is described. Baseline demographics, operative duration, length of stay, and adverse events (intraoperative, 30-days, and 1-year) of all primary totally robot BPD/DS cases are reported. From Nov. 2011 to Jan. 2014, 59 totally robotic BPD/DS operations were attempted. One was completed hybrid, and the rest were totally robotic. No robotic operation was converted to an open operation. Five trocars were placed, the small bowel was anchored to the anterior abdominal wall, and the robot was docked. Mean age was 44 ± 10 years with a mean preoperative BMI of 56 ± 9 kg/m(2). 69 % was female, and 71 % was Caucasian. Mean operative duration was 306 ± 80 min (60 min less than the hybrid technique). There were no mortality, leaks, venous thromboembolism, or bleeding requiring transfusion. Mean length of stay was 4.6 ± 4.3 days. Three patients were readmitted for nausea and vomiting. There was one superficial wound infection, and three patients needed reoperations in the first year, two for strictures, and one for debriding a suture abscess. All key technical components of the BPD/DS were performed with low morbidity and mortality with a single dock. Since the surgeon performed all key parts of the operation from the console, the need for experienced bedside assistance was minimized, resulting in shorter operative duration compared to the hybrid technique.

  7. Total Reconstruction of the Auricle: Our Experiences on Indications and Recent Techniques

    Directory of Open Access Journals (Sweden)

    K. Storck

    2014-01-01

    Full Text Available Introduction. Auricular reconstruction is a great challenge in facial plastic surgery. With the advances in surgical techniques and biotechnology, different options are available for consideration. The aim of this paper is to review the knowledge about the various techniques for total auricular reconstruction based on the literature and our experience. Methods. Approximately 179 articles published from 1980 to 2013 were identified, and 59 articles were included. We have focused on the current status of total auricular reconstruction based on our personal experience and on papers of particular interest, published within the period of review. We have also included a prospective view on the tissue engineering of cartilage. Results. Most surgeons still practice total auricular reconstruction by employing techniques developed by Brent, Nagata, and Firmin with autologous rib cartilage. Within the last years, alloplastic frameworks for reconstruction have become well established. Choosing the reconstruction techniques depends mainly on the surgeon’s preference and experience. Prosthetic reconstruction is still reserved for special conditions, even though the material is constantly improving. Tissue engineering has a growing potential for clinical applicability. Conclusion. Auricular reconstruction still receives attention of plastic/maxillofacial surgeons and otolaryngologists. Even though clinical applicability lags behind initial expectations, the development of tissue-engineered constructs continues its potential development.

  8. A modified two-incision technique for primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Bal B

    2008-01-01

    Full Text Available Background: Minimally invasive surgery can be technically demanding but minimizes surgical trauma, pain and recovery. Two-incision minimally invasive surgery allows only intermittent visualization and may require fluoroscopy for implant positioning. We describe a modified technique for primary total hip arthroplasty, using two small incisions with a stepwise approach and adequate visualization to reliably and reproducibly perform the surgery without fluoroscopy. Materials and Methods: One hundred and two patients with an average age of 60 years underwent modified two-incision minimally invasive technique for primary THA without fluoroscopy. The M/L taper femoral stem (Zimmer, Warsaw, IN and Trilogy (Zimmer hemispherical titanium shell, with a highly cross-linked polyethylene liner, was used. Operative time, blood loss, postoperative hospital stay, radiographic outcomes and complications were recorded. Results: The mean operating time was 77 min. The mean blood loss was 335 cc. The mean hospital stay was 2.4 days. Mean cup abduction angle was 43.8°. Mean leg length discrepancy was 1.7 mm. Thirteen patients had lateral thigh numbness and two patients had wound complications that resolved without any treatment. Conclusion: A modified two-incision technique without fluoroscopy for primary total hip arthroplasty has the advantage of preserving muscles and tendons, shorter recovery and return to function with minimal complications. Provided that the surgeon has received appropriate training, primary total hip arthroplasty can be performed safely with the modified two-incision technique.

  9. In vivo dosimetry for total body irradiation: five-year results and technique comparison.

    Science.gov (United States)

    Patel, Reshma P; Warry, Alison J; Eaton, David J; Collis, Christopher H; Rosenberg, Ivan

    2014-07-08

    The aim of this work is to establish if the new CT-based total body irradiation (TBI) planning techniques used at University College London Hospital (UCLH) and Royal Free Hospital (RFH) are comparable to the previous technique at the Middlesex Hospital (MXH) by analyzing predicted and measured diode results. TBI aims to deliver a homogeneous dose to the entire body, typically using extended SSD fields with beam modulation to limit doses to organs at risk. In vivo dosimetry is used to verify the accuracy of delivered doses. In 2005, when the Middlesex Hospital was decommissioned and merged with UCLH, both UCLH and the RFH introduced updated CT-planned TBI techniques, based on the old MXH technique. More CT slices and in vivo measurement points were used by both; UCLH introduced a beam modulation technique using MLC segments, while RFH updated to a combination of lead compensators and bolus. Semiconductor diodes were used to measure entrance and exit doses in several anatomical locations along the entire body. Diode results from both centers for over five years of treatments were analyzed and compared to the previous MXH technique for accuracy and precision of delivered doses. The most stable location was the field center with standard deviations of 4.1% (MXH), 3.7% (UCLH), and 1.7% (RFH). The least stable position was the ankles. Mean variation with fraction number was within 1.5% for all three techniques. In vivo dosimetry can be used to verify complex modulated CT-planned TBI, and demonstrate improvements and limitations in techniques. The results show that the new UCLH technique is no worse than the previous MXH one and comparable to the current RFH technique.

  10. Wire trapping technique combined with retrograde approach for recanalization of chronic total occlusion

    Institute of Scientific and Technical Information of China (English)

    GE Jun-bo; ZHANG Feng; GE Lei; QIAN Ju-ying; WANG Hao

    2008-01-01

    @@ Coronary chronic total occlusion (CTO),defined as a total occlusion of duration >3 months,remains a technical challenge for the interventional cardiologists.The major limitation in percutaneous coronary intervention (PCI) of CTO is the inability to penetrate and cross the occlusion with a guidewire.It was reported that the immediate angiographic success rate varied from 50%to 70% using the standard antegrade techniques,1 To improve this suboptimal success rate,the authors firstly introduced retrograde approach through the collateral channels as a novel technique2 and successfully recanalized a left main CTO using this technique when demonstrating the live cases in Transcatheter Cardiovascular Therapeutics (TCT) 2005.Recently,modified techniques based on the retrograde approach have demonstrated that this approach could provide a high success rate with PCI.3-5 In the present report,we described a new method,wire trapping technique combined with retrograde approach,which was applied successfully in three patients with CTO.

  11. Appraisal of soft computing techniques in prediction of total bed material load in tropical rivers

    Indian Academy of Sciences (India)

    C K Chang; H Md Azamathulla; N A Zakaria; A Ab Ghani

    2012-02-01

    This paper evaluates the performance of three soft computing techniques, namely Gene-Expression Programming (GEP) (Zakaria et al 2010), Feed Forward Neural Networks (FFNN) (Ab Ghani et al 2011), and Adaptive Neuro-Fuzzy Inference System (ANFIS) in the prediction of total bed material load for three Malaysian rivers namely Kurau, Langat and Muda. The results of present study are very promising: FFNN (2 = 0.958, RMSE = 0.0698), ANFIS (2 = 0.648, RMSE = 6.654), and GEP (2 = 0.97, RMSE = 0.057), which support the use of these intelligent techniques in the prediction of sediment loads in tropical rivers.

  12. Recanalization of Chronic Total Occlusion Lesions: A Critical Appraisal of Current Devices and Techniques

    Science.gov (United States)

    2016-01-01

    Chronic Total Occlusion (CTO) has been considered as one of the “final frontier” in interventional cardiology. Until recently, the patients with CTO are often managed surgically or medically due to lack of published evidence of clinical benefits and lower success rate of percutaneous recanalization of CTO. However, the introduction of enhanced guidewires, microcatheters combined with novel specialized devices and techniques reduce the number of unapproachable CTO. In this review article, current techniques and devices of percutaneous recanalization of CTO have been systematically summarized, which may help budding interventional cardiologists to theoretically understand these complex procedures and to deliver safe and effective percutaneous management of CTO to the patients. PMID:27790503

  13. Multi-wire plaque crushing as a novel technique in treating chronic total occlusions

    Institute of Scientific and Technical Information of China (English)

    HAN Ya-ling; WANG Dong-mei; LI Yi; WANG Shou-li; JING Quan-min; MA Ying-yan; WANG Geng; LUAN Bo; WANG Bin; WANG Zhu-lu

    2008-01-01

    Background Failure of balloon catheter passing through the occluded segment accounts for 10%-15% of all procedures during percutaneous coronary intervention(PCI)for chronic total occlusion(CTO).We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing.Methods Between July 2000 and October 2007,152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique.The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment,thus facilitating the balloon passing.Results Both overall lesion and technique success rates were 91.5%(150/164).A total of 211 crushing wires were used during PCI,including 1 crushing wire for 117(71.3%)lesions and 2 crushing wires for 47(28.7%)lesions.Approximately 57.3%(121/211)of all crushing wires were those already used in the same procedure.Technique failure occurred in 14 lesions(8.5%).Technique failure was due to crushing wires entering false lumen(92.9%,13/14)and coronary perforation(7.1%,1/14).Major procedural complications included coronary perforation(1 case)and severe coronary dissection(2 cases),all of which were successfully treated.Conclusions Multi-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI.It is feasible,economical and relatively safe with a low rate of procedural complications.

  14. Management strategies for infected total hip arthroplasty. A critical appreciation of problems and techniques.

    Science.gov (United States)

    Karachalios, Theofilos; Koutalos, Antonios; Komnos, George

    2014-10-02

    Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. The nature of the disease is heterogeneous and for satisfactory management one has to weigh factors related to pathogen, host, local soft tissue, bone stock, surgeon experience and financial resources. Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.

  15. Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy.

    Science.gov (United States)

    Marszałek, Sławomir; Zebryk-Stopa, Anna; Kraśny, Jacek; Obrebowski, Andrzej; Golusiński, Wojciech

    2009-08-01

    In patients after total laryngectomy, increased tension in myofascial neck and arm areas might be observed. Via fascial continuity it has an adverse impact on the superior esophageal constrictor forming the "mouth of the oesophagus", which hinders learning of esophageal speech. The aim is to assess the effect of manual myofascial release techniques on esophageal pressure in patients after total laryngectomy. Forty patients (12 F, 28 M), aged 43-75 (mean 56.8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node resection, 38 patients (95%) after radiotherapy. Esophageal pressure was assessed using modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limb areas. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. Statistically significant decrease of the mean esophageal pressure was observed after the physiotherapy treatment. The average pressure among the examined patients decreased from 37.9 to 26.6 mmHg. The application of myofascial manual techniques decreases esophageal pressure, thus allowing patients to learn esophagus speech at a faster pace.

  16. Total Gaussian curvature, drop shapes and the range of applicability of drop shape techniques.

    Science.gov (United States)

    Saad, Sameh M I; Neumann, A Wilhelm

    2014-02-01

    Drop shape techniques are used extensively for surface tension measurement. It is well-documented that, as the drop/bubble shape becomes close to spherical, the performance of all drop shape techniques deteriorates. There have been efforts quantifying the range of applicability of drop techniques by studying the deviation of Laplacian drops from the spherical shape. A shape parameter was introduced in the literature and was modified several times to accommodate different drop constellations. However, new problems arise every time a new configuration is considered. Therefore, there is a need for a universal shape parameter applicable to pendant drops, sessile drops, liquid bridges as well as captive bubbles. In this work, the use of the total Gaussian curvature in a unified approach for the shape parameter is introduced for that purpose. The total Gaussian curvature is a dimensionless quantity that is commonly used in differential geometry and surface thermodynamics, and can be easily calculated for different Laplacian drop shapes. The new definition of the shape parameter using the total Gaussian curvature is applied here to both pendant and constrained sessile drops as an illustration. The analysis showed that the new definition is superior and reflects experimental results better than previous definitions, especially at extreme values of the Bond number.

  17. Double-wire sternal closure technique in bovine animal models for total artificial heart implant.

    Science.gov (United States)

    Karimov, Jamshid H; Sunagawa, Gengo; Golding, Leonard A R; Moazami, Nader; Fukamachi, Kiyotaka

    2015-08-01

    In vivo preclinical testing of mechanical circulatory devices requires large animal models that provide reliable physiological and hemodynamic conditions by which to test the device and investigate design and development strategies. Large bovine species are commonly used for mechanical circulatory support device research. The animals used for chronic in vivo support require high-quality care and excellent surgical techniques as well as advanced methods of postoperative care. These techniques are constantly being updated and new methods are emerging.We report results of our double steel-wire closure technique in large bovine models used for Cleveland Clinic's continuous-flow total artificial heart development program. This is the first report of double-wire sternal fixation used in large bovine models.

  18. A simplified technique for delivering total body irradiation (TBI) with improved dose homogeneity

    Energy Technology Data Exchange (ETDEWEB)

    Yao Rui; Bernard, Damian; Turian, Julius; Abrams, Ross A.; Sensakovic, William; Fung, Henry C.; Chu, James C. H. [Department of Radiation Oncology, Rush University Medical Center, 500 South Paulina Street, Chicago, Illinois 60612 (United States); Sections of Hematology and Stem Cell Transplantation, Division of Hematology/Oncology, Rush University Medical Center, 500 South Paulina Street, Chicago, Illinois 60612 (United States); Department of Radiation Oncology, Rush University Medical Center, 500 South Paulina Street, Chicago, Illinois 60612 (United States)

    2012-04-15

    Purpose: Total body irradiation (TBI) with megavoltage photon beams has been accepted as an important component of management for a number of hematologic malignancies, generally as part of bone marrow conditioning regimens. The purpose of this paper is to present and discuss the authors' TBI technique, which both simplifies the treatment process and improves the treatment quality. Methods: An AP/PA TBI treatment technique to produce uniform dose distributions using sequential collimator reductions during each fraction was implemented, and a sample calculation worksheet is presented. Using this methodology, the dosimetric characteristics of both 6 and 18 MV photon beams, including lung dose under cerrobend blocks was investigated. A method of estimating midplane lung doses based on measured entrance and exit doses was proposed, and the estimated results were compared with measurements. Results: Whole body midplane dose uniformity of {+-}10% was achieved with no more than two collimator-based beam modulations. The proposed model predicted midplane lung doses 5% to 10% higher than the measured doses for 6 and 18 MV beams. The estimated total midplane doses were within {+-}5% of the prescribed midplane dose on average except for the lungs where the doses were 6% to 10% lower than the prescribed dose on average. Conclusions: The proposed TBI technique can achieve dose uniformity within {+-}10%. This technique is easy to implement and does not require complicated dosimetry and/or compensators.

  19. Comparison of three techniques for skin total irradiation with electrons; Comparacao de tres tecnicas de irradiacao total da pele com eletrons

    Energy Technology Data Exchange (ETDEWEB)

    Batista, Delano V.S., E-mail: dbatista@ird.gov.b [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil); Bardella, Lucia H. [Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil); Rosa, Luiz A.R. da, E-mail: lrosa@ird.gov.b [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2011-10-26

    This paper compared three techniques of skin total irradiation with electrons: 1) horizontal positioning, 2) vertical positioning - rotatory technique and 3) vertical positioning - six fields technique. For that, a anthropomorphic phantom was positioned according to the recommendation for each technique and was i radiated at the linear accelerator by using the 6 MeV electrons. Radiochromic films were positioned on the surface in various regions of the phantom for measurement of absorbed dose. A ionization chamber was positioned inside of equivalent issue plates for dose evaluation due to the photons produced by electron stopping. The technique 2 and 3 have shown too similar in the results and number or discrepant points (8 and 10 respectively) of prescription lower than the technique 1 (22 points). The total body dose of photons of the 1, 2 and 3 techniques was 2.2%, 5.3% and 5.2% respectively

  20. Deairing Techniques for Double-Ended Centrifugal Total Artificial Heart Implantation.

    Science.gov (United States)

    Karimov, Jamshid H; Horvath, David J; Byram, Nicole; Sunagawa, Gengo; Grady, Patrick; Sinkewich, Martin; Moazami, Nader; Sale, Shiva; Golding, Leonard A R; Fukamachi, Kiyotaka

    2016-09-22

    The unique device architecture of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) requires dedicated and specific air-removal techniques during device implantation in vivo. These procedures comprise special surgical techniques and intraoperative manipulations, as well as engineering design changes and optimizations to the device itself. The current study evaluated the optimal air-removal techniques during the Cleveland Clinic double-ended centrifugal CFTAH in vivo implants (n = 17). Techniques and pump design iterations consisted of developing a priming method for the device and the use of built-in deairing ports in the early cases (n = 5). In the remaining cases (n = 12), deairing ports were not used. Dedicated air-removal ports were not considered an essential design requirement, and such ports may represent an additional risk for pump thrombosis. Careful passive deairing was found to be an effective measure with a centrifugal pump of this design. In this report, the techniques and design changes that were made during this CFTAH development program to enable effective residual air removal and prevention of air embolism during in vivo device implantation are explained.

  1. Total reflection of x-ray fluorescence (TXRF): a mature technique for environmental chemical nanoscale metrology

    Science.gov (United States)

    Borgese, L.; Zacco, A.; Bontempi, E.; Colombi, P.; Bertuzzi, R.; Ferretti, E.; Tenini, S.; Depero, L. E.

    2009-08-01

    Total reflection x-ray fluorescence (TXRF) is a technique well established for chemical analysis of samples deposited as a thin layer. Nowadays it is mainly employed for electronic industry quality control. Recently, very compact and economic TXRF instrumentation was proposed. Combining this with the capability to analyze liquid samples, this technique is suitable to be employed in many different applications, comprising the very critical field of environmental analysis. Comparisons with the standard atomic absorption spectroscopy (AAS) technique show that TXRF is a practical, accurate, and reliable technique. Indeed, round-robin activities have already been started. Despite the efficiency and economy of the developed portable TXRF instrumentation, this is not widely employed for chemical laboratory analysis probably because TXRF is not an officially recognized technique, i.e. it is not yet normative-subjected. This fact could also be due to the long background of analytical applications developed for AAS, ICPS or inductively coupled plasma mass spectroscopy (ICP-MS) up to now. In this paper, we present a work of environmental monitoring of an industrial site, performed by means of bioindicators (lichens). The analysis of trace elements concentration in lichen was usually conducted with spectrophotometric techniques, such as AAS and ICP-MS, which were accepted by common regulations and normative-subjected. In this study, we accomplished a comparative lichen analysis by AAS and TXRF. The reproducibility of the obtained results showed the high correspondence between the two techniques. This comparison highlighted the versatility of the TXRF apparatus that allowed more rapid and simultaneous element detection. The obtained results suggested that this portable TXRF system could be suitable for regulation to produce certificated analysis upto ppb concentrations for some elements.

  2. Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

    Directory of Open Access Journals (Sweden)

    Ercan Erdogan

    2013-10-01

    Full Text Available OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%. There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001, while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively. The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001. The global longitudinal strain showed a significant increase after successful revascularization (p<0.001. An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02. The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular

  3. Is expertise in pediatric surgery necessary to perform laparoscopic splenectomy in children? An experience from a department of general surgery.

    Science.gov (United States)

    Guaglio, Marcello; Romano, Fabrizio; Garancini, Mattia; Degrate, Luca; Luperto, Margherita; Uggeri, Fabio; Scotti, Mauro; Uggeri, Franco

    2012-06-01

    Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a monocentric experience and to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in a department of general surgery. 57 consecutive LSs have been performed in a pediatric population between January 2000 and October 2010. There were 33 females and 24 males with a median age of 12 years (range 4-17). Indications were: hereditary spherocytosis 38 cases, idiopathic thrombocytopenic purpura 10, sickle cell disease (SCD) 6, thrombocytopenic thrombotic purpura 2 and non-hodgkin lymphoma 1 case. Patients were operated on using right semilateral position, employing Atlas Ligasure vessel sealing system in 49 cases (86%) and Harmonic Scalpel + EndoGIA in 8. In 24 patients (42.1%), a cholecystectomy was associated. Two patients required conversion to open splenectomy (3.5%). In three cases, a minilaparotomy was performed for spleen removal (5.2%). Accessory spleens were identified in three patients (5.2%). Complications (8.8%) included bleeding (two), abdominal collection (one) and pleural effusion (two). There was no mortality. Average operative time was 128 min (range 80-220). Average length of stay was 3 days (range 2-7). Mean blood loss was 80 ml (range 30-500) with a transfusion rate of 1.7% (one patient). Laparoscopic spleen surgery is safe, reliable and effective in the pediatric population with hematologic disorders and is associated with minimal morbidity, zero mortality, and a short length of stay. Ligasure vessel sealing system shortened operative time and blood loss. On the basis of the results, we consider laparoscopic approach the gold standard for the treatment of these patients even in a department of general surgery.

  4. The simultaneous boost technique; The concept of relative normalized total dose

    Energy Technology Data Exchange (ETDEWEB)

    Lebesque, J.V.; Keus, R.B. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands))

    1991-09-01

    Simultaneous boost technique in radiotherapy consists of delivering the boost treatment (additional doses to reduced volumes) simultaneously with the basic (large-field) treatment for all treatment sessions. Both the dose per fraction delivered by basic-treatment fields and by boost-treatment fields have to be reduced to end up with the same total dose in boost volume as in the original schedule, where basic treatment preceded boost treatment. These dose reductions and corresponding weighting factors have been calculated using the linear-quadratic (LQ) model and the concept of Normalized Total Dose (NTD). Relative NTD distributions were computed to evaluate the dose distributions resulting for the simultaneous boost technique with respect to acute and late normal tissue damage and tumor control. For the example of treatment of prostate cancer the weighting factors were calculated on basis of NTD for late normal tissue damage. For treatment of oropharyngeal cancer NTD for acute and normal tissue damage was used to determine the weighting factors. In this last example a theoretical sparing of late normal tissue damage can be demonstrated. Another advantage of simultaneous boost technique is that megavoltage images of the large basic-treatment fields facilitates the determination of the position of the patient with respect to the small boost-treatment fields. (author). 42 refs., 8 figs.

  5. Revision Total Hip Arthroplasty Using the Cement-in-Cement Technique.

    Science.gov (United States)

    Amanatullah, Derek F; Pallante, Graham D; Floccari, Lorena V; Vasileiadis, George I; Trousdale, Robert T

    2017-03-01

    The cement-in-cement technique is useful in the setting of revision total hip arthroplasty (THA), especially to gain acetabular exposure, change a damaged or loose femoral component, or change the version, offset, or length of a fixed femoral component. The goal of this retrospective study was to assess the clinical and radiographic characteristics of revision THA using the cement-in- cement technique. Between 1971 and 2013, a total of 63 revision THAs used an Omnifit (Osteonics, Mahwah, New Jersey) or Exeter (Howmedica, Mahwah, New Jersey) stem and the cement-in-cement technique at the senior author's institution. Aseptic loosening (74%) was the predominant preoperative diagnosis followed by periprosthetic fracture (14%), instability (8%), and implant fracture (6%). Mean clinical follow-up was 5.5±3.8 years. The Harris Hip Score had a statistically significant increase of 18.5 points (Pfracture, or circumferential lucent lines at final follow-up. The patients who underwent cement-in-cement revision THA at the senior author's institution had good restoration of function but a high complication rate. [Orthopedics. 2017; 40(2):e348-e351.]. Copyright 2016, SLACK Incorporated.

  6. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study.

    Science.gov (United States)

    Lin, Jiun-Nong; Chen, Hsuan-Ju; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2016-01-01

    The spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000-2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per 10,000 person-years in the splenic injury patients with splenectomy, splenic injury patients without splenectomy, and comparison patients, respectively. Compared with the comparison cohort, splenic injury patients with splenectomy exhibited a 2.21-fold risk of VTE (95% confidence interval [CI], 1.43-3.43), whereas those without splenectomy exhibited a 1.71-fold risk of VTE (95% CI, 1.05-2.80). The overall incidence rate of VTE was 1.97-fold higher in the splenic injury cohort than the comparison cohort (95% CI, 1.38-2.81). Although splenectomy increased the risk of VTE 1.35-fold compared with no splenectomy, the difference was not statistically significant (95% CI, 0.74-2.45). These results may alert physicians and patients to the complications of splenic injury and splenectomy.

  7. 优化腹腔镜脾切除和贲门周围血管离断术的临床研究%Modified laparoscopic splenectomy plus pericardial devascularization for the treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    成剑; 洪德飞; 沈国樑; 谢志杰; 孙晓东; 王知非; 张远标; 黄东胜

    2014-01-01

    Objective To evaluate a modified totally laparoscopic splenectomy plus pericardial devascularization (LSPD) for the treatment of portal hypertension.Methods We applied the technique of ligating the splenic artery in advance followed by the establishment of a tunnel underneath the splenic hilum and the consecutive transection of secondary splenic pedicles and gastric coronary vein with Endo-GIA during the process of splenectomy.Results Totally laparoscopic procedures were performed successfully in 28 cases.Procedure was converted to open surgery in one case because of uncontrollable splenic bleeding.Of the 28 patients that received the total LSPD,the operation time was (207.2 ± 59.3) min,intraoperative blood loss was (287.7 ± 212) ml,intraoperative blood transfusion volume was (106.7 ± 98.3) ml,postoperative passing gas time was (4.6 ± 1.7) d,postoperative hospital stay was (11.8 ± 2.9) d.Abdominal infection,postoperative portal vein thrombosis and liver failure were found in 1,1,2 cases respectively.There were no pancreatic fistula,intraabdominal hemorrhage,postoperative upper gastrointestinal hemorrhage cases.One patient died of liver failure,the other was cured by artificial liver therapy.Conclusions The technique of modified LSPD could reduce the conversion rate of laparoscopic splenectomy and intraoperative blood loss.%目的 探讨完全腹腔镜脾切除、贲门周围血管离断术(laparoscopic splenectomy plus pericardial devascularization,LSPD)的优化技术.方法 应用预先结扎脾动脉,建立脾门后隧道,根据脾门形态应用直线或可转弯切割闭合器分次离断二级脾蒂、应用直线切割闭合器离断胃冠状曲张静脉丛的方法优化LSPD来治疗门静脉高压症及脾功能亢进.结果 29例患者手术均顺利完成,1例中转开腹.28例腹腔镜手术时间(207.2±59.3)min,术中出血量(287.7 ±212) ml,术中输血量(106.7 ±98.3) ml.术后肛门排气时间(4.6±1.7)d,术后住院时间(11.8±2.9)d

  8. Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion.

    Science.gov (United States)

    Nihei, Taro; Yamamoto, Yoshito; Kudo, Shun; Hanawa, Kenichiro; Hasebe, Yuhi; Takagi, Yusuke; Minatoya, Yutaka; Sugi, Masafumi; Shimokawa, Hiroaki

    2016-08-30

    The Rendezvous technique, which requires bidirectional wiring, is one of the useful methods for improving the success rate of recanalization for chronic total occlusion (CTO) in the field of peripheral intervention. Recently, advanced new devices for percutaneous coronary intervention have enabled us to perform the Rendezvous technique for peripheral as well as for coronary CTO lesions. We used the Intracoronary Rendezvous technique to perform angioplasty for coronary CTO. "Intracoronary Rendezvous" means that Rendezvous was achieved within the CTO lesion. From March 2009 to November 2015, 189 patients underwent CTO angioplasty at our institute, and we treated 10 patients with the Intracoronary Rendezvous technique. This technique involves crossing the Gaia series guidewire to the contralateral Corsair microcatheter located inside the plaque of CTO lesions. The majority of the CTO sites examined were in the proximal RCA (60 %). Lesion length of the occlusion was relatively long (64.4 ± 12.2 mm). Using the biplane imaging system, we were able to control the Gaia guidewires in a specific direction. Furthermore, if the antegrade and retrograde wires can be advanced into contiguous space inside the CTO lesion, we intentionally entered either wire into the contralateral Corsair microcatheter, followed by successful CTO crossing. CTO recanalization was completed for all patients without controlled antegrade retrograde subintimal tracking (CART) or reverse CART. No major complications occurred during hospitalization. These results indicate that the Rendezvous technique, assisted by new devices and a biplane imaging system, represents one of the primary options to achieve successful coronary CTO recanalization. (249/250 words).

  9. Simple technique for fabrication of shielding blocks for total body irradiation at extended treatment distances

    Directory of Open Access Journals (Sweden)

    Ravichandran R

    2009-01-01

    Full Text Available Techniques are being standardized in our department for total body irradiation (TBI with six MV photons in linear accelerator for preconditioning to bone marrow transplantation (BMT. Individualized shields with low melting point alloy are to be fabricated for shielding critical organs such as lungs, kidneys etc. A method to mount diminished dimension of shields in a tray at 3.75m is designed in the department for a teletreatment distance of four meters with magna field with A simulator image taken with the patient′s midplane (MP at one meter distance is used to mark the dimensions of lung, scaled down by a factor of 3.75/4.0. These lung dimensions are reprinted from the digital simulator image for making the shield. The methodology of the technique using digitized minification in radiography is the first of its kind to be used for shield cutting in magna field radiotherapy.

  10. A TOTAL MANUFACTURING SOLUTIONS TECHNIQUE TO SELECT APPROPRIATE IMPROVEMENT STRATEGY: CASE STUDY OF A FOOTWEAR FACTORY

    Directory of Open Access Journals (Sweden)

    Gezahegn Tesfaye

    2014-09-01

    Full Text Available The Government of Ethiopia is promoting the manufacturing sector to join the global market in a large scale. Due to its comparative advantages, the Ethiopian leather and leather products industry have been given due attention. To fully utilize such advantages, the country shifted its export items from hides/skins to footwear products. Nevertheless, the performance of the leather sector in general and footwear sub-sector in particular is far below the desired standards. The improvement strategies applied hitherto were mainly to tackle a small portion of their total problems. If the Ethiopian footwear companies have to become globally competitive, their entire business spectrum has to be assessed and appropriate improvement strategies must be selected. In this research, we used a Total manufacturing solutions (TMS technique to identify areas of improvement and improvement strategy of one of Ethiopian footwear companies. For this purpose, we conducted two surveys using structured questionnaire. The first survey was to test the TMS technique against the context of footwear industry. The result proved that the original TMS model can be used to measure the performance of footwear companies. The second survey was done to identify company's total problems, map its current position and select appropriate improvement strategy. The result revealed that the company has company-wide problems and its current position is a plodder. For plodders which have company-wide problems, the improvement strategy must include aggressive application of BPR; and the implementation of best practices to develop workers skills that encourages networking and promotion, a market-led manufacturing strategy, employee involvement and team work cultures. According to the findings of this research, we suggested that a BPR technique followed by a continuous improvement programme could be an appropriate improvement strategy for this company. The company requires long-term improvement

  11. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls.

    Science.gov (United States)

    Barg, Alexej; Knupp, Markus; Henninger, Heath B; Zwicky, Lukas; Hintermann, Beat

    2012-12-01

    Total ankle replacement (TAR) has become a valuable treatment option in patients with end-stage ankle osteoarthritis. One popular 3-component system, the HINTEGRA TAR, is an unconstrained system that provides inversion-eversion stability. More natural biomechanics of the replaced ankle may be expected when anatomic considerations drive prosthesis design. The HINTEGRA prosthesis includes 2 anatomically contoured metal components and a polyethylene insert, providing axial rotation and physiologic flexion-extension mobility. This article describes the HINTEGRA TAR design and surgical technique. Use of the prosthesis for complex hindfoot reconstruction in patients with an osteoarthritic, varus, or valgus ankle deformity is described.

  12. A novel computer-assisted surgical technique for revision total knee arthroplasty.

    Science.gov (United States)

    Marcacci, Maurilio; Nofrini, Laura; Iacono, Francesco; Di Martino, Alessandro; Bignozzi, Simone; Lo Presti, Mirco

    2007-12-01

    Revision total knee arthroplasty (RTKA) is a skill-demanding intervention presenting several technical challenges to the surgeon due to bone deficiencies and lack of anatomical references. Computer-assisted navigation systems can potentially solve these problems. An innovative computer-assisted surgical technique for RTKA is presented. The system is image free. Based on anatomical landmarks acquired on the patient, the system automatically plans the intervention, and provides the surgeon with tools to analyse and modify the proposed plan and to accurately reproduce it on the patient. Although we performed few cases with this navigated procedure, early results obtained demonstrated to be very promising.

  13. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique.

    Science.gov (United States)

    Koulouvaris, Panagiotis; Stafylas, Kosmas; Sculco, Thomas; Xenakis, Theodore

    2008-10-01

    Successful total hip arthroplasty (THA) in congenital dislocated hips demands anatomical reduction in the normal center of rotation without overstretching the sciatic nerve and without excessive compression or abnormal forces across the joint. Proximal femoral and subtrochanteric shortening osteotomy has been described for THA for the treatment of dislocated hips. However, these osteotomies are demanding, associated with deformation of femoral canal and nonunion, and may increase the femoral stem stress. This study reports excellent results in 24 patients with a new surgical technique that combines THA with a distal femoral shortening in severely deformed hips using customized components.

  14. [Certitudes and controversy regarding neural elements preservation in total mesorectal excision technique (ETM)].

    Science.gov (United States)

    Ion, D; Stoian, R V; Păduraru, D N; Bolocan, A; Serban, M B

    2012-01-01

    The total excision of the mezorect, as a technique of reference in the surgical solution of rectal cancer, is evaluated today through the view of the oncological and functional outcome. Within the functional outcome, the genito-urinary disorders which follow the damage of the pelvic vegetative nervous structures, still cause discussions and controversy among dedicated specialists in this area. The work plans to share an experience of over ten years of ETM practice, in which the technico-tactical accumulation have been realized progressively, outlining a relatively codificated attitude, centered on the "critical moments" of this intervention.

  15. Total Field and Scattered Field Technique for Fourth-Order Symplectic Finite Difference Time Domain Method

    Institute of Scientific and Technical Information of China (English)

    SHA Wei; HUANG Zhi-Xiang; WU Xian-Liang; CHEN Ming-Sheng

    2006-01-01

    Using symplectic integrator propagator, a three-dimensional fourth-order symplectic finite difference time domain (SFDTD) method is studied, which is of the fourth order in both the time and space domains. The method is nondissipative and can save more memory compared with the traditional FDTD method. The total field and scattered field (TF-SF) technique is derived for the SFDTD method to provide the incident wave source conditions. The bistatic radar cross section (RCS) of a dielectric sphere is computed by using the SFDTD method for the first time. Numerical results suggest that the SFDTD algorithm acquires better stability and accuracy compared with the traditional FDTD method.

  16. The use of Monte Carlo technique to optimize the dose distribution in total skin irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Poli, M.E.R. E-mail: esmeraldapoli@hotmail.com; Pereira, S.A.; Yoriyaz, H

    2001-06-01

    Cutaneous T-cell lymphoma (mycosis fungoides) is an indolent disease with a low percentage of cure. Total skin irradiation using an electron beam has become an efficient treatment of mycosis fungoides with curative intention, with success in almost 40% of the patients. In this work, we propose the use of a Monte Carlo technique to simulate the dose distribution in the patients during total skin irradiation treatments. Use was made of MCNP-4B, a well known and established code used to simulate transport of electrons, photons and neutrons through matter, especially in the area of reactor physics, and also finding increasing utility in medical physics. The goal of our work is to simulate different angles between each beam with a fixed treatment distance in order to obtain a uniform dose distribution in the patient.

  17. Reliable and reproducible technique to mark center of ankle in total knee arthroplasty☆

    Science.gov (United States)

    Sobti, Anshul; Maniar, Shriji; Chaudhari, Sameer; Shetty, Vivek

    2015-01-01

    Aim Bony and soft tissue landmarks have been used in the past to determine the center of the ankle to facilitate the tibial cut using an extramedullary guide in total knee arthroplasty. However literature reports are scanty in regards to the most ideal method available and its reproducibility in marking the center of the ankle intra-operatively. Methods We describe a method of using an electrocardiogram (ECG) lead in determining the center of the ankle, thus facilitating the alignment of the extramedullary guide for the tibia. Results: Using this technique, in our study the mean lateral tibial component angle was 90.09(84.2°–94.3°). The number of knees in the range of 88°–92.4° were 120 out of 122 knees (98.40%). Conclusion The described method is reliable and cheap, with reproducibility in determining the tibial cut in total knee arthroplasty. PMID:25983524

  18. Modified surgical techniques for total alloplastic temporomandibular joint replacement: One institution's experience.

    Science.gov (United States)

    ShanYong, Zhang; Liu, Huan; Yang, Chi; Zhang, XiaoHu; Abdelrehem, Ahmed; Zheng, JiSi; Jiao, ZiXian; Chen, MinJie; Qiu, YaTing

    2015-07-01

    To present three modified techniques of total alloplastic temporomandibular joint replacement (TMJ TJR) and to evaluate the outcomes regarding prosthesis stability and heterotopic bone formation. A total of 15 patients (19 joints), treated with the Biomet stock prosthesis from May 2006 to May 2013, were retrospectively analyzed. Surgical procedures were performed with the following three modifications: bone grafting of the glenoid fossa; salvage of TMJ discs; and harvesting of retro-mandibular subcutaneous fats. The glenoid fossa depth was measured preoperatively by Surgicase 5.0 software. All patients were evaluated by radiographic examination and surgical observation. The fossa was grafted with an autogenous bone in 15 joints (78.9%). In 4 joints (21.1%), only bone repair was performed. Radiographic evaluation revealed a good integration between the autogenous and host bones. All patients showed postoperative occlusal stability. In 5 joints (26.3%), the discs were salvaged. Both bleeding and operation time were reduced. Fat grafts were harvested in 17 joints (89.5%), in which there were no abnormalities in the periprosthetic bone structure. In 2 joints (10.5%), with no fat grafting, heterotopic bone formation was found. The modified techniques of TJR help to improve prostheses stability, reducing heterotopic bone formation and avoiding additional scars. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. Improving prediction of total viable counts in pork based on hyperspectral scattering technique

    Science.gov (United States)

    Tao, Feifei; Peng, Yankun; Song, Yulin; Guo, Hui; Chao, Kuanglin

    2012-05-01

    A hyperspectral scattering technique was investigated for predicting the total viable counts (TVC) of pork in the article. Fresh pork was purchased from a local market and stored at 4°C for 1-15 days. Totally 35 samples were used in the experiment and 2-4 samples were taken out randomly each day for collecting hyperspectral images and reference microbiological tests. Gompertz function was applied to fit the scattering profiles of pork and Teflon, and the fitting results were pretty good in the spectral range of 470-1010 nm. Both individual parameters and integrated parameters were explored to develop the multi-linear regression models for predicting pork TVC, and the results indicated that individual Gompertz parameter α was superior to other individual parameters, while the integrated parameters can perform better. The best result for predicting pork TVC was achieved by the form of (α, β, ɛ), with the RCV of 0.963. The study demonstrated that hyperspectral scattering technique combined with Gompertz function was potential for rapid determination of pork TVC, and would be a valid tool for monitoring the quality and safety attributes of meat in the future.

  20. SU-E-T-357: Electronic Compensation Technique to Deliver Total Body Dose

    Energy Technology Data Exchange (ETDEWEB)

    Lakeman, T [State University of New York at Buffalo, Buffalo, NY (United States); Wang, I; Podgorsak, M [State University of New York at Buffalo, Buffalo, NY (United States); Roswell Park Cancer Institute, Buffalo, NY (United States)

    2015-06-15

    Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient’s immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has conventionally been used to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Methods: Treatment plans utilizing electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two, specifically weighted, pair of opposed fields. One pair of open, large fields (collimator=45°), to encompass the patient’s entire anatomy, and one pair of smaller fields (collimator=0°) focused only on the thicker midsection of the patient. The optimal fluence for each one of the smaller fields was calculated at a patient specific penetration depth. Irregular surface compensators provide a more uniform dose distribution within the smaller opposed fields. Results: Dose-volume histograms (DVH) were calculated for the evaluating the electronic compensation technique. In one case, the maximum body doses calculated from the DVH were reduced from the non-compensated 195.8% to 165.3% in the electronically compensated plans, indicating a more uniform dose with the region of electronic compensation. The mean body doses calculated from the DVH were also reduced from the non-compensated 120.6% to 112.7% in the electronically compensated plans, indicating a more accurate delivery of the prescription dose. All calculated monitor units were well within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not substantially increase the beam on time while it can significantly reduce the compensator

  1. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization

    Directory of Open Access Journals (Sweden)

    Damiano Patrono

    2014-01-01

    CONCLUSION: Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy.

  2. [Hemi-splenectomy in epidermoid cyst of the spleen. Presentation of a case].

    Science.gov (United States)

    Meca Garrido, J; Ruiz Jiménez, J I; Guitiérrez Cantó, M A; Zambudio, G A

    1993-04-01

    We report a case of non-parasitic splenic cyst, diagnosed by abdominal ultrasound scan. These were treated by partial splenectomy. The anatomopathological study indicated the existence of epithelial coating.

  3. Glucose-6-phosphate dehydrogenase Guadalajara--a case of chronic non-spherocytic haemolytic anaemia responding to splenectomy and the role of splenectomy in this disorder.

    Science.gov (United States)

    Hamilton, J W; Jones, F G C; McMullin, Mary Frances

    2004-08-01

    Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme of the pentose phosphate shunt pathway a major function of which is to prevent cellular oxidative damage. Deficiency in red blood cells is associated with a number of varied clinical manifestations. Chronic non-spherocytic haemolytic anaemia is uncommon but is usually characterized by chronic haemolysis, often with severe anaemia. In the past splenectomy in this condition has been thought to be of questionable benefit. We report a case of G6PD Guadalajara where splenectomy produced transfusion independence and have reviewed the literature. Those cases with exon 10 mutations often have a severe clinical phenotype, which responds to splenectomy. This procedure should be considered in this condition.

  4. Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients.

    Science.gov (United States)

    Stanek, Aleksander; Stefaniak, Tomasz; Makarewicz, Wojciech; Kaska, Lukasz; Podgórczyk, Hanna; Hellman, Andrzej; Lachinski, Andrzej

    2005-02-01

    The preoperative detection of accessory spleen (AS) is still a very important and serious problem. The aim of the study was to assess the reasons for failure and the long-term results of laparoscopic splenectomy (LS) in patients with idiopathic thrombocytopenic purpura (ITP). Fifty-eight ITP patients underwent LS between June 1998 and December 2002. There were 42 women and 16 men. Preoperatively, we performed computed tomography (CT) and sonography to evaluate the size of the spleen and possibly to recognize the presence of the accessory spleens, which were found preoperatively in three cases. Intraoperatively, ASs were found in the course of laparoscopy in six cases overall, three preoperatively false negative. During follow-up (median time 31 months), in three patients the low platelet count was recognized, respectively after 5 months and 1.5 and 1.8 years. In all those cases scintigraphy was performed and in one case the residual accessory spleen, missed both in preoperative examination and during laparoscopy, was revealed. In two other patients, in spite of thrombocytopenia, no residual spleens were found. We conclude that the problem of accessory spleens can be managed by careful videoscopic examination of the abdominal cavity during splenectomy, while the use of preoperative imaging techniques in detection of accessory spleens is still limited by the insufficient sensitivity of the examination.

  5. Splenectomy alters distribution and turnover but not numbers or protective capacity of de novo generated memory CD8 T cells.

    Directory of Open Access Journals (Sweden)

    Marie eKim

    2014-11-01

    Full Text Available The spleen is a highly compartmentalized lymphoid organ that allows for efficient antigen presentation and activation of immune responses. Additionally, the spleen itself functions to remove senescent red blood cells, filter bacteria, and sequester platelets. Splenectomy, commonly performed after blunt force trauma or splenomegaly, has been shown to increase risk of certain bacterial and parasitic infections years after removal of the spleen. Although previous studies report defects in memory B cells and IgM titers in splenectomized patients, the effect of splenectomy on CD8 T cell responses and memory CD8 T cell function remains ill defined. Using TCR-transgenic P14 cells, we demonstrate that homeostatic proliferation and representation of pathogen-specific memory CD8 T cells in the blood are enhanced in splenectomized compared to sham surgery mice. Surprisingly, despite the enhanced turnover, splenectomized mice displayed no changes in total memory CD8 T cell numbers nor impaired protection against lethal dose challenge with Listeria monocytogenes. Thus, our data suggest that memory CD8 T cell maintenance and function remain intact in the absence of the spleen.

  6. Application of the Spectral Structure Parameterization technique: retrieval of total water vapor columns from GOME

    Directory of Open Access Journals (Sweden)

    R. Lang

    2002-07-01

    Full Text Available We use a recently proposed spectral sampling technique for measurements of atmospheric transmissions called the Spectral Structure Parameterization (SSP in order to retrieve total water vapor columns (WVC from reflectivity spectra measured by the Global Ozone Monitoring Experiment (GOME. SSP provides a good compromise between efficiency and speed when performing retrievals on highly structured spectra of narrow-band absorbers like water vapor. We show that SSP can be implemented in a radiative transfer scheme which treats both direct-path absorption and absorption by singly scattered light directly. For the retrieval we exploit a ro-vibrational overtone band of water vapor located in the visible around 590 nm. We compare our results to independent values given by the data assimilation model of ECMWF. In addition, results are compared to those obtained from the more accurate, but slower, Optical Absorption Coefficient Spectroscopy (OACS.

  7. Application of the Spectral Structure Parameterization technique: retrieval of total water vapor columns from GOME

    Directory of Open Access Journals (Sweden)

    R. Lang

    2003-01-01

    Full Text Available We use a recently proposed spectral sampling technique for measurements of atmospheric transmissions called the Spectral Structure Parameterization (SSP in order to retrieve total water vapor columns (WVC from reflectivity spectra measured by the Global Ozone Monitoring Experiment (GOME. SSP provides a good compromise between efficiency and speed when performing retrievals on highly structured spectra of narrow-band absorbers like water vapor. We show that SSP can be implemented in a radiative transfer scheme which treats both direct-path absorption and absorption by singly-scattered light directly. For the retrieval we exploit a ro-vibrational overtone band of water vapor located in the visible around 590 nm. We compare our results to independent values given by the data assimilation model of ECMWF. In addition, results are compared to those obtained from the more accurate, but more computationally expensive, Optical Absorption Coefficient Spectroscopy (OACS.

  8. Totally percutaneous thoracic endovascular aortic repair with the preclosing technique: a case-control study

    Institute of Scientific and Technical Information of China (English)

    NI Zhong-han; LUO Jian-fang; HUANG Wen-hui; LIU Yuan; XUE Ling; FAN Rui-xin; CHEN Ji-yan

    2011-01-01

    Background The conventional thoracic endovascular aortic repair (TEVAR) involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is desirable.In this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown approaches.Methods The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 (group A) were compared with those using surgical femoral cutdown from January 2008 to November 2009 (group B). Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit (CCU) stay, time from procedure to discharge,hospital stay, procedure expense, hospital cost.Results Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% (85/85) in group A vs. 97.4% (147/151) in group B (P <0.05).There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% (8/85) vs. 22.5% (34/151) (P <0.01). Local anesthesia with conscious sedation was used more often in group A, 68.2% (58/85) vs. 51.7% (78/151) in group B (P<0.01). The procedure duration was shorter, (96±33)minutes in group Avs. (127±41) minutes in group B (P<0.01). The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, (117.3±88.3) hours, (7.5±5.3) days and (15.3±6

  9. Median Sternotomy or Right Thoracotomy Techniques for Total Artificial Heart Implantation in Calves.

    Science.gov (United States)

    Karimov, Jamshid H; Moazami, Nader; Sunagawa, Gengo; Kobayashi, Mariko; Byram, Nicole; Sale, Shiva; Such, Kimberly A; Horvath, David J; Golding, Leonard A R; Fukamachi, Kiyotaka

    2016-10-01

    The choice of optimal operative access technique for mechanical circulatory support device implantation ensures successful postoperative outcomes. In this study, we retrospectively evaluated the median sternotomy and lateral thoracotomy incisions for placement of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) in a bovine model. The CFTAH was implanted in 17 calves (Jersey calves; weight range, 77.0-93.9 kg) through a median sternotomy (n = 9) or right thoracotomy (n = 8) for elective chronic implantation periods of 14, 30, or 90 days. Similar preoperative preparation, surgical techniques, and postoperative care were employed. Implantation of the CFTAH was successfully performed in all cases. Both methods provided excellent surgical field visualization. After device connection, however, the median sternotomy approach provided better visualization of the anastomoses and surgical lines for hemostasis confirmation and repair due to easier device displacement, which is severely limited following right thoracotomy. All four animals sacrificed after completion of the planned durations (up to 90 days) were operated through full median sternotomy. Our data demonstrate that both approaches provide excellent initial field visualization. Full median sternotomy provides larger viewing angles at the anastomotic suture line after device connection to inflow and outflow ports.

  10. Trochanteric osteotomies in revision total hip arthroplasty: contemporary techniques and results.

    Science.gov (United States)

    Jando, Victor T; Greidanus, Nelson V; Masri, Bassam A; Garbuz, Donald S; Duncan, Clive P

    2005-01-01

    Revision total hip arthroplasty (THA) presents several challenges to the orthopaedic surgeon and typically requires the use of a more extensile surgical approach. Osteotomy of the greater trochanter can be considered as the ultimate extensile exposure in revision THA. The methods of trochanteric osteotomy can be categorized into three types: the standard trochanteric osteotomy, the trochanteric slide, and the extended trochanteric osteotomy. Although the standard osteotomy and trochanteric slide osteotomy provide excellent acetabular exposure, in the revision setting they are frequently associated with an unacceptably high rate of nonunion and proximal migration of the trochanteric fragment. The extended trochanteric osteotomy (ETO) has increased in popularity as the number and complexity of revision THAs continue to increase. Two commonly used techniques are the ETO via a posterolateral approach or via a modified direct lateral approach. Both techniques provide wide exposure of the acetabulum, facilitate femoral component exposure and removal, aid in canal preparation and femoral reconstruction, and allow for correction of proximal femoral deformity. The osteotomy fragment is easily secured and may be advanced distally to achieve proper tensioning of the abductors. Recent literature demonstrates that the ETO has a relatively low rate of nonunion and is associated with fewer intraoperative femoral fractures or cortical perforations, as well as decreased surgical time.

  11. Optimally invasive exposure in revision total hip arthroplasty: a guide to selection and technique.

    Science.gov (United States)

    Toms, Andrew; Greidanus, Nelson; Garbuz, Donald; Masri, Bassam A; Duncan, Clive P

    2006-01-01

    Revision total hip arthroplasty requires a careful surgical plan. Selection of the appropriate exposure is an essential step for success. Exposure is important not only for the complete and safe visualization and extraction of components and cement, but also for the achievement of a stable construct at the end of the procedure. In addition, controlled exposure minimizes intraoperative complications and bone and soft-tissue damage, essential considerations for eradication of infection. Three questions need to be addressed at the preoperative stage: (1) Is this a straightforward revision that can be handled with a standard approach? (2) Is this a more complex revision requiring an extensile exposure? (3) Is this an unusual revision requiring special techniques to allow adequate access that cannot be obtained using standard extensile techniques? Each group of exposures presents three further possibilities, each of which has specific indications, advantages, and disadvantages. In conjunction with the preoperative analysis, this knowledge should enable the revision surgeon to select the most appropriate approach, resulting in optimal exposure for each individual revision scenario.

  12. Intraoperative monitoring for safety of total hip arthroplasty using third-generation cementing technique

    Institute of Scientific and Technical Information of China (English)

    LI Zi-jian; ZHANG Ke; YANG Hong; LIU Yan; L(U) Jing-qiao

    2009-01-01

    Background Controversies on the safety of the cement application between cemented and uncemented total hip arthroplasty (THA) have been existing for decades. The purpose of this study was to observe the changes in mean arterial pressure (MAP), heart rate (HR) and oxygen pressure (PaO2) during cemented THA, and to evaluate the intraoperative safety of using the third-generation cementing technique and investigate whether the intraoperative risk is higher in acute femoral neck fracture patients than non-traumatic patients. Methods Forty-two patients who underwent cemented THA between November 2005 and September 2007 were prospectively included in this study. The third-generation cementing technique as vacuum mixing and pulsatile lavage was used strictly. The MAP and HR were monitored and documented during each operation. Blood gas analysis was performed at exposure, cup implantation, stem implantation and wound closure. MAP, HR and PaO2 were compared between pre- and post-cement application. Comparisons of MAP, HR and PaO2 between patients with acute femoral neck fracture and non-traumatic patiens were performed as well. Results No intraoperative cardiopulmonary complication occurred in these cases. No obvious changes were observed in MAP, HR and PaO2 after cement application. There was no significant difference in MAP, HR and PaO2 between acute femoral fracture patients (18 patients) and non-traumatic patients (24 patients).Conclusions The results of this study suggested that the invasive blood pressure monitoring and blood gas analysis are essential for patients undergoing cemented THA, especially for patients with femoral neck fracture. The third-generation cementing technique is safe to use in THA.

  13. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study

    Directory of Open Access Journals (Sweden)

    Felipe Araujo

    2014-01-01

    Full Text Available Objective: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP technique. Background : TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. Patients and Methods : Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. Results: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014. Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042. There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. Conclusion: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.

  14. Dosimetric evaluation using the diode measurements for total skin electron therapy technique

    Institute of Scientific and Technical Information of China (English)

    Ehab M.Attalla; Nashaat A.Deiab; Walaa S.Abd Elgawad

    2014-01-01

    The purpose of this study was to present the dosimetric study and evaluation the dose delivered to the skin tumor by using diode detector with total skin electron therapy (TSET).Methods: The total skin electron irradiation (TSEI) technique was used to treat ten patients with histological confirmed mycosis fungoides according to the Stanford staging system at the Radiotherapy Department, National Cancer Institute, Cairo University, Egypt. High dose rate electron beams with low electron energy 5 MeV from a Siemens linear accelerator were used for treatment. Diodes were calibrated at TSET distance 300 cm and field size (35 x 35) cm2.Results:The result of diodes measurements showed the dose to flat surface of the body was within ±10 % from the prescribed dose. Special areas of the body such as the perineum & eyelid showed large deviation up to 30% variation from the prescription dose.Conclusion:The diode results of this study wil be used as a quality assurance check for al new patients treated with TSET and to compare it to the prescribed dose delivered to the patients. It is recommends to evaluate the diodes measurements for al patients throughout the ful treatment cycle and to identify individu-aly the boost dose areas.

  15. Theoretical and practical limitations of the acetylene inhibition technique to determine total denitrification losses

    Directory of Open Access Journals (Sweden)

    R. Felber

    2012-10-01

    Full Text Available The loss of N2 from intensively managed agro-ecosystems is an important part of the N budget. Flux monitoring of N2 emissions at the field scale, e.g., by eddy correlation or aerodynamic gradient method, is impossible due to the large atmospheric N2 background (78%. The acetylene (C2H2 inhibition technique (AIT is a rather simple and frequently used, albeit imperfect, method to determine N2 losses from intact soil cores. In principle, AIT allows an estimation of total denitrification at high temporal resolution and on small spatial scales, with limited workload and costs involved. To investigate its potential and limitations, a laboratory system with two different detection systems (photoacoustic IR spectroscopy and gas chromatography is presented, which allowed simultaneous measurements of up to 7 intact soil cores in air-tight glass tubes in a temperature controlled cabinet (adjusted to field conditions with automated C2H2 injection. A survey of total denitrification losses (N2 + N2O over 1.5 yr in soil cores from an intensively managed, cut grassland system in central Switzerland supports previous reports on severe limitations of the AIT, which precluded reliable estimates of total denitrification losses. Further, the unavoidable sampling and transfer of soil samples to the laboratory causes unpredictable deviations from the denitrification activity in the field.

  16. Rotational alignment in total knee arthroplasty: nonimage-based navigation system versus conventional technique

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xian-long; ZHANG Wen; SHAO Jun-jie

    2012-01-01

    Background Proper rotational alignment during total knee arthroplasty (TKA) is important for adequate postoperative patellofemoral and tibiofemoral kinematics,as well as for achieving balanced flexion space at 90°.The effects of computer navigation-assisted total knee replacement and conventional total knee arthroplasty on rotational alignment,mechanical axis,component position and clinical outcomes were compared.Methods Two methods were used in 82 patients and the rotation of the femoral and tibial components in the transverse plane,the combined rotation of the two components,the mismatch between them,and the mechanical axis of the lower limb were analyzed.All of these parameters were measured from postoperative radiographs and computed tomography images.Functional outcomes were compared at 6 weeks and 6 months postoperatively.Results Significant differences were found between the two techniques (P <0.05) in the following parameters:average rotation of the femoral component ((1.51±3.55)° vs.(-0.63±3.04)°); combined rotation of the femoral and tibial components (2.85±4.07)° vs.(0.28±3.43)°); and mismatch between the femoral and tibial components ((1.44±4.55)° vs.(-0.43±2.86)°).Differences in the rotation of the tibial component were not statistically significant.The prevalence of outliers (malalignment >±3° intemal/external rotation) of the femoral component (31.7% vs.12.5%) and the tibial component (36.6% vs.15%) were significantly reduced when the navigation system was used (P<0.05).In addition,while patients in the navigation group had significantly better mechanical axis and functional outcomes at 6 weeks after surgery (P <0.05),there was no significant difference between the two groups (P >0.05) with respect to functional outcomes at 6 months.Conclusion The navigation system exhibited higher accuracy than the conventional technique in the transverse and coronal plane,and provided better early functional outcomes.

  17. Analysis of behavioral change techniques in community-led total sanitation programs.

    Science.gov (United States)

    Sigler, Rachel; Mahmoudi, Lyana; Graham, Jay Paul

    2015-03-01

    The lack of sanitation facilitates the spread of diarrheal diseases-a leading cause of child deaths worldwide. As of 2012, an estimated 1 billion people still practiced open defecation (OD). To address this issue, one behavioral change approach used is community-led total sanitation (CLTS). It is now applied in an estimated 66 countries worldwide, and many countries have adopted this approach as their main strategy for scaling up rural sanitation coverage. While it appears that many of the activities used in CLTS-that target community-level changes in sanitation behaviors instead of household-level changes-have evolved out of existing behavior change frameworks and techniques, it is less clear how these activities are adapted by different organizations and applied in different country contexts. The aims of this study are to (i) show which behavior change frameworks and techniques are the most common in CLTS interventions; (ii) describe how activities are implemented in CLTS interventions by region and context; and (3) determine which activities program implementers considered the most valuable in achieving open defecation free (ODF) status and sustaining it. The results indicate that a wide range of activities are conducted across the different programs and often go beyond standard CLTS activities. CLTS practitioners ranked follow-up and monitoring activities as the most important activities for achieving an ODF community, yet only 1 of 10 organizations conducted monitoring and follow-up throughout their project. Empirical studies are needed to determine which specific behavioral change activities are most effective at ending OD and sustaining it. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. SU-E-T-31: Alternative VMAT Technique Reduces Total Monitor Units for Lung SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Happersett, L; Mechalakos, J; Kuo, L; Zhang, P; Rimner, A [Memorial Sloan-Kettering Cancer Center, NY, NY (United States)

    2014-06-01

    Purpose: To investigate an alternative approach to VMAT optimization for hypofractionation lung treatment which increases average aperture opening and results in lower total Monitor Units (MU) without significantly sacrificing plan quality. Methods: Benchmark Volumetric Modulated Arc Therapy (bVMAT) plans were generated for 10 lung Stereotactic Body radiotherapy (SBRT) cases using Eclipse Version 11.0.42 (Varian Medical Systems) without a maximum MU constraint. Prescriptions ranged from 40 to 54Gy in 3 to 5 fractions. AAA dose calculation and PRO fluence based optimization was utilized. Two comparison VMAT plans were generated for each case, one that forced an initial “open” mlc aperture conformal to the tumor as a starting condition (oVMAT) with similar optimization parameters and arc geometries, and one that repeated the bVMAT optimization but added a maximum MU constraint (muVMAT). All plans used two arcs with lengths between 168 to 230 degrees. PTV D 95% and Dmean, lung V20 Gy, chest wall V30 Gy, average aperture opening and MU's were compared. Statistical significance was evaluated using Wilcoxon signed rank test. Results: Average PTV D(95), PTV mean and lung V20Gy over all plans was 99.2 ± 1.7%, 103.3 ± 0.6% and 7.8 ± 2.4% respectively. The average chest wall V30Gy was 61 ± 61 cc and ranged between 0 to 166 cc. There were no significant differences between the three techniques for the dosimetric quantities. MUs were reduced by 11 ±11% (p<0.01) and 25 ± 5% (p<0.01) and the average aperture size was increased by 13.7 ± 14% (p=0.02) and 35.8 ± 10% (p<0.01) with muVMAT and oVMAT, respectively, compared to bVMAT. Conclusion: oVMAT and muVMAT techniques were both able to increase average aperture size and reduce total MU compared to the benchmark VMAT plan, but the magnitude of the changes observed for oVMAT was larger.

  19. Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".

    Science.gov (United States)

    Azzalini, Lorenzo; Carlino, Mauro; Brilakis, Emmanouil S; Vo, Minh; Rinfret, Stéphane; Uretsky, Barry F; Karmpaliotis, Dimitri; Colombo, Antonio

    2017-03-17

    Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc.

  20. Total reflection X-ray fluorescence as a fast multielemental technique for human placenta sample analysis

    Science.gov (United States)

    Marguí, E.; Ricketts, P.; Fletcher, H.; Karydas, A. G.; Migliori, A.; Leani, J. J.; Hidalgo, M.; Queralt, I.; Voutchkov, M.

    2017-04-01

    In the present contribution, benchtop total reflection X-ray fluorescence spectrometry (TXRF) has been evaluated as a cost-effective multielemental analytical technique for human placenta analysis. An easy and rapid sample preparation consisting of suspending 50 mg of sample in 1 mL of a Triton 1% solution in deionized water showed to be the most suitable for this kind of samples. However, for comparison purposes, an acidic microwave acidic digestion procedure was also applied. For both sample treatment methodologies, limits of detection for most elements were in the low mg/kg level. Accurate and precise results were obtained using internal standardization as quantification approach and applying a correction factor to compensate for absorption effects. The correction factor was based on the proportional ratio between the slurry preparation results and those obtained for the analysis of a set of human placenta samples analysed by microwave acidic digestion and ICP-AES analysis. As a study case, the developed TXRF methodology was applied for multielemental analysis (K, Ca, Fe, Cu, Zn, As, Se, Br, Rb and Sr) of several healthy women's placenta samples from two regions in Jamaica.

  1. Neonatal total liquid ventilation: is low-frequency forced oscillation technique suitable for respiratory mechanics assessment?

    Science.gov (United States)

    Bossé, Dominick; Beaulieu, Alexandre; Avoine, Olivier; Micheau, Philippe; Praud, Jean-Paul; Walti, Hervé

    2010-08-01

    This study aimed to implement low-frequency forced oscillation technique (LFFOT) in neonatal total liquid ventilation (TLV) and to provide the first insight into respiratory impedance under this new modality of ventilation. Thirteen newborn lambs, weighing 2.5 + or - 0.4 kg (mean + or - SD), were premedicated, intubated, anesthetized, and then placed under TLV using a specially design liquid ventilator and a perfluorocarbon. The respiratory mechanics measurements protocol was started immediately after TLV initiation. Three blocks of measurements were first performed: one during initial respiratory system adaptation to TLV, followed by two other series during steady-state conditions. Lambs were then divided into two groups before undergoing another three blocks of measurements: the first group received a 10-min intravenous infusion of salbutamol (1.5 microg x kg(-1) x min(-1)) after continuous infusion of methacholine (9 microg x kg(-1) x min(-1)), while the second group of lambs was chest strapped. Respiratory impedance was measured using serial single-frequency tests at frequencies ranging between 0.05 and 2 Hz and then fitted with a constant-phase model. Harmonic test signals of 0.2 Hz were also launched every 10 min throughout the measurement protocol. Airway resistance and inertance were starkly increased in TLV compared with gas ventilation, with a resonant frequency ventilation. We show that LFFOT is an effective tool to track respiratory mechanics under TLV.

  2. Failure modes and effects analysis of total skin electron irradiation technique.

    Science.gov (United States)

    Ibanez-Rosello, B; Bautista, J A; Bonaque, J; Perez-Calatayud, J; Gonzalez-Sanchis, A; Lopez-Torrecilla, J; Brualla-Gonzalez, L; Garcia-Hernandez, T; Vicedo-Gonzalez, A; Granero, D; Serrano, A; Borderia, B; Solera, C; Rosello, J

    2017-08-04

    Total skin electron irradiation (TSEI) is a radiotherapy technique which consists of an homogeneous body surface irradiation by electrons. This treatment requires very strict technical and dosimetric conditions, requiring the implementation of multiple controls. Recently, the Task Group 100 report of the AAPM has recommended adapting the quality assurance program of the facility to the risks of their processes. A multidisciplinary team evaluated the potential failure modes (FMs) of every process step, regardless of the management tools applied in the installation. For every FM, occurrence (O), severity (S) and detectability (D) by consensus was evaluated, which resulted in the risk priority number (RPN), which permitted the ranking of the FMs. Subsequently, all the management tools used, related to the TSEI process, were examined and the FMs were reevaluated, to analyze the effectiveness of these tools and to propose new management tools to cover the greater risk FMs. 361 FMs were identified, 103 of which had RPN ≥80, initially, and 41 had S ≥ 8. Taking this into account the quality management tools FMs were reevaluated and only 30 FMs had RPN ≥80. The study of these 30 FMs emphasized that the FMs that involved greater risk were related to the diffuser screen placement and the patient's position during treatment. The quality assurance program of the facility has been adapted to the risk of this treatment process, following the guidelines proposed by the TG-100. However, clinical experience continually reveals new FMs, so the need for periodic risk analysis is required.

  3. Flame slice algebraic reconstruction technique reconstruction algorithm based on radial total variation

    Science.gov (United States)

    Zhang, Shufang; Wang, Fuyao; Zhang, Cong; Xie, Hui; Wan, Minggang

    2016-09-01

    The engine flame is an important representation of the combustion process in the cylinder, and the three-dimensional (3-D) shape reconstruction of the flame can provide more information for the quantitative analysis of the flame, so as to contribute to further research on the mechanism of the combustion flame. One important method of 3-D shape reconstruction is to reconstruct the two-dimensional (2-D) projection image of the flame, so the optimization problem of the flame 2-D slice reconstruction algorithm is studied in this paper. According to the gradient sparsity characteristics in the total variation (TV) domain and radial diffusion characteristics of the engine combustion flame, a flame 2-D slice algebraic reconstruction technique (ART) reconstruction algorithm based on radial TV (ART-R-TV) is proposed. Numerical simulation results show that the new proposed ART-R-TV algorithm can reconstruct flame slice images more stably and have a better robustness than the two traditional ART algorithms especially in a limited-angle situation.

  4. Splenectomy increases the survival time of heart allograft via developing immune tolerance.

    Science.gov (United States)

    Zhu, Jinguo; Chen, Shuzhen; Wang, Jinju; Zhang, Cheng; Zhang, Wei; Liu, Peng; Ma, Ruilian; Chen, Yanfang; Yao, Zhen

    2013-05-16

    The spleen is an active lymphoid organ. The effect of splenectomy on the immune response remains unclear. This study investigated whether splenectomy can induce immune tolerance and has a beneficial role in cardiac allograft. Wistar rats were used for heart donors. The Sprague-Dawley (SD) rats designated as the recipients of heart transplantation (HT) were randomly assigned into four groups: sham, splenectomy, HT, splenectomy + HT. The survival of transplanted hearts was assessed by daily checking of abdominal palpation. At various time points after transplantation, the transplanted hearts were collected and histologically examined; the level of CD4+CD25+ T regulatory lymphocytes (Tregs) and rate of lymphocyte apoptosis (annexin-v+ PI+ cells) in the blood were analyzed by using flow cytometric method. 1) Splenectomy significantly prolonged the mean survival time of heart allografts (7 ± 1.1 days and 27 ± 1.5 days for HT and splenectomy + HT, respectively; n = 12-14/group, HT vs. splenectomy + HT, p Tregs in the blood of splenectomized rats was significantly increased within 7 days (2.4 ± 0.5%, 4.9 ± 1.3% and 5.3 ± 1.0% for sham, splenectomy and splenectomy + HT, respectively; n = 15/group, sham vs. splenectomy or splenectomy + HT, p increased the rate of lymphocyte apoptosis (day 7: 0.3 ± 0.05%, 3.9 ± 0.9% and 4.1 ± 0.9% for sham, splenectomy and splenectomy + HT, respectively; n = 15/group, sham vs. splenectomy or splenectomy + HT, p Tregs in the blood. Splenectomy inhibits the development of pathology and prolongs the survival time of cardiac allograft. The responsible mechanism is associated with induction of immune tolerance via elevating CD4+CD25+ Tregs and increasing lymphocyte apoptosis.

  5. Assessment of the associated particle prompt gamma neutron activation technique for total body nitrogen measurement in vivo

    Science.gov (United States)

    Total Body Nitrogen (TBN) can be used to estimate Total Body Protein (TBP), an important body composition component at the molecular level. A system using the associated particle technique in conjunction with prompt gamma neutron activation analysis has been developed for the measurement of TBN in ...

  6. Partiële in plaats van complete splenectomie bij kinderen voor pathologische stadiëring van de ziekte van Hodgkin

    NARCIS (Netherlands)

    Hoekstra, H J; Tamminga, R Y; Timens, W

    1993-01-01

    OBJECTIVE: Evaluation of partial splenectomy in children for pathological staging of Hodgkin's disease. DESIGN: Prospective clinical study. PLACE: University Hospital Groningen. METHOD: From 1982 to 1988, 12 children with Hodgkin's disease underwent partial splenectomy during laparotomy for patholog

  7. Portal vein thrombosis after laparoscopic splenectomy during childhood.

    Science.gov (United States)

    Gelas, Thomas; Scalabre, Aurélien; Hameury, Frédéric; Dubois, Rémi; Grosos, Céline; Mouriquand, Pierre D; Mure, Pierre-Yves

    2014-01-01

    Portal vein thrombosis (PVT) is a rare but potentially life-threatening complication of laparoscopic splenectomy (LS) and can lead to bowel ischemia or portal hypertension. In childhood, this complication is reported in 5-10 % of the cases whereas it can be up to 50 % in adult population. Our aim was to evaluate PVT incidence after LS and associated risks factors. A retrospective chart review identified 37 children who underwent elective LS from 2005 to 2013. The main indications were spherocytosis or sickle cell disease. Median age and weight were respectively 7.4 years and 25.1 kg. Thromboembolic prophylaxis was not routinely given. Duration of surgery was 129 min and hospital length of stay 4 days. Doppler ultrasound scan (USS) was performed post-operatively in 26 cases. Post-operative course was uneventful in all but one patient. She was a 17 year-old girl previously operated for an ovarian tumor with hyperandrogenism. Histopathology revealed a splenic lymphoma. At day 4, a systematic USS showed a PVT extending in the portal branches. Therapeutic low molecular weight heparin was used and then transitioned to fluindione for 3 months. Follow-up USS performed at 1 and 4 months demonstrated complete resolution of the PVT. PVT after pediatric LS is a rare event in our series. Clinician should be cautious in oncologic cases and if very large spleen or if thrombocythemia >650.10(9)/L is present. If detected early, PVT can be treated efficiently. We therefore recommend a systematic USS during the first postoperative week.

  8. Transforming management of patients undergoing splenectomy in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-02-06

    BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a \\'patient information leaflet\\' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.

  9. Transforming management of patients undergoing splenectomy in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a \\'patient information leaflet\\' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.

  10. Thrombocytosis following splenectomy and aortic valve replacement for idiopathic thrombocytopaenic purpura with bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Sarika Katiyar

    2015-01-01

    Full Text Available Idiopathic thrombocytopaenic purpura (ITP patients are at high risk for complications during and after cardiac surgeries involving cardiopulmonary bypass. The main clinical problem of primary ITP is an increased risk of bleeding although bleeding may not always be present. More recently, thrombosis has become appreciated as another potential complication of the procedure. We report a 22-year-old female patient with ITP with bicuspid aortic valve and splenomegaly, who underwent uncomplicated aortic valve replacement and splenectomy simultaneously. She was readmitted with chest pain due to coronary thrombosis following splenectomy which made the management difficult. We describe our experience in managing this patient who presented with thrombotic complication rather than bleeding in post-operative period and the challenges met in maintaining appropriate anticoagulation for aortic valve replacement as well as thrombosis, post-splenectomy

  11. Splenic and portal vein thrombosis following laparoscopic splenectomy in a pediatric patient with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Henrique Manoel Lederman

    Full Text Available CONTEXT: Splenic or portal vein thrombosis is a rare complication following splenectomy. CASE REPORT: We report a case of splenic and portal venous thrombosis in a 10-year-old girl with chronic myeloid leukemia who underwent laparoscopic splenectomy prior to bone marrow transplant. Clinical suspicion of such thrombosis should be high for patients who have had splenectomy. The diagnosis is confirmed by Doppler ultrasound or contrast-enhanced computed tomography; magnetic resonance imaging magnetic resonance angiography or arteriography can also be used. Proposals for postoperative screening protocols are discussed. Patients with primary myeloproliferative disorders are at increased risk of portal vein thrombosis, independent of surgical intervention, perhaps due to platelet dysfunction resulting from abnormalities of pluripotent stem cells. Marked splenomegaly (with larger draining veins is thought to increase the risk of thrombosis.

  12. Serial CT Findings of Resolving Extramedullary Hematopoiesis as Unilateral Posterior Mediastinal Mass after Splenectomy in Hereditary Spherocytosis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Mi Yeon; Lee, Ju Won; Kim, Yeo Ju; Kim, Youn Jeong; Kang, Young Hye; Lee, Kyung Hee [Dept. of Radiology, Inha University Hospital, Incheon (Korea, Republic of)

    2012-03-15

    Intrathoracic extramedullary hematopoiesis (EMH) is a rare condition of the hereditary spherocytosis. EMH usually regresses or disappears after treatment; such as splenectomy in the case of spherocytosis. We report a case of hereditary spherocytosis. It is presented with an unilateral paravertebral posterior mediastinal mass. After splenectomy, it revealed shrinkage and fatty replacement on serial CT scans.

  13. Validation of total skin electron irradiation (TSEI) technique dosimetry data by Monte Carlo simulation.

    Science.gov (United States)

    Nevelsky, Alexander; Borzov, Egor; Daniel, Shahar; Bar-Deroma, Rachel

    2016-07-08

    Total skin electron irradiation (TSEI) is a complex technique which requires many nonstandard measurements and dosimetric procedures. The purpose of this work was to validate measured dosimetry data by Monte Carlo (MC) simulations using EGSnrc-based codes (BEAMnrc and DOSXYZnrc). Our MC simulations consisted of two major steps. In the first step, the incident electron beam parameters (energy spectrum, FWHM, mean angular spread) were adjusted to match the measured data (PDD and profile) at SSD = 100 cm for an open field. In the second step, these parameters were used to calculate dose distributions at the treatment distance of 400 cm. MC simulations of dose distributions from single and dual fields at the treatment distance were performed in a water phantom. Dose distribution from the full treatment with six dual fields was simulated in a CT-based anthropomorphic phantom. MC calculations were compared to the available set of measurements used in clinical practice. For one direct field, MC calculated PDDs agreed within 3%/1 mm with the measurements, and lateral profiles agreed within 3% with the measured data. For the OF, the measured and calculated results were within 2% agreement. The optimal angle of 17° was confirmed for the dual field setup. Dose distribution from the full treatment with six dual fields was simulated in a CT-based anthropomorphic phantom. The MC-calculated multiplication factor (B12-factor), which relates the skin dose for the whole treatment to the dose from one calibration field, for setups with and without degrader was 2.9 and 2.8, respectively. The measured B12-factor was 2.8 for both setups. The difference between calculated and measured values was within 3.5%. It was found that a degrader provides more homogeneous dose distribution. The measured X-ray contamination for the full treatment was 0.4%; this is compared to the 0.5% X-ray contamination obtained with the MC calculation. Feasibility of MC simulation in an anthropomorphic phantom

  14. Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients.

    Science.gov (United States)

    Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

    2016-07-19

    BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152-61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247-276.949; clinically significant PVST: OR=40.415, 95%CI=3.895-419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953-0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895-0.980; clinically significant PVST: OR=0.935, 95%CI=0.891-0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909-0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. CONCLUSIONS Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.

  15. Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Li W

    2015-08-01

    Full Text Available Wei Li, Shi-Qiang Shen, Shan-Min Wu, Zu-Bing Chen, Chao Hu, Rui-Chen YanDepartment of General Surgery, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of ChinaBackground: This study systematically compared the efficacy and safety of simultaneous hepatectomy and splenectomy (HS with hepatectomy (H alone in patients with hepatocellular carcinoma (HCC and hypersplenism.Methods: The PubMed, Web of Science, Science Direct, EMBASE, and Cochrane Library databases were systematically searched by two independent researchers through to March 31, 2015 to identify relevant studies. All the extracted literature were managed by Bibliographic citation management software. Quality assessment of the included studies was performed using a modified Newcastle–Ottawa Scale judgment. The data were analyzed using RevMan5.2 software.Results: Eight studies including a total of 761 patients with HCC and hypersplenism (360 in the HS group, 401 in the H group were finally included in the analysis. Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups. HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83–95.46, P=0.003, and CD4/CD8 ratio (MD 0.69, 95% CI 0.61–0.77, P<0.00001, CD4 subset, platelet count (MD 213.06, 95% CI 202.59–223.53, P<0.0001, white blood cell count (MD 4.85, 95% CI 4.58–5.13, P<0.0001, interferon-gamma levels (MD 18.52, 95% CI 13.93–23.11, P<0.00001, and interleukin-2 levels (MD 20.73, 95% CI 16.05–25.41, P<0.0001. In addition, lower CD8 subset (MD −7.85, 95% CI −9.07, −6.63, P<0.00001 and interleukin-10 levels (MD −18.56, 95% CI −22.61, −14.50, P<0.00001 were observed for HS.Conclusion: We identified that simultaneous HS do not increase postoperative complications, operation time, or perioperative

  16. A report of two cases of splenectomy in children younger than two years old with hereditary spherocytosis

    Directory of Open Access Journals (Sweden)

    Sheng Jin

    2015-02-01

    Full Text Available Hereditary spherocytosis (HS is a common pediatric hemolytic anemia and one of the most common types of familial hemolytic anemia caused by congenital red blood cell defects. HS often presents clinically as childhood anemia, jaundice, and progressive splenomegaly. It is generally accepted that splenectomy is the most effective treatment for HS, but development of overwhelming infections with symptoms such as chills, high fever, and septicemia may occur because of immune dysfunction after splenectomy. As a result, the generally proposed age for children to undergo splenectomy is after 5 years of age. Splenectomy in younger HS patients is rarely reported. Here, however, we report 2 cases of HS in children younger than 2 years of age (15 months and 18 months who underwent splenectomy; we also report on their follow-up.

  17. Upper abdominal body shape is the risk factor for postoperative pancreatic fistula after splenectomy for advanced gastric cancer: A retrospective study

    Directory of Open Access Journals (Sweden)

    Fujii Shoichi

    2008-10-01

    Full Text Available Abstract Background Postoperative pancreas fistula (POPF is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy. Methods Fifty patients who underwent total gastrectomy with splenectomy were studied. The maximum vertical distance measured by computed tomography (CT between the anterior abdominal skin and the back skin (U-APD and the maximum horizontal distance of a plane at a right angle to U-APD (U-TD were measured at the umbilicus. The distance between the anterior abdominal skin and the root of the celiac artery (CAD and the distance of a horizontal plane at a right angle to CAD (CATD were measured at the root of the celiac artery. The CA depth ratio (CAD/CATD was calculated. Results POPF occurred in 7 patients (14.0% and was associated with a higher BMI, longer CAD, and higher CA depth ratio. However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF. Logistic-regression analysis revealed that a high BMI (≥25 and a high CA depth ratio (≥0.370 independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively. Conclusion Surgical procedures such as total gastrectomy with splenectomy should be very carefully executed in obese patients or patients with a deep abdominal cavity to decrease the risk of postoperative pancreatic fistula. BMI and body shape can predict the risk of POPF simply by CT.

  18. ANAESTHETIC MANAGEMENT OF A CASE OF HEREDITARY SPHEROCYTOSIS FOR SPLENECTOMY AND CHOLECYSTECTOMY.

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    Jyotsna

    2012-11-01

    Full Text Available ABSTRACT: We report successful anaesthetic management of a pat ient with hereditary spherocytosis who underwent laproscopic splenectomy, ch olecystectomy and appendioectomy. Hereditary spherocytosis is a familial hemolytic di sorder with marked heterogeneity of clinical features, ranging from asymptomatic condition to a f ulminant hemolytic anaemia. Commonly recommended perioperative management in these patien ts includes preemptive erythrocyte transfusion, aggressive hydration and avoidance of hypoxia, aplastic crisis, hypothermia and acidosis. The management of such a case is challeng ing from anaesthetic point of view because of sickling oriented anaesthetic approach. Key words: Hereditary spherocytosis, splenectomy, cholecystectomy, perioperative management.

  19. Open partial splenectomy for trauma using GIA-Stapler and FloSeal matrix haemostatic agent.

    Science.gov (United States)

    Costamagna, Daniela; Rizzi, Sabrina; Zampogna, Annunziatino; Alonzo, Amedeo

    2010-08-09

    A ruptured spleen caused by blunt abdominal injury is often treated by splenectomy. In view of the gravity of the 'postsplenectomy syndrome,' a conservative approach has been increasingly used. We present the case of a 29-year-old man with a Grade III splenic lesion for a blunt abdominal trauma after a car accident. We performed a partial splenectomy of the upper pole using GIA-Stapler. A supplemental haemostasis of the stapled line was successfully achieved by the application of FloSeal matrix haemostatic agent. The splenic remnant was fixed into the left-upper quadrant using human fibrin glue.

  20. Splenectomy versus cladribine therapy in hairy cell leukemia patients: a clinical trial

    Directory of Open Access Journals (Sweden)

    Jalaee Khoo H

    2009-11-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Hairy cell leukemia (HCL is a rare B-cell neoplasm that comprise approximately 2% of all lymphoid leukemias. Over the past 20 years splenectomy was the only effective therapy but with the advent of purine analogues such as cladribine, splenectomy has been limited to certain situations. After cladribine therapy most patients achieve complete and durable remission. The aim of this study was to compare effectiveness of splenectomy and cladribine in Iranian patients with HCL and also to evaluate the clinical and laboratory features of patients at diagnosis."n"nMethods: 50 patients with the diagnosis of HCL enrolled to our study. The male to female ratio was 3:1, and the median age at diagnosis was 50 years. After diagnosis  20(40% and 12(24% of patients had splenectomy and cladribine therapy respectively. The reminder of patients were treated with both splenectomy and cladribine."n"nResults: The most common clinical findings were splenomegaly (98% and fatigue (80% respectively. Leucopenia and anemia was present in 96% and 80% patients in order. 88.6% and 55.5% of patients achieved complete remission after cladribine therapy and splenectomy respectively. After cladribine therapy and splenectomy relapse occurred

  1. Acute Central Retinal Vein Occlusion Secondary to Reactive Thrombocytosis after Splenectomy

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    Nursen Oncel Acir

    2014-01-01

    Full Text Available The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases.

  2. Cirurgias conservadoras do baço para tratamento da doença de Gaucher Partial splenectomy in the treatment of Gaucher's disease

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    Andy Petroianu

    2004-03-01

    , have been treated by partial splenectomy. However, the splenic remnant, vascularized by the hilar vessels, may enlarge leading to recurrent splenomegaly and all its adverse effects. More than eighteen years of experience treating portal hypertension, splenic trauma, myeloid splenomegaly, splenomegalic somatic and sexual hypodevelopment, chronic lymphocytic lymphoma and cystadenoma of pancreatic tail by subtotal splenectomy, maintaining the upper pole supplied only by the splenogastric vessels showed that the splenic remnant does not increase its size. Based on evidence that the hilar vessels may contribute to the increase of the splenic remnant, we performed in five cases with Gaucher's disease subtotal splenectomy, maintaining the upper pole supplied only by the splenogastric vessels. The splenic remnant did not modify in size during a postoperative follow-up of more than twelve years, and the hematological parameters remained normal. Another patient whose splenogastric vessels were insufficient to maintain the upper splenic pole, was submitted to total splenectomy and autologous splenic tissue transplantation on the greater omentum. The autotransplant survived and presented with function. All six patients had uneventful postoperative follow-up in relation to the splenic conservative procedure. In conclusion, in presence of giant splenomegaly with severe hematologic and clinical symptoms the spleen must be resected in a conservative fashion such as subtotal splenectomy or total splenectomy followed by autotransplants of splenic tissue.

  3. Techniques for managing varus and valgus malalignment during total ankle replacement.

    Science.gov (United States)

    Choi, Woo Jin; Yoon, Hang Seob; Lee, Jin Woo

    2013-01-01

    The ultimate goal of primary total ankle replacement is to provide a well-balanced soft-tissue envelope around a well-aligned, well-fixated implant. Some surgeons have emphasized that good outcomes in total ankle replacement are more dependent on ligament balancing, along with the procedure itself, than the extent of preoperative coronal deformity in the ankle. Thus, it is imperative that the surgeon be familiar with additional procedures to address the varus, valgus, and other associated deformities commonly encountered in primary total ankle replacement.

  4. Total neutron cross-sections for rare isotopes using a digital-signal-processing technique: Case study {sup 48}Ca

    Energy Technology Data Exchange (ETDEWEB)

    Shane, R. [Department of Physics, Washington University, Campus Box 1134, St. Louis, MO 63130 (United States); Charity, R.J.; Elson, J.M. [Department of Chemistry, Washington University, Campus Box 1134, St. Louis, MO 63130 (United States); Sobotka, L.G., E-mail: lgs@wustl.ed [Department of Physics, Washington University, Campus Box 1134, St. Louis, MO 63130 (United States); Department of Chemistry, Washington University, Campus Box 1134, St. Louis, MO 63130 (United States); Devlin, M.; Fotiades, N.; O' Donnell, J.M. [LANSCE Division, Los Alamos National Laboratory, Los Alamos, NM 87545 (United States)

    2010-03-11

    A digital-signal-processing method was developed and used to measure the total neutron cross-sections of {sup 48}Ca from 15 to 300 MeV. This technique allows for cross-sections to be obtained with high statistical accuracy even for samples that are an order of magnitude smaller than those used with conventional (non-digital) techniques. The isotopic and energy dependence of rare-isotope total neutron cross-sections are of considerable value for extracting the n/p asymmetry dependence of optical-model potentials.

  5. Shapes of the $^{192,190}$Pb ground states from beta decay studies using the total absorption technique

    CERN Document Server

    Estevez Aguado, M.E.; Agramunt, J.; Rubio, B.; Tain, J.L.; Jordan, D.; Fraile, L.M.; Gelletly, W.; Frank, A.; Csatlos, M.; Csige, L.; Dombradi, Zs.; Krasznahorkay, A.; Nacher, E.; Sarriguren, P.; Borge, M.J.G.; Briz, J.A.; Tengblad, O.; Molina, F.; Moreno, O.; Kowalska, M.; Fedosseev, V.N.; Marsh, B.A.; Fedorov, D.V.; Molkanov, P.L.; Andreyev, A.N.; Seliverstov, M.D.; Burkard, K.; Huller, W.

    2015-01-01

    The beta decay of $^{192,190}$Pb has been studied using the total absorption technique at the ISOLDE(CERN) facility. The beta-decay strength deduced from the measurements, combined with QRPA theoretical calculations, allow us to infer that the ground states of the $^{192,190}$Pb isotopes are spherical. These results represent the first application of the shape determination method using the total absorption technique for heavy nuclei and in a region where there is considerable interest in nuclear shapes and shape effects.

  6. An Attempted Substitute Study of Total Skin Electron Therapy Technique by Using Helical Photon Tomotherapy with Helical Irradiation of the Total Skin Treatment: A Phantom Result

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    Chi-Ta Lin

    2013-01-01

    Full Text Available An anthropomorphic phantom was used to investigate a treatment technique and analyze the dose distributions for helical irradiation of the total skin (HITS by helical tomotherapy (HT. Hypothetical bolus of thicknesses of 0, 10, and 15 mm was added around the phantom body to account for the dose homogeneity and setup uncertainty. A central core structure was assigned as a “complete block” to force the dose tangential delivery. HITS technique with prescribed dose (Dp of 36 Gy in 36 fractions was generated. The radiochromic EBT2 films were used for the dose measurements. The target region with 95.0% of the Dp received by more than 95% of the PTV was obtained. The calculated mean doses for the organs at risk (OARs were 4.69, 3.10, 3.20, and 2.94 Gy for the lung, heart, liver, and kidneys, respectively. The measurement doses on a phantom surface for a plan with 10 mm hypothetical bolus and bolus thicknesses of 0, 1, 2, and 3 mm are 89.5%, 111.4%, 116.9%, and 117.7% of Dp, respectively. HITS can provide an accurate and uniform treatment dose in the skin with limited doses to OARs and is safe to replace a total skin electron beam regimen.

  7. Total Pancreatectomy and Islet Cell Autotransplantation: Outcomes, Controversies and New Techniques

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    Michal Radomski

    2015-01-01

    Full Text Available Chronic pancreatitis is a challenging disease; the constellation of chronic abdominal pain and metabolic derangements present unique difficulties to the treating physician. Initial treatment revolves around lifestyle modification, pain control, and management of exocrine insufficiency. In refractory cases, total pancreatectomy with islet cell auto transplantation (TP-IAT is an option for patients with diffuse disease not amenable to subtotal pancreatectomy or a decompressive (drainage operation. This procedure aspires to alleviate pain and avoid surgically induced brittle diabetes, a morbid complication of total pancreatectomy alone. Herein, we review the indications, optimal timing, surgical outcomes and controversies for TP-IAT, focusing on recently published reports.

  8. Total pancreatectomy and islet cell autotransplantation: outcomes, controversies and new techniques.

    Science.gov (United States)

    Radomski, Michal; Zureikat, Amer H

    2015-01-31

    Chronic pancreatitis is a challenging disease; the constellation of chronic abdominal pain and metabolic derangements present unique difficulties to the treating physician. Initial treatment revolves around lifestyle modification, pain control, and management of exocrine insufficiency. In refractory cases, total pancreatectomy with islet cell auto transplantation (TP-IAT) is an option for patients with diffuse disease not amenable to subtotal pancreatectomy or a decompressive (drainage) operation. This procedure aspires to alleviate pain and avoid surgically induced brittle diabetes, a morbid complication of total pancreatectomy alone. Herein, we review the indications, optimal timing, surgical outcomes and controversies for TP-IAT, focusing on recently published reports.

  9. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia.

    LENUS (Irish Health Repository)

    Doodnath, R.

    2010-04-01

    With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.

  10. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia.

    LENUS (Irish Health Repository)

    Doodnath, R

    2012-02-01

    With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.

  11. Biodistribution of the radiopharmaceutical technetium-99m-sodium phytate in rats after splenectomy

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Kercia Regina Santos Gomes; Acucena, Maria Kadja Meneses Torres; Villarim Neto, Arthur; Rego, Amalia Cinthia Meneses [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Centro de Ciencias da Saude; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria; Azevedo, Italo Medeiros; Araujo Filho, Irami; Medeiros, Aldo Cunha [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Dept. de Cirurgia]. E-mail: aldo@ufrnet.br

    2008-12-15

    Drugs and surgery can interfere with the biodistribution of radiopharmaceuticals and data about the effect of splenectomy on the metabolism of phytate-Tc-99m are scarce. This study aimed at evaluating the interference of splenectomy on phytate-Tc-99m biodistribution and liver function in rats. The SP group rats (n=6) underwent splenectomy. In group C (control) the animals were not operated on. After 15 days, all rats were injected with 0.1 mL of Tc-99m-phytate via orbital plexus (0.66 MBq). After 30 minutes, liver samples were harvested, weighed and the percentage of radioactivity per gram (%ATI/g) was determined by a Wizard Perkin-Elme gamma counter. The ATI%/g in splenectomized rats (0.99{+-}0.02) was significantly higher than in controls (0.4{+-}0.02), (p=0.034). ALT, AST and HDL were significantly lower in SP rats (p= 0.001) and leucocytosis was observed in SP rats. In conclusion, splenectomy in rats changed the hepatic biodistribution of Tc-99m-phytate and liver enzymatic activity. (author)

  12. Salmonella sepsis following posttraumatic splenectomy and implantation of autologous splenic tissue

    DEFF Research Database (Denmark)

    Schrøder, H M; Hovendal, C

    1985-01-01

    A severe complication following implantation of autologous splenic tissue occurred in a 51-year-old man. Indirect injury to abdomen resulted in a lesion of the splenic artery. Following splenectomy and reimplantation of splenic tissue into three pouches, a severe Salmonella sepsis developed withi...

  13. Splenectomy complicated by sustained extreme thrombocytosis and extensive portosplenomesenteric vein thrombosis in pyrimidine 5'-nucleotidase deficiency.

    Science.gov (United States)

    Al-Jafar, Hassan A; Taqi, Ali; Madda, John Patrick; Abdullah, Thamer A

    2013-11-28

    Reactive and redistributional thrombocytosis is a well-known postsplenectomy occurrence .Usually it is transient and it rarely reaches extreme levels. We report a rare case of haemolytic anaemia where splenectomy was carried out following trauma to a massively enlarged spleen and was followed by extreme sustained thrombocytosis associated with extensive portal, splenic and mesenteric vein thrombosis despite standard antithrombotic prophylaxis.

  14. Adherence to vaccination guidelines post splenectomy: A five year follow up study.

    Science.gov (United States)

    Boam, Tristan; Sellars, Peter; Isherwood, John; Hollobone, Chloe; Pollard, Cristina; Lloyd, David M; Dennison, Ashley R; Garcea, Giuseppe

    2017-02-08

    Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Variaciones de la técnica convencional de histerectomía total abdominal Variations of the conventional technique of total abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2008-12-01

    Full Text Available INTRODUCCIÓN. La histerectomía total abdominal es un procedimiento quirúrgico frecuente. El presente estudio pretendió mostrar y a la vez proponer una modificación de la técnica convencional de histerectomía total abdominal, en diferentes momentos de la técnica, y que comprende en conjunto tanto la apertura y cierre de la cavidad abdominal, la sutura y fijación de la cúpula vaginal como la ligadura de los pedículos vasculares. MÉTODOS. Se realizó un estudio descriptivo con el objetivo de exponer las modificaciones introducidas a la técnica tradicional de histerectomía total abdominal de Richardson en 155 pacientes operadas en el Hospital Universitario Clinicoquirúrgico «Amalia Simoni» (Camagüey, entre el 2002 y el 2007. La fuente primaria de la información fue una encuesta y los datos recogidos fueron procesados con medios automatizados mediante el paquete estadístico Microstat. RESULTADOS. La edad promedio fue de 42,35 años. La anestesia más utilizada fue la regional espinal (75,48 %, el tiempo quirúrgico medio fue de 56,15 min y se observó un 7,74 % de complicaciones posoperatorias. Entre ellas las más frecuentes fueron las hemorragias (3,23 % y las infecciones (2,58 %. No se reintervino ningún caso y se obtuvieron excelentes resultados en cuanto a estética, reducción del tiempo quirúrgico, disminución del dolor posoperatorio y de la estadía hospitalaria. CONCLUSIONES. Las complicaciones encontradas no se relacionaron con las variaciones de la técnica realizada, y las intervenciones fueron poco dolorosas y más estéticas que las convencionales.INTRODUCTION. Total abadominal histerectomy is a common surgical procedure. The objective of the present study was to show and propose at the same time a modification to the conventional technique of total abdominal hysterectomy at different moments of the technique, including the opening and closure of the abdominal cavity, the suture and fixation of the vaginal cupule

  16. Implantation technique of the 50-cm3 SynCardia Total Artificial Heart: does size make a difference?

    Science.gov (United States)

    Spiliopoulos, Sotirios; Guersoy, Dilek; Dimitriou, Alexandros Merkourios; Koerfer, Reiner; Tenderich, Gero

    2015-01-01

    Despite downsizing, implantation technique of the 50-cm(3) SynCardia Total Artificial Heart and settings of the Companion driver remain unchanged. Owing to the absence of de-airing nipples, de-airing procedure is even more crucial and has to be performed carefully.

  17. Novel Sampling Techniques for Measurement of Turbine Engine Total Particulate Matter Emissions

    Science.gov (United States)

    This is the first progress report of a study to evaluate two different condensation devices for the measurement of the total (volatile + non-volatile) particulate matter (PM) emissions from aircraft turbine engines by direct sampling at the engine exit. The characteristics of th...

  18. Total elemental composition of soils contaminated with wastewater irrigation by combining IBA techniques

    Energy Technology Data Exchange (ETDEWEB)

    Huerta, L. E-mail: lazaro@fisica.unam.mx; Contreras-Valadez, R.; Palacios-Mayorga, S.; Miranda, J.; Calva-Vasquez, G

    2002-04-01

    The purpose of this work was to obtain the total elemental composition of agricultural soils irrigated with well water and wastewater. The studied area is located in the Valle del Mezquital in Hidalgo State, Mexico. The studied soils were collected, every two months during one year. Particle induced X-ray emission (PIXE), Rutherford backscattering spectrometry (RBS) and nuclear reaction analysis (NRA) were applied for elemental analysis. PIXE analyses gave elemental contents of major and trace elements (Al, Si, P, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Br, Rb, Sr, Y, Zr, and Pb). Total concentrations of Na, Mg, C, N and O were obtained by RBS and NRA. PIXE analyses were carried out with 2 MeV proton beams, RBS with 2 MeV helium ions, while NRA was applied with a 1.2 MeV deuterium beam. Results indicated that heavy metal total concentrations exceed the critical soil total concentrations according to environmental regulations.

  19. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results

    NARCIS (Netherlands)

    Capanna, R.; Totti, F.; Geest, I.C.M. van der; Muller, D.A.

    2015-01-01

    HYPOTHESIS: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS: The data of 6 patients who underwent scapular allograft reconstruction after a

  20. Institutional experience with a rotational total skin electron irradiation (RTSEI) technique-A three decade review (1981-2012).

    Science.gov (United States)

    Evans, Michael D C; Hudon, Christine; Podgorsak, Ervin B; Freeman, Carolyn R

    2014-03-01

    Total skin electron irradiation (TSEI) for patients with cutaneous lymphomas is technically challenging, and numerous approaches have been developed to overcome the many field matching problems associated with such a large and complex treatment volume. Since 1981 we have delivered TSEI using a rotational total skin electron irradiation (RTSEI) technique in conjunction with patch, treat and boost fields in order to provide complete skin and dose coverage. Initially we used a 6 MeV electron beam at an extended source-skin distance (SSD) on a modified linear accelerator. More recently we began using a high dose rate electron mode on a commercially available linear accelerator. The RTSEI technique allows the delivery of a seamless surface dose to the majority of the patient's skin surface in a single treatment. In this review paper we present our three-decade experience with the technical development, dosimetry, treatment delivery and clinical outcomes of our RTSEI technique.

  1. Attenuated total reflection infrared spectroscopy (ATR-IR) as an in situ technique for dissolution studies.

    Science.gov (United States)

    Kassis, Abe; Bhawtankar, Vrushali M; Sowa, John R

    2010-11-02

    Dissolution studies are critical tests for measuring the performance of a drug product. We have developed a novel technique using in situ ATR-IR spectroscopy to monitor dissolutions of pharmaceutical drug products. The accuracy of this technique is +/-3% relative to HPLC using salicylic acid calibrator tablets and acetaminophen OTC tablets. This novel approach also gives the research laboratory the capability of analyzing individual ingredients in multiple tablets; for example, individual components of salicylic acid and acetaminophen tablets are easily distinguished. In addition, the individual ingredients of a multi-component tablet containing acetylsalicylic acid and acetaminophen are readily distinguished. The ATR-IR system was found to have good sensitivity and can analyze samples as low as 0.03 mg/ml. With improved sensitivity, this is a promising method for monitoring dissolution of pharmaceutical tablets with an excellent in situ capability for distinguishing individual components. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  2. Determination of Total Volatile Basic Nitrogen (TVB-N) Content in Beef by Hyperspectral Imaging Technique

    OpenAIRE

    Liu Shanmei; Gan Lu

    2016-01-01

    Non-destructive determination of TVB-N content in beef using hyperspectral imaging (HSI) technique was evaluated. In order to create a robust model to predict the TVB-N content in beef, partition of sample set, spectral pretreatment, and the optimum wavelength selection were discussed. After the beef sample set was parted by concentration gradient (CG) algortithm, and the spectra of beef samples were preprocessed by standard normalized variate (SNV) combined with auto scale(AS), the partial l...

  3. Application of the Total Reflection X-ray Fluorescence technique to trace elements determination in tobacco

    Energy Technology Data Exchange (ETDEWEB)

    Martinez, T. [National University of Mexico, Faculty of Chemistry, Building D, CU (O4510) Mexico, D.F. Mexico (Mexico)], E-mail: tmc@servidor.unam.mx; Lartigue, J. [National University of Mexico, Faculty of Chemistry, Building D, CU (O4510) Mexico, D.F. Mexico (Mexico); Zarazua, G.; Avila-Perez, P. [National Institute of Nuclear Research. Carr. Mexico-Toluca Km 36.5, (52045) Salazar, Ocoyoacac, Edo. de Mexico (Mexico); Navarrete, M. [National University of Mexico, Faculty of Chemistry, Building D, CU (O4510) Mexico, D.F. Mexico (Mexico); Tejeda, S. [National Institute of Nuclear Research. Carr. Mexico-Toluca Km 36.5, (52045) Salazar, Ocoyoacac, Edo. de Mexico (Mexico)

    2008-12-15

    Many studies have identified an important number of toxic elements along with organic carcinogen molecules and radioactive isotopes in tobacco. In this work we have analyzed by Total Reflection X-Ray Fluorescence 9 brands of cigarettes being manufactured and distributed in the Mexican market. Two National Institute of Standards and Technology standards and a blank were equally treated at the same time. Results show the presence of some toxic elements such as Pb and Ni. These results are compared with available data for some foreign brands, while their implications for health are discussed. It can be confirmed that the Total Reflection X-Ray Fluorescence method provides precise (reproducible) and accuracy (trueness) data for 15 elements concentration in tobacco samples.

  4. Reduction techniques for discrete-time Markov chains on totally ordered state space using stochastic comparisons

    OpenAIRE

    2000-01-01

    We propose in this paper two methods to compute Markovian bounds for monotone functions of a discrete time homogeneous Markov chain evolving in a totally ordered state space. The main interest of such methods is to propose algorithms to simplify analysis of transient characteristics such as the output process of a queue, or sojourn time in a subset of states. Construction of bounds are based on two kinds of results: well-known results on stochastic comparison between Markov cha...

  5. A meta-analysis study of laparoscopic versus open splenectomy with or without esophagogastric devascularization in the management of liver cirrhosis and portal hypertension.

    Science.gov (United States)

    Zheng, Xin; Dou, Changwei; Yao, Yingmin; Liu, Qingguang

    2015-02-01

    The aim of this meta-analysis was to determine whether laparoscopic splenectomy (LS) and LS with esophagogastric devascularization (LSED) were the minimally invasive alternative for portal hypertension. A meta-analysis of comparative clinical trials was performed to assess our questions noted above. The databases PubMed, ScienceDirect, and Springerlink were searched. In total, 725 patients with liver cirrhosis and/or portal hypertension from eight published comparative trials were included. The operation time in the laparoscopic group was more than that in the open group [weighted mean difference (WMD) 35.24 (16.74, 53.74); P<.001]. However, there were less intraoperative blood loss [WMD -194.84 (-321.34, -68.34); P=.003] and a shorter postoperative hospital stay [WMD -4.33 (-5.30, -3.36); P<.001] in the laparoscopic group. The incidence of complications was similar in the two groups. In the subgroup studies about LS versus open splenectomy, no significant differences were found in operation time, intraoperative blood loss, and complication rates. The postoperative hospital stay in the LS group was apparently decreased [WMD -4.07 (-4.93, -3.21); P<.001]. Although the operation time of LSED was longer [WMD 43.23 (17.13, 69.32); P=.001], LSED was associated with less intraoperative blood loss [WMD -189.26 (-295.71, -82.81); P<.001] and a shorter postoperative hospital stay [WMD -5.41 (-7.84, -2.98); P<.001]. Meta-analysis did not favor either LSED or open splenectomy with esophagogastric devascularization in term of complication rates. The results of this meta-analysis were in favor of LS and LSED for being a safe, minimally invasion alternative for patients with liver cirrhosis and portal hypertension.

  6. Totally robotic single-position 'flip' arm technique for splenic flexure mobilizations and low anterior resections.

    Science.gov (United States)

    Obias, Vincent; Sanchez, Caroline; Nam, Arthur; Montenegro, Grace; Makhoul, Rami

    2011-06-01

    Using the da Vinci robot in low anterior resection (LAR) has not been widely adopted due to limited range of motion of the robotic arms and the need to move the robot during operations. Our technique uses all three arms for both the splenic flexure and the pelvis, but with only one docking position. The robot is placed to the left of the patient. The camera port is 3 cm to the right of the umbilicus. Arm 1 is placed in the RLQ. Arm 2 is placed midepigastric. Arm 3 is placed in the LLQ. Arm 3 starts off on the left side of the robot, on the same side as Arm 1 aimed cephalad. During mobilization of colon and splenic flexure, Arms 2 and 3 help retract the colon while Arm 1 dissects. Our pelvic dissection begins with Arm 3 "flipped" to the right side of the robot and redocked to the same left sided port aimed caudally. The robot does not need to be repositioned and the patient does not need to be moved. The pelvic dissection can now be done in the standard fashion. Our early experience includes four patients: two LARs and two left hemicolectomies. Mean operative time = 347 minutes, docking time = 20 minutes, and robotic surgical time = 195 minutes. Two complications occurred: post-operative ileus and high ostomy output. Mean LOS = 5. The robotic "flip" arm technique allows the surgeon to fully utilize all the robotic arms in LAR, which is unique versus other techniques. Copyright © 2011 John Wiley & Sons, Ltd.

  7. DEVELOPMENT OF RAPID TECHNIQUE FOR DETERMINATION OF THE TOTAL MINERALIZATION OF NATURAL WATERS

    Directory of Open Access Journals (Sweden)

    T. A. Kuchmenko

    2015-01-01

    Full Text Available A new approach has been proposed for rapid and easy evaluation of a indicator of quality and properties of natural water - soluble salt content (mineralization. The method of quartz crystal microbalance is employed at load of the mass-sensitive resonator electrode (BAW-type with investigated water. The degree of correlation between the various indicators related to the contents of salts and insoluble compounds and the level of mineralization obtained by the standard method (gravimetry has been studied. A procedure for salt weighing by single sensor at unilateral load with small sample of natural water has been developed. The optimal conditions for measurement is established using the design of experiment by model 23 . The possibilities of quartz crystal microbalance for determination of non-volatile compounds in the water are described. The calibration of piezosensor is produced by standard solution NaCl (c = 1.000 g / dm3 at optimal conditions of experiment. The adequacy and accuracy of proposed technique is assessed by the correlation between the results of quartz crystal microbalance and conductometry. The correlation between indicators of mineralization established by quartz crystal microbalance and gravimetry is found. It has been obtained an equation that can be used to calculate the standard indicator of the mineralization by the results of a quartz crystal microbalance using single sensor. The approaches to enhance the analytical capabilities of the developed technique for water with low and high mineralization are proposed. The metrological characteristics of quartz crystal microbalance of insoluble compounds in natural water are estimated. A new technique of determination of the mass concentration of the dry residue in water with a conductivity of 0.2 mS or above has been developed, which can be used for rapid analysis of the water at nonlaboratory conditions and in the laboratory for rapid obtaining the information about a sample.

  8. Flow analysis techniques as effective tools for the improved environmental analysis of organic compounds expressed as total indices.

    Science.gov (United States)

    Maya, Fernando; Estela, José Manuel; Cerdà, Víctor

    2010-04-15

    The scope of this work is the accomplishment of an overview about the current state-of-the-art flow analysis techniques applied to the environmental determination of organic compounds expressed as total indices. Flow analysis techniques are proposed as effective tools for the quick obtention of preliminary chemical information about the occurrence of organic compounds on the environment prior to the use of more complex, time-consuming and expensive instrumental techniques. Recently improved flow-based methodologies for the determination of chemical oxygen demand, halogenated organic compounds and phenols are presented and discussed in detail. The aim of the present work is to demonstrate the highlight of flow-based techniques as vanguard tools on the determination of organic compounds in environmental water samples.

  9. Determination of Total Volatile Basic Nitrogen (TVB-N Content in Beef by Hyperspectral Imaging Technique

    Directory of Open Access Journals (Sweden)

    Liu Shanmei

    2016-01-01

    Full Text Available Non-destructive determination of TVB-N content in beef using hyperspectral imaging (HSI technique was evaluated. In order to create a robust model to predict the TVB-N content in beef, partition of sample set, spectral pretreatment, and the optimum wavelength selection were discussed. After the beef sample set was parted by concentration gradient (CG algortithm, and the spectra of beef samples were preprocessed by standard normalized variate (SNV combined with auto scale(AS, the partial least square regression (PLSR model was established using the full spectral range, which had the best prediction abilities with Rcv2 of 0.9124, Rp2 of 0.8816, RMSECV of 1.5889, and RMSEP of 1.7719, respectively. After the optimum wavelengths which is closely related to the TVB-N content of beef samples was obtained using the competitive adaptive re-weighted (CARS algorithm, a new PLSR model was established using the optimum wavelengths, which had outstanding prediction abilities with Rcv2 of 0.9235, Rp2 of 0.9241, RMSECV of 1.4881, and RMSEP of 1.4882, respectively.The study showed that HSI is a powerful technique to predict the TVB-N content in beef by a nondestructive way.

  10. Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome.

    Science.gov (United States)

    Kavallaris, Andreas; Chalvatzas, N; Kelling, K; Bohlmann, M K; Diedrich, K; Hornemann, A

    2011-05-01

    Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases. Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps. There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g. Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.

  11. Discrimination of nylon polymers using attenuated total reflection mid-infrared spectra and multivariate statistical techniques.

    Science.gov (United States)

    Enlow, Elizabeth M; Kennedy, Jennifer L; Nieuwland, Alexander A; Hendrix, James E; Morgan, Stephen L

    2005-08-01

    Nylons are an important class of synthetic polymers, from an industrial, as well as forensic, perspective. A spectroscopic method, such as Fourier transform infrared (FT-IR) spectroscopy, is necessary to determine the nylon subclasses (e. g., nylon 6 or nylon 6,6). Library searching using absolute difference and absolute derivative difference algorithms gives inconsistent results for identifying nylon subclasses. The objective of this study was to evaluate the usefulness of peak ratio analysis and multivariate statistics for the identification of nylon subclasses using attenuated total reflection (ATR) spectral data. Many nylon subclasses could not be distinguished by the peak ratio of the N-H vibrational stretch to the sp(3) C-H(2) vibrational stretch intensities. Linear discriminant analysis, however, provided a graphical visualization of differences between nylon subclasses and was able to correctly classify a set of 270 spectra from eight different subclasses with 98.5% cross-validated accuracy.

  12. Evolution of gastric surger y techniques and outcomes

    Institute of Scientific and Technical Information of China (English)

    Hironori Shiozaki; Jaffer A Ajani; Yusuke Shimodaira; Elena Elimova; Roopma Wadhwa; Kazuki Sudo; Kazuto Harada; Jeannelyn S Estrella; Prajnan Das; Brian Badgwell

    2016-01-01

    Surgical management of gastric cancer improves survival. However, for some time, surgeons have had diverse opin-ions about the extent of gastrectomy. Researchers have conducted many clinical studies, making slow but steady progress in determining the optimal surgical approach. The extent of lymph node dissection has been one of the major issues in surgery for gastric cancer. Many trials demonstrated that D2 dissection resulted in greater morbidity and mortality than D1 dissection. However, long-term outcomes demonstrated that D2 dissection resulted in longer survival than D1 dissection. In 2004, the Japan Clinical Oncology Group reported a pivotal trial which was performed to determine whether para-aortic lymph node dissection combined with D2 dissection was superior to D2 dissec-tion alone and found no beneift of the additional surgery. Gastrectomy with pancreatectomy, splenectomy, and bursectomy was initially recommended as part of the D2 dissection. Now, pancreas-preserving total gastrectomy with D2 dissection is standard, and ongoing trials are addressing the role of splenectomy. Furthermore, the feasibility and safety of laparoscopic gastrectomy are well established. Survival and quality of life are increasingly recognized as the most important endpoints. In this review, we present perspectives on surgical techniques and important trials of these techniques in gastric cancer patients.

  13. The influence of surgical technique on early posttransplant atrial fibrillation – comparison of biatrial, bicaval, and total orthotopic heart transplantation

    Science.gov (United States)

    Rivinius, Rasmus; Helmschrott, Matthias; Ruhparwar, Arjang; Erbel, Christian; Gleissner, Christian A; Darche, Fabrice F; Thomas, Dierk; Bruckner, Tom; Katus, Hugo A; Doesch, Andreas O

    2017-01-01

    Purpose Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. Patients and methods This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. Results A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (Pvalvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. Conclusion Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012). PMID:28331331

  14. A technique for evaluating the influence of spatial sampling on the determination of global mean total columnar ozone

    Science.gov (United States)

    Tolson, R. H.

    1981-01-01

    A technique is described for providing a means of evaluating the influence of spatial sampling on the determination of global mean total columnar ozone. A finite number of coefficients in the expansion are determined, and the truncated part of the expansion is shown to contribute an error to the estimate, which depends strongly on the spatial sampling and is relatively insensitive to data noise. First and second order statistics are derived for each term in a spherical harmonic expansion which represents the ozone field, and the statistics are used to estimate systematic and random errors in the estimates of total ozone.

  15. Technique of totally robotic delta-shaped anastomosis in distal gastrectomy

    Directory of Open Access Journals (Sweden)

    Hidehiko Kitagami

    2017-01-01

    Full Text Available Background: We aimed to clarify the utility of delta-shaped anastomosis (Delta, an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG, in robot-assisted distal gastrectomy (RADG. Methods: RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler. Results: The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission. Conclusions: Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.

  16. Clinical application of glass dosimeter for in vivo dose measurements of total body irradiation treatment technique

    Energy Technology Data Exchange (ETDEWEB)

    Rah, Jeong-Eun; Hwang, Ui-Jung; Jeong, Hojin; Lee, Sang-Yeob; Lee, Doo-Hyun; Shin, Dong Ho; Yoon, Myonggeun; Lee, Se Byeong [Proton Therapy Center, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 410-769 (Korea, Republic of); Lee, Rena [Department of Radiation Oncology, Mokdong Hospital, Ewha Womans University College of Medicine (Korea, Republic of); Park, Sung Yong, E-mail: cool_park@ncc.re.k [Proton Therapy Center, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 410-769 (Korea, Republic of)

    2011-01-15

    The commercially available glass dosimeter (model GD-301) was investigated for its dosimetric characteristics, in order to evaluate its use for in vivo dosimetry. We specifically assessed overall precision of dosimetric dose data in patients who received treatment with the total body irradiation (TBI). Uniformity obtained in this study was within 1.2% (1 SD). The dose-response was linear in the range of 0.5-10 Gy with R of 0.999. Dose rate, SSD, field size, angular and energy dependence were found to be within 3.0%. In vivo skin dosimetry for TBI was performed for 3 patients. For all patients, the glass dosimeter was exposed and measured dose recorded for one fraction in addition to conventional used TLD and MOSFET. Overall uncertainty of the glass dosimeter for in vivo dose measurement was estimated at 2.4% (68.3% confidence level). The measured doses of the glass dosimeter were well within {+-}5.0% of the prescription dose at all sites expect mediastinum of one patient, for which it is within {+-}5.7%. Agreement of measured doses between glass dosimeter and TLD, MOSFET was within {+-}6.3% and {+-}6.6%, respectively. Results show that the glass dosimeter can be used as an accurate and reproducible dosimeter for TBI treatment skin dose measurements. The glass dosimeter is a practical alternative to TLD or MOSFET as an in vivo dosimeter.

  17. Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty.

    Science.gov (United States)

    Schirm, Andreas C; Jeffcote, Benjamin O; Nicholls, Rochelle L; Jakob, Hilaire; Kuster, Markus S

    2011-06-01

    Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone cuts have been made and the trial components inserted. We have sought to quantify how altering the polyethylene thickness may affect post-operative soft tissue tension for a range of prosthetic designs. Four different prosthetic designs were implanted into fresh-frozen cadaveric knee joints. All four designs were implanted in the standard manner, with a 100 Newton distraction force used to set soft tissue balance. The tibiofemoral force was then recorded at 15° intervals throughout the passive flexion range. After the standard implantation of each prosthesis, the tibial component was raised or lowered to mimic increasing and decreasing the polyethylene thickness by 2mm and the force measurements repeated. Tibiofemoral force in extension correlated with implantation tightness for all prosthesis designs. Between 15° and 90° of knee flexion, all four designs were insensitive to changes in implantation tightness. Beyond 90° the effect was more notable in rotating platform mobile-bearing and cruciate-retaining prostheses than in posterior-stabilised mobile-bearing designs. The findings of this research may be useful in assisting surgical decision-making during the implantation of TKA prostheses.

  18. New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty.

    Science.gov (United States)

    Elmallah, Randa K; Cherian, Jeffrey J; Pierce, Todd P; Jauregui, Julio J; Harwin, Steven F; Mont, Michael A

    2016-02-01

    Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed.

  19. Validation of a technique by high-performance liquid chromatography for the determination of total isoflavones

    Directory of Open Access Journals (Sweden)

    Pilar A. Soledispa Cañarte

    2017-04-01

    Full Text Available Context: Isoflavones may act as selective regulators in the prevention of various diseases. The most important source of isoflavones is the soy, from which different phytotherapeutics are elaborated of use in Ecuadorian population. However, its concentration varies depending on several factors, therefore quality assessment need to be carried out through out several analytical methods. Aims: To validate an analytical method by high precision liquid chromatography (HPLC to quantify total isoflavones in herbal medicine. Methods: To quantify isoflavones, it was used a brand liquid chromatography with UV/VIS detector at 260 nm, C-18 column using isocratic method. The mobile phase was composed of 2% acetic acid: acetonitrile (75:25. The quantification was performed against reference standard. The parameters for the validation followed the established in the USP 33. Results: The chromatogram presented six peaks with elution between 1.557 and 18.913 min. The linearity of the system and the method got r2 equal to 0.98 and 0.99 respectively. The coefficients of variation 1.5% in the study of repetitiveness and 2% in intermediate precision. The accuracy of the adjusted lineal model exhibited r=0.95 and intercept reliable interval (-0.921; 1.743. Conclusions: The validated method was specific, accurate, precise and linear. It can be used for quality control and stability studies of isoflavones present in herbal medicine.

  20. The Synergy Between Total Scattering and Advanced Simulation Techniques: Quantifying Geopolymer Gel Evolution

    Energy Technology Data Exchange (ETDEWEB)

    White, Claire [Los Alamos National Laboratory; Bloomer, Breaunnah E. [Los Alamos National Laboratory; Provis, John L. [The University of Melbourne; Henson, Neil J. [Los Alamos National Laboratory; Page, Katharine L. [Los Alamos National Laboratory

    2012-05-16

    With the ever increasing demands for technologically advanced structural materials, together with emerging environmental consciousness due to climate change, geopolymer cement is fast becoming a viable alternative to traditional cements due to proven mechanical engineering characteristics and the reduction in CO2 emitted (approximately 80% less CO2 emitted compared to ordinary Portland cement). Nevertheless, much remains unknown regarding the kinetics of the molecular changes responsible for nanostructural evolution during the geopolymerization process. Here, in-situ total scattering measurements in the form of X-ray pair distribution function (PDF) analysis are used to quantify the extent of reaction of metakaolin/slag alkali-activated geopolymer binders, including the effects of various activators (alkali hydroxide/silicate) on the kinetics of the geopolymerization reaction. Restricting quantification of the kinetics to the initial ten hours of reaction does not enable elucidation of the true extent of the reaction, but using X-ray PDF data obtained after 128 days of reaction enables more accurate determination of the initial extent of reaction. The synergies between the in-situ X-ray PDF data and simulations conducted by multiscale density functional theory-based coarse-grained Monte Carlo analysis are outlined, particularly with regard to the potential for the X-ray data to provide a time scale for kinetic analysis of the extent of reaction obtained from the multiscale simulation methodology.

  1. Effect of Bacterial Infection on Proliferating Cell Nuclear Antigen Expression after Partial Splenectomy of Rabbits Using Microwave Coagulator

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ The purpose of this study was to investigate the proliferating cell nuclear antigen (PCNA) expression of preserved spleen in rabbits when pneumonia diplococcus suspension was administered after partial splenectomy using microwaver coagulator.

  2. Splenectomy in children with idiopathic thrombocytopenic purpura : A prospective study of 134 children from the Intercontinental Childhood ITP Study Group

    NARCIS (Netherlands)

    Kuehne, Thomas; Blanchette, Victor; Buchanan, George R.; Ramenghi, Ugo; Donato, Hugo; Tamminga, Rienk Y. J.; Rischewski, Johannes; Berchtold, Willi; Imbach, Paul

    2007-01-01

    Background. Splenectomy is an effective procedure for children and adults with severe or refractory idiopathic thrombocytopenic purpura (ITP). Data regarding pediatric patients are limited. Procedure. Sixty-eight Intercontinental Childhood ITP Study Group (ICIS) investigators from 57 institutions in

  3. Efficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty.

    Science.gov (United States)

    Kim, Min Woo; Koh, In Jun; Kim, Ju Hwan; Jung, Jae Jong; In, Yong

    2015-09-01

    We investigated the efficacy and safety of our novel three-step medial release technique in varus total knee arthroplasty (TKA) over time. Two hundred sixty seven consecutive varus TKAs were performed by applying the algorithmic release technique which consisted of sequential release of the deep medial collateral ligament (step 1), the semimembranosus (step 2), and multiple needle puncturing of the superficial medial collateral ligament (step 3). One hundred seventeen, 114, and 36 knees were balanced after step 1, 2, and 3 releases, respectively. There were no significant differences in changes of medial and lateral laxities between groups in over a year. Our novel stepwise medial release technique was efficacious and safe in balancing varus knees during TKA.

  4. Evaluation of a catalytic reduction technique for the measurement of total reactive odd-nitrogen NOy in the atmosphere

    Science.gov (United States)

    Fahey, D. W.; Eubank, C. S.; Hubler, C. S.; Fehsenfeld, F. C.

    1985-01-01

    The suitability of a technique for the measurement of total reactive odd-nitrogen NOy-containing species in the atmosphere has been examined. In the technique, an NOy component species, which may include NO, NO2, NO3, HNO3, peroxyacetyl nitrate, and particulate nitrate, are catalytically reduced by CO to form NO molecules on the surface of a metal converter tube, and the NO product is detected by chemiluminescence produced in reaction with O3. Among the catalysts tested in the temperature range of 25-500 C, Au was the preferred catalyst. The results of laboratory tests investigating the effects of pressure, O3, and H2O on NOy conversion, and the possible sources of interference, have shown that the technique is suitable for atmospheric analyses. The results of a test in ambient air at a remote ground-based field site are included.

  5. Investigation of a fusion technique for the determination of total sulfur in geological samples by ion chromatography

    Energy Technology Data Exchange (ETDEWEB)

    Stallings, E.A.; Candelaria, L.M.; Gladney, E.S.

    1988-06-01

    The authors have encountered the need for a rapid, accurate, precise, and sensitive method for measuring total sulfur in large numbers of geological samples. Numerous environmental studies of sulfur deposition due to sulfur dioxide emission from combustion and industry are currently under way. Several techniques for measuring total sulfur in soils and other silicate materials have been published including neutron activation analysis, thermal neutron capture prompt ..gamma..-ray spectrometry, inductively coupled plasma atomic emission spectrometry, isotope dilution mass spectrometry, X-ray fluorescence, turbidimetry, ion chromatography (IC), iodimetric titration, and fluorometry. However, none of these methods is completely satisfactory for routine analysis of large numbers of samples. Many have levels of detection that are inadequate for measuring low levels of total sulfur (<100 ..mu..g/g) often encountered in soils. Several utilize only aqueous extracts of the soils and do not provide a total sulfur determination. Others require extensive sample preparation, are susceptible to loss of sulfur during oxidation, or produce incomplete conversion of sulfur species to sulfate. The objective of this work was to evaluate the accuracy of IC determination of sulfate for Na/sub 2/O/sub 2/ soil fusions by comparing the results obtained for reference materials with literature values reported for other techniques. They were also interested in determining if this fusion method would be rapid enough to handle large numbers of samples.

  6. Use of the Cusum technique for evaluation of a CT-based navigation system for total knee replacement.

    Science.gov (United States)

    Nizard, Remy S; Porcher, Raphael; Ravaud, Philippe; Vangaver, Edouard; Hannouche, Didier; Bizot, Pascal; Sedel, Laurent

    2004-08-01

    Most of the early failures of total knee replacements are related to technical flaws. Conventional ancillary devices achieve good alignment in the frontal plane in only an average of 75% of total knee replacements. Computer-assisted surgery may improve the technical quality of implantation surgery. The aim of our study was to evaluate the use of computer-assisted surgery using a quality control process. Seventy-eight total knee arthroplasties were done with a CT-based computer-assisted surgery system. The outcomes studied were alignment of the lower limb, implant positioning, and operative time. The target for alignment was 180 degrees +/- 3 degrees. Cusum analysis showed that the three outcomes were controlled during the study. The cusum test identified any existing outliers. Because few data were available at the beginning of this study regarding computer-assisted surgery for total knee replacement, a randomized study was not relevant. However, a control of the procedure was mandatory. The cusum technique allowed continuous evaluation of the performance of the new procedure, and is a useful tool in assessing new technology. The results of this study showed that it is possible to do a randomized study to determine if computer-assisted surgery can improve the technical result of total knee replacement.

  7. Anesthetic management of a case with hereditary spherocytosis for splenectomy and open cholecystectomy

    Directory of Open Access Journals (Sweden)

    Sonal S Khatavkar

    2016-01-01

    Full Text Available Hereditary spherocytosis (HS is a familial hemolytic disorder with marked heterogeneity of clinical features ranging from asymptomatic condition to a fulminant hemolytic anemia. HS is characterized by the strong family history of anemia, jaundice, splenomegaly and cholelithiasis. Anesthetic Management of HS with liver dysfunction is very challenging since most of the anesthetic drugs are metabolized by the liver. Hereby, we report anesthetic management in a case of HS with splenomegaly and gall stones for elective splenectomy and cholecystectomy.

  8. Extrahepatic portal venous obstruction: The effects of early ligation of splenic artery during splenectomy

    Directory of Open Access Journals (Sweden)

    Gazula Suhasini

    2009-01-01

    Full Text Available Aim: To objectively demonstrate the gain in blood volume and blood components following early ligation of splenic artery during splenectomy and splenorenal shunts in children with extra hepatic portal venous obstruction (EHPVO. Methods: Twenty-eight children (20 males and 8 females, mean age: 9.9 (±3.2 years with EHPVO and hypersplenism were recruited. We followed a protocol of systematically locating and ligating the splenic artery first, followed by a 30-minute waiting period to allow the massive spleen to decongest via the splenic vein and venous collaterals and then completing the splenectomy by standard procedure. No intravenous fluid was administered during this 30-minute period. Blood samples were drawn just prior to splenic artery ligation and soon after splenectomy for the estimation of hematological and biochemical parameters. Results: We noticed a highly significant increase in the hemoglobin, hematocrit, leukocyte, platelet, and RBC counts by early ligation of the splenic artery (p < 0.0004. The gain in hemoglobin and hematocrit was equivalent to a transfusion of atleast 100-150 ml of packed RBC. The increase in platelet count was equivalent to a platelet transfusion of atleast 4 units of platelet concentrates in an adult. There is a positive correlation between the splenic weight and the platelet gain (p= 0.0568 and the splenic volume on preoperative imaging and the platelet gain (p= 0.0251. Conclusion: Early ligation of the splenic artery during splenectomy results in passive splenic decongestion and thereby a significant gain in blood components. This protocol appears to be a feasible blood conservation method to avoid blood transfusions in this group of hypersplenic EHPVO patients.

  9. Autoimmune thrombocytopenia in response to splenectomy in cirrhotic patients with accompanying hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Tetsuro Sekiguchi; Takeaki Nagamine; Hitoshi Takagi; Masatomo Mori

    2006-01-01

    AIM: To estimate the contribution of autoimmune thrombocytopenia to hepatitis C virus-related liver cirrhosis (type C cirrhosis), we evaluated the influence of splenectomy upon platelet-associated immunoglobulin G (PAIgG) levels and platelet numbers.METHODS: PAIgG titers and immune markers were determined in 24 type C cirrhotic patients with an intact spleen, 17 type C cirrhotic patients submitted to splenectomy, and 21 non-C cirrhosis with an intact spleen.RESULTS: Thrombocytopenia (PLT<15×104/μL) in type C cirrhosis was diagnosed in all patients with an intact spleen, 8 patients submitted to splenectomy, and in 19 non-C cirrhosis with intact spleen. Elevated titers of PAIgG at more than 25.0 ng/107 cells were detected in all cirrhotic patients except for one splenectomized patient.PAIgG titers (ng/107 cells) were significantly higher in the type C cirrhosis with an intact spleen (247.9 ± 197.0)compared with the splenectomized patients (125.6±87.8)or non-C cirrhosis (152.4± 127.4). PAIgG titers were negatively correlated with platelet counts in type C cirrhotic patients with an intact spleen. In comparison with the type C cirrhosis with an intact spleen, the splenectomized patients had a reduced CD4/CD8 ratio and serum neopterin levels. The spleen index (cm2) was negatively correlated with platelet counts in the non-C cirrhosis, but not in the type C cirrhosis.CONCLUSION: Our data indicate that the autoimmune mechanism plays an important role in thrombocytosis complicated by HCV-positive cirrhosis. In addition,splenectomy may impair T ceils function through, at least in part, a reduction of CD4/CD8 ratio, consequently suppressing PAIgG production.

  10. Diagnostic splenectomy in patients with fever of unknown origin and splenomegaly.

    Science.gov (United States)

    Han, Bing; Yang, Zhiying; Yang, Ti; Gao, Weisheng; Sang, Xinting; Zhao, Yongqiang; Shen, Ti

    2008-01-01

    To review the diagnostic significance, safety and possible risk factors of splenectomy in fever of unknown origin (FUO) with splenomegaly. The records of 54 patients with FUO and splenomegaly who underwent splenectomy in our hospital in the past 20 years were reviewed retrospectively. Pathologic findings, morbidity, mortality and possible risk factors were analyzed. Histologic findings included 29 cases of non-Hodgkin lymphoma, 4 cases of spleen tuberculosis, 3 cases of Hodgkin lymphoma, 1 case of Castleman disease and 2 cases of hemophagocytic syndrome. An etiologic diagnosis was made in 72.2% of the patients undergoing splenectomy. Surgical complications occurred in 25.9% of the patients and 1-month operative mortality was 16.7%. The mortality rate 1 month after surgery was significantly associated with serous cavity effusion (46.2 vs. 7.5%, p = 0.006) and spleen weight >1,500 g (50.0 vs. 9.1%, p = 0.007). There was no significant difference in the mortality rate of the patients with or without jaundice, pancytopenia, elevated serum alanine aminotransferase (ALT) or elevated LDH (p > 0.5). Multivariate analysis revealed serous cavity effusion (odds ratio 21.0; 95% confidence interval 2.2-212.8; p = 0.01) and spleen weight >1,500 g (odds ratio 18.0; 95% confidence interval 1.9-173.8; p = 0.01) as independent risk factors. Splenectomy is an effective diagnostic modality for FUO presenting with splenomegaly. The presence of serous cavity effusions and spleen weight >1,500 g identifies patients with the greatest operative risk. 2008 S. Karger AG, Basel

  11. Splenectomy protects experimental rats from cerebral damage after stroke due to anti-inflammatory effects

    Institute of Scientific and Technical Information of China (English)

    ZHANG Bing-jun; MEN Xue-jiao; LU Zheng-qi; LI Hai-yan; QIU Wei; HU Xue-qiang

    2013-01-01

    Background A recent study demonstrated that the inflammatory response accompanying necrotic brain injury played an important role in stroke.Thus,inhibition of this response may help to stop the expansion of infarcts.It has been also shown that the spleen,a major peripheral immune organ,plays a role in stroke-induced immune responses.This study aimed to establish rat models of middle cerebral artery occlusion (MCAO) and to investigate the effect of splenectomy and possible mechanisms in that rat models.Methods Infarct size in a stroke model was measured with the Nissl body staining method,numbers of inflammatory cells in ischemic regions were detected by immunofluorescence staining,and inflammatory factors were assayed by enzyme-linked immunosorbent assay and real-time polymerase chain reaction (PCR) in brain homogenates and sera.The significance of differences was determined by one-way analysis of variance (ANOVA) followed by the least significant difference post hoc test.Results Infarct size in the brain of rats that underwent splenectomies 2 weeks before permanent MCAO ((34.93±3.23)%) was over 50% smaller than that of rats subjected to the stroke surgery alone ((74.33±2.36)%,P <0.001; (77.30±2.62)%,P <0.001).Lower numbers of T cells,neutrophils,and macrophages in brain tissue and lower levels of pro-inflammatory cytokines,such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α,were observed in rats that underwent splenectomies,compared with the two other groups,but splenectomized rats showed higher levels of the anti-inflammatory factor IL-10 in the brain.Conclusion The mechanism(s) by which splenectomy protects brain from damage induced by stroke may correlate with the decreased numbers of inflammatory cells and changes in inflammatory cytokines.

  12. The acetylene inhibition technique to determine total denitrification (N2 + N2O losses from soil samples: potentials and limitations

    Directory of Open Access Journals (Sweden)

    A. Neftel

    2012-03-01

    Full Text Available The loss of N2 from intensively managed agro-ecosystems is an important part of the N budget. The monitoring of N2 emissions at the field scale is impossible due to the high atmospheric background of 78%, which precludes the measurement of fluxes. The acetylene (C2H2 inhibition technique is a rather simple, albeit imperfect, method to determine N2 losses from entire soil cores. Despites serious limitations it is one among very few methodological options to estimate total denitrification at high temporal resolution and on small spatial scale, with limited workload and costs involved. A laboratory system with two different detection systems (photoacoustic IR spectroscopy and gas chromatography is presented, which allowed parallel measurements of up to 7 intact soil cores in air-tight glass tubes in a temperature controlled cabinet (adjusted to field conditions with an automated C2H2 injection. A survey of total denitrification losses (N2 + N2O over 1.5 yr in soil from an intensively managed, cut grassland system in central Switzerland showed a lower bound loss in the range of 6 to 25 kg N ha−1 yr−1 (3–13% of added N, roughly 3.4 times higher than the N2O loss. However, several drawbacks of the C2H2 inhibition technique preclude a more precise determination of the total denitrification loss.

  13. Acute chest syndrome after laparoscopic splenectomy in children with sickle cell disease: operative time dependent?

    Science.gov (United States)

    Bonnard, A; Masmoudi, M; Boimond, B; Capito, C; Holvoet, L; Skhiri, A; El Ghoneimi, A

    2014-11-01

    Laparoscopic splenectomy remains a technically demanding procedure. On patients with sickle cell disease (SCD), a post operative acute chest syndrome (ACS) can occur. The aim of the study was to look for predictive factors of post operative ACS. It's a retrospective study on patients with SCD, who underwent a laparoscopic splenectomy in Robert Debré hospital, Paris, France, between March 2008 and December 2013. Diagnosis of ACS was done if the patient developed hypoxemia associated with fever above 38.5 °C and an infiltrate on chest x ray during the post operative course. Pre-, post- and operative factors were studied. Descriptive statistics were compared using the Mann-Whitney test or the exact Fisher test. A p inferior to 0.05 was considered as significant. 52 patients with SCD underwent a laparoscopic splenectomy. Twelve patients presented a post operative ACS (23%) (mean age at surgery 4 years old) while forty did not (mean age 5.25 years old). Neither previous episode of ACS nor any factors reflecting SCD severity were significant. The shorter the operative time was, the greater the risk of developing an ACS (p post operative management, in the absence of predictive factors for ACS, should be carefully followed in a high dependency unit at least for 48 h for all patients.

  14. Is Tc-99m Sulfur Colloid Scintigraphy Necessary in Chronic Immune Thrombocytopenic Purpura Before Splenectomy?

    Directory of Open Access Journals (Sweden)

    Ilçe HT et al.

    2011-05-01

    Full Text Available One of the most common reasons for elective splenectomy on adults ischronic immune thrombocytopenic purpura. It is characterized by thrombocyte destruction in spleen, so, management of splenectomy is the gold standard. However if there is remnant spleen tissue postoperatively it cause to going on thrombocytopenia. The principal reason of remnant spleen tissue is accessory spleen. So it is important to detect this tissue pre or postoperatively. Thirty years old, male patient underwent splenectomy four years ago because of chronic immunethrombocytopenic purpura. When thrombocytopenia recurrence occurredabdominal ultrasonography was performed and there was no abnormal sign. Then, Tc–99 m Sulfur Colloid Spleen Scintigraphy was performed and spleen tissue was detected in left hypochondriac region. Tc-99mSulfur Colloid Spleen Scintigraphy is one of the imaging method for accessory spleen. Especially if it is performed preoperatively the surgeon can be careful during the operation and at the same time detected accessory spleen was removed and recurrence can be prevented.

  15. Effects of Splenectomy on Spontaneously Chronic Pancreatitis in aly/aly Mice

    Directory of Open Access Journals (Sweden)

    Heng-Xiao Wang

    2010-01-01

    Full Text Available Background and Aim. Mice with alymphoplasia (aly/aly mutation characterized by a lack of lymph nodes, Peyer's patches, and well-defined lymphoid follicles in the spleen were found. In this study, we used splenectomized aly/aly mice to elucidate the effects of secondary lymphoid organs in the development of aly/aly autoimmune pancreatitis. Methods. Forty-eight 10-week-old aly/aly mice were divided into two groups for splenectomy and sham operation. Histological and immunohistochemical analyses of the pancreas were performed at the ages of 20, 30, and 40 weeks old after operation, respectively. Results. Our results showed that mononuclear cell infiltration was restricted to the interlobular connective tissues at the age of 20 weeks, and not increase obviously at the age of 30 and 40 weeks in splenectomized aly/aly mice. Furthermore, an apparent decrease in the expressions of CD4+ T, CD8+ T, and B cells was detected in the pancreatic tissues compared with sham aly/aly mice, however, no significant difference in macrophage expression between mice with and without a splenectomy. Conclusions. Inflammation infiltration and development of the pancreatitis in aly/aly mice were suppressed effectively after splenectomy, which was, at least partly, correlated to inhibition of the infiltration of T and B cells in pancreatic tissues but not to macrophages.

  16. Enhancing problem list documentation in electronic health records using two methods: the example of prior splenectomy.

    Science.gov (United States)

    McEvoy, Dustin; Gandhi, Tejal K; Turchin, Alexander; Wright, Adam

    2017-07-28

    Quality improvement professionals often choose between patient-specific interventions, like clinical decision support (CDS), and population-based interventions, like registries or care management. In this paper, we explore the synergy of these two strategies, targeting the problem of procedure documentation for patients with a history of splenectomy. We developed a population health documentation (PHD) intervention and a CDS intervention to improve splenectomy documentation within our electronic health record. Rates of splenectomy documentation were collected before and after the implementation of both interventions to assess their impact on the rate of procedure documentation. Both the PHD and CDS interventions led to statistically significant (pleading to a larger number of incremental procedure documentations, in batches, and the CDS intervention augmenting procedure documentation on an ongoing basis. Our results suggest that population health and CDS strategies complement each other and, where possible, should be used in conjunction. PHD and CDS strategies may best be used in conjunction to create a symbiotic relationship in which current problem and procedure documentation gaps are closed using PHD strategies, while new gaps are prevented through ongoing CDS interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

    Directory of Open Access Journals (Sweden)

    Anais Rosich-Medina

    2015-09-01

    Discussion & conclusion: The total ‘rib’-preservation technique of IMV exposure is a safe, reliable and versatile method for microvascular breast reconstruction and should be considered as a valid alternative to the ‘rib’-sacrificing techniques.

  18. Research on the Forecast Model of Total Viable Count on Bacon Based on Hyper spectral Imaging Technique

    Directory of Open Access Journals (Sweden)

    Zhao Junhua

    2016-01-01

    Full Text Available The total viable count (TVC in bacon overweight can cause serious damage to human health. In order to find a rapid and nondestructive method of TVC, hyper spectral imaging technique was applied to quantitatively analysis of TVC on bacon. Comprehensively comparing the pretreatment method of multiple scattering, derivative method and so on finally the multiple scattering for pretreatment was used. And the interval optimization method of least squares model was set up to predict, and get a good prediction results. The correlation coefficient of the calibration and predictions respectively was 0.808 and 0.808, interactive authentication root mean square error was 0.115 and 0.198 respectively. Therefore, hyper spectral imaging technique combining iPLS can be used for the rapid detection of TVC on bacon.

  19. Reconstruction of a deficient patella in revision total knee arthroplasty: results of a new surgical technique using transcortical wiring.

    Science.gov (United States)

    Seo, Jai-Gon; Moon, Young-Wan; Lee, Byung-Hoon; Kim, Sang-Min

    2015-02-01

    This study aimed to report the results of a novel surgical technique for the reconstruction of a deficient patella during revision total knee arthroplasty (TKA). Twenty-eight patients (30 knees) with a deficient patella were treated with an onlay-type prosthesis and bone-augmenting procedure, using acrylic bone cement and transcortical wiring. The technique was indicated when the thickness of remnant patella was less than 8mm with variable amounts of the peripheral rim. Mean follow-up period was 36.6months (range, 24 to 55months).The respective mean Knee Society scores for knee and function improved from 34.2 and 23 points, preoperatively to 73.5 and 61 points, at final follow-up. One patient experienced patellar fracture 1week after surgery. There were no complications associated with implanted hardware. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Total hip replacement in an ipsilateral above-the-knee amputation: surgical technique, rehabilitation, and review of the literature.

    Science.gov (United States)

    Malagelada, Francesc; Coll Rivas, Moisès; Jiménez Obach, Albert; Auleda, Jaume; Guirao, Lluis; Pleguezuelos, Eulogio

    2013-03-01

    In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.

  1. Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Cariati, Maurizio, E-mail: cariati.maurizio@sancarlo.mi.it [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Mingazzini, Pietro; Dallatana, Raffaello [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy); Rossi, Umberto G. [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Settembrini, Alberto [San Carlo Borromeo Hospital, Università degli Studi di Milano (Italy); Santuari, Davide [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy)

    2013-05-02

    Conventional endovascular therapy of thoracoabdominal aortic aneurysm with involving visceral and renal arteries is limited by the absence of a landing zone for the aortic endograft. Solutions have been proposed to overcome the problem of no landing zone; however, most of them are not feasible in urgent and high-risk patients. We describe a case that was successfully treated by total endovascular technique with a two-by-two chimney-and-periscope approach in a patient with acute symptomatic type IV thoracoabdominal aortic aneurysm with supra-anastomotic aneurysm formation involving the renal and visceral arteries and a pseduaneurismatic sac localized in the left ileopsoas muscle.

  2. Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases

    Directory of Open Access Journals (Sweden)

    Enver Ay

    2012-03-01

    Full Text Available Objectives: Splenectomy is performed in order to provide the treatment in the patients with severe idiopathic thrombocytopenic purpura, refractory to medical treatment. In this study, we aimed to investigate the postoperatif and longterm outcomes in the patients who underwent splenectomy with the diagnosis of idiopathic thrombocytopenic purpura.Materials and Methods: Between 2001-2010 at Dicle University Medical Faculty, General Surgery Department, a retrospective review of the 109 patients who had undergone splenectomy for ITP was reviewed. Age, gender, presence of accessory spleens and location, duration of the operation, number of preoperative platelet tranfusion, number of preoperative and postoperative blood transfusion, length of hospital stay, long-term outcomes, morbidity and mortality were recorded.Results: The mean age was 37.10 ± 16.62 (16-72, and there were 88 (80.7% female and 21 (19.3% male patients. The mean operation time was 44.87 ± 10:32 (30-120 minutes. The average postoperative blood and preoperative platelet transfusion were 1.63 ± 0.85 (0-3 and 2.01 ± 0.71 (1-3 units, respectively. The accessory spleens were encountered in 20 (18.3% patients at the ultrasonographic examination. And also the accessory spleens were encountered in 23 (21.1% patients during operation and confirmed with histopathologic examination. The most common localization of accessory spleens were splenic hilus. The postoperative complications were occurred in 16 patients (14.7% and the most complication was atelectasia. The mean length of hospital stay was 4:56 ± 2:45 (2-12 days. Patients were followed for an average of 28 (9-48 months. At the follow-up period, 1 (0.9 % patient had died.Conclusion: Splenectomy can be performed safely in the treatment of the patients with idiopathic thrombocytopenic purpura unresponsive to medical treatment. Long-term good results can be obtained with splenectomy in these patients. The accessory spleens should not be

  3. Comparison of Venae Sectio vs. modified Seldinger Technique for Totally Implantable Access Ports; Portas-trial [ISRCTN:52368201

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    Luntz S

    2006-06-01

    Full Text Available Abstract Background The insertion of a Totally Implantable Access Port (TIAP is a routinely employed technique in patients who need a safe and permanent venous access. The number of TIAP implantations is increasing constantly mainly due to advanced treatment options for malignant diseases. Therefore it is important to identify the implantation technique which has the optimal benefit/risk ratio for the patient. Study design A single-centre, randomized, controlled superiority trial to compare two different TIAP implantation techniques. Sample size: 160 patients will be included and randomized intra-operatively. Eligibility criteria: Age equal or older than 18 years, patients scheduled for primary elective implantation of a TIAP in local anaesthesia and a signed informed consent. Primary endpoint: Primary success rate of the randomized technique. Intervention: Venae Sectio in combination with the Seldinger Technique (guide wire and a peel away sheath will be used to place a TIAP. Reference treatment: Conventional Venae Sectio will be used with a direct insertion of the TIAP without guide wire or peel away sheath. Duration of study: Approximately 20 months. Organisation/Responsibility The trial will be conducted in compliance with the protocol and in accordance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and Good Clinical Practice (GCP. The trial will also be carried out in keeping with local and regulatory requirements. The Klinisches Studienzentrum Chirurgie (KSC – Centre of Clinical Trials in Surgery at the Department of Surgery, University Hospital Heidelberg is responsible for planning and conduction of the trial. Documentation of patient's data will be accomplished via electronical Case Report Files (eCRF with MACRO®-Software by the KSC. Randomization, data management, monitoring and biometry are provided by the independent Koordinierungszentrum f

  4. Clinical experience with a single field rotational total skin electron irradiation technique for cutaneous T-cell lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Freeman, C.R.; Shenouda, G.; Vuong, T.; Souhami, L.; Pla, M.; Podgorsak, E.B.; Pla, C. (McGill University, Montreal (Canada). Division of Radiation Oncology, Department of Oncology); Suissa, S. (McGill University, Montreal (Canada). Department of Epidemiology and Biostatics)

    1992-07-01

    Between October 1981 and December 1989, 44 patients with CTCL (cutaneous T-cell lymphoma) were treated with a single-field RTSEI (rotational total skin electron irradiation) technique developed in McGill University Radiation Oncology Department. Only 11/44 patients received no prior treatment (25%). Advanced (T[sub 3] or T[sub 4]) disease had 75% (33/44). Complete response was seen in 32/44 (73%) of patients (91% T[sub 2], 71% T[sub 3] and 58% T[sub 4]), only 27% (3/11) of patients with T[sub 2] and 14% (3/21) with T[sub 3] disease remain in continuous complete remission in the skin, after median intervals of 58 and 35 moths, resp. Median cause-specific survival for whole group is 43 months and survival at 5 years is 38%. Survival was much better for patients with T[sub 2] disease than for patients with T[sub 3] disease (relative risk 4.3; 95% CI 1.4-13.2) and patients with T[sub 4] disease (relative risk 3.1; 95% CI 0.8-12.1). The RTSEI technique used at McGill has depth-dose characteristics and photon contamination similar to other commonly used TSEI techniques. It is relatively simple and provides a homogenous dose distribution over entire skin surface in short treatment time. Results of treatment are similar to those obtained with other techniques. For T[sub 2] disease, TSEI is an effective treatment modality with a possibility of long-term tumor control. For more advanced disease, more aggressive treatment, which may include TSI, is necessary. (author). 27 refs.; 7 figs.; 3 tab.

  5. Large primary splenic cyst: A laparoscopic technique.

    LENUS (Irish Health Repository)

    Geraghty, M

    2009-01-01

    Splenic cysts are rare lesions with around 800 cases reported in the world literature. Traditionally splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function have been developed. This case emphasizes that in selected cases splenic preservation is appropriate.

  6. Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Joseph T. Cline

    2015-01-01

    Full Text Available Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA. In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA.

  7. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials

    NARCIS (Netherlands)

    Koning, G.G.; Wetterslev, J.; Laarhoven, C.J. van; Keus, F.

    2013-01-01

    BACKGROUND: Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared wit

  8. The effect of relaxation techniques and back massage on pain and anxiety in Turkish total hip or knee arthroplasty patients.

    Science.gov (United States)

    Büyükyılmaz, Funda; Aştı, Türkinaz

    2013-09-01

    The purpose of this study was to examine the effects of relaxation techniques and back massage on postoperative pain, anxiety, and vital signs on postoperative days 1-3 in patients who had undergone total hip or knee arthroplasty (THA, TKA). Sixty patients having a THA or TKA were randomly assigned to either a experimental group or a control group. The McGill Pain Questionnaire Short Form (MPQ-SF) and State Anxiety Inventory (SAI) were used to measure pain and anxiety, respectively. Vital signs, including blood pressure (systolic and diastolic), pulse, and respiratory rate, were also obtained. Statistically significant differences in pain intensity (F = 14.50; p = .000), anxiety level (F = 19.13; p = .000), and vital signs (F = 169.61, 9.14, 14.23, 65.64; p = .000) measured over time were found between the experimental and the control group. Results of this research provide evidence to support the use of relaxation techniques and back massage at bed rest times of patients to decrease pain and anxiety. The interventions helped them to forget about their pain for a while and improved their anxiety state. After an evaluation of the conclusions, use of these interventions should be implemented by nurses into routine plans of care for patients. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  9. Total quality management (TQM) and the future of the environmental industry: Integration of quality tools and techniques among competing interests

    Energy Technology Data Exchange (ETDEWEB)

    Bicknell, B.A.; Bicknell, K.D. (Bicknell Consulting, Littleton, CO (United States))

    1993-01-01

    One of the most difficult problems facing industry, regulators, consultants and attorneys involved in the environmental arena is the lack of a functional method of prioritization of the seemingly unreconcilable interests of the varying entities involved in waste reduction, elimination and cleanup. This paper and presentation will address this problem by presenting methodology for problem solving that can be adopted by the competing interests to form a unified systems analysis that has enjoyed widespread use and success in both commercial business and industry, and other regulated government industries such as defense, aerospace and communication. The authors will employ specific examples of case studies with focus on hazardous waste reduction and how the quality tools and techniques commonly referred to as Total Quality Management (such as Quality Function Deployment, Experimental Design, Statistical Process Control and Functional Analysis) are and can be utilized in the process. The authors will illustrate the application of TQM techniques to areas such as process integration (e.g. implementation of the NEPA decision-making), as well as functional implementation in risk assessment, cost analysis and concurrent engineering (in the case of waste minimization technology development).

  10. Kissing iliac artery stent technique for salvage of a total occlusion of a jailed common iliac artery.

    Science.gov (United States)

    Ishizuka, Shuichi; Habara, Maoto; Nasu, Kenya

    2014-03-01

    A 70-year-old female was admitted to our hospital due to claudication of the left leg. The patient was diagnosed with peripheral artery disease and received endovascular therapy (EVT) with a stent implanted in the right common iliac artery (CIA) at another hospital 3 months earlier. The left CIA was jailed by the stent. We performed EVT for the chronic total occlusion (CTO) of the jailed left CIA. A kissing-stent strategy was selected because the strut could not be fully opened. The wire was crossed through the stent strut, since passing the wire outside of the stent was problematic. A balloon was dilated at the stent strut and further inserted while dilated in order to create a space between the implanted stent and opposite aorta wall. Finally, a wire was successfully crossed outside of the stent in this space. A balloon-expandable stent was implanted at the aorta to left CIA in order to perform the kissing-stent technique. Additionally, a self-expandable stent was deployed at the left external iliac artery. To facilitate kissing-stent technique for a jailed CIA CTO lesion, inserting the balloon while inflated at the bifurcation was useful to create space for advancing the guidewire along the stent.

  11. Total Energy Expenditure in Obese Kuwaiti Primary School Children Assessed by the Doubly-Labeled Water Technique

    Directory of Open Access Journals (Sweden)

    Lena Davidsson

    2016-10-01

    Full Text Available The aim of this pilot study was to assess body composition and total energy expenditure (TEE in 35 obese 7–9 years old Kuwaiti children (18 girls and 17 boys. Total body water (TBW and TEE were assessed by doubly-labeled water technique. TBW was derived from the intercept of the elimination rate of deuterium and TEE from the difference in elimination rates of 18O and deuterium. TBW was used to estimate fat-free mass (FFM, using hydration factors for different ages and gender. Fat mass (FM was calculated as the difference between body weight and FFM. Body weight was not statistically different but TBW was significantly higher (p = 0.018 in boys (44.9% ± 3.3% than girls (42.4% ± 3.0%, while girls had significantly higher estimated FM (45.2 ± 3.9 weight % versus 41.6% ± 4.3%; p = 0.014. TEE was significantly higher in boys (2395 ± 349 kcal/day compared with girls (1978 ± 169 kcal/day; p = 0.001. Estimated physical activity level (PAL was significantly higher in boys; 1.61 ± 0.167 versus 1.51 ± 0.870; p = 0.034. Our results provide the first dataset of TEE in 7–9 years old obese Kuwaiti children and highlight important gender differences to be considered during the development of school based interventions targeted to combat childhood obesity.

  12. Contact Kinematic Differences Between Gap Balanced vs Measured Resection Techniques for Single Radius Posterior-Stabilized Total Knee Arthroplasty.

    Science.gov (United States)

    Teeter, Matthew G; Perry, Kevin I; Yuan, Xunhua; Howard, James L; Lanting, Brent A

    2017-06-01

    Measured resection (MR) and gap balancing (GB) are common surgical techniques for total knee arthroplasty (TKA). Controversy has arisen as each conceptually differs in how the knee is balanced through bone and soft tissue management. The objective of the present study was to compare both the frequency of condylar liftoff and the location of femorotibial contact from extension through midflexion between patients undergoing GB or MR TKA. A total of 24 knees (23 patients) were randomly assigned at referral to either a surgeon performing MR or GB TKA with the same single radius, posterior-stabilized implant (12 per cohort). At 1-year postoperation, patients underwent biplanar radiographic imaging at 0°, 20°, 40°, and 60° of flexion. Condylar liftoff, contact location, and magnitude of excursion on each condyle were measured. Preoperative and postoperative clinical outcome scores were also collected. There was no difference (P = .41) in the frequency of liftoff between cohorts. The MR cohort had more posterior contact on the medial condyle (P < .01) and more anterior contact on the lateral condyle (P < .01) throughout flexion. Motion patterns were similar between cohorts, with similar medial (P = .48) and lateral (P = .44) excursion, which was equal in magnitude between condyles for both MR (P = .48) and GB (P = .73). There was no difference in clinical outcome scores between groups. For this particular implant system, GB and MR appear to produce similar kinematic and patient-reported outcome results. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty.

    Science.gov (United States)

    Krackow, K A; Holtgrewe, J L

    1990-09-01

    Total knee arthroplasty (TKA) after valgus proximal tibial osteotomy poses no major difficulties in most cases. There is, however, a small subgroup of severely overcorrected patients in whom TKA is particularly difficult. These patients require special considerations. A complex ligament reconstruction has been developed to allow simultaneous implantation of a minimally constrained total knee prosthesis for patients with failed, severely overcorrected valgus high tibial osteotomies. The technique is described in five patients. The mean age of the group was 57 years and the average follow-up period was 34 months (range, 12-72 months). A 100-point knee-evaluation scale was used to rate the knees before and after TKA. The average pre- and postoperative scores were 50 and 94, respectively. None of the patients was noted to have any more than mild instability in any direction postoperatively. Despite this extensive reconstruction, the group functioned as well as most recipients of more standard primary TKAs and demonstrated it is possible to avoid highly constrained implants, custom prostheses, or major bone grafts.

  14. Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

    Institute of Scientific and Technical Information of China (English)

    Wei Lai; Shi-Chun Lu; Guan-Yin Li; Chuan-Yun Li; Ju-Shan Wu; Qing-Liang Guo; Meng-Long Wang; Ning Li

    2012-01-01

    AIM:To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion alter splenectomy with gastroesophageal devascularization.METHODS:We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010.Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation,respectively.Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly.Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery,followed by oral warfarin and aspirin for one month regularly.The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50.Platelet and PT/INR were monitored.Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS:The patients' data were collected and analyzed retrospectively.Among the patients,94 developed early postoperative mural PSVT,including 63patients in group A (63/153,41.17%) and 31 patients in group B (31/148,20.94%).There were 50 (32.67%)patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein.After the administration of thrombolytic,anticoagulant and antiaggregation therapy,complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.CONCLUSION:Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization,and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy.Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

  15. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach.

    Science.gov (United States)

    Marte, Gianpaolo; Scuderi, Vincenzo; Rocca, Aldo; Surfaro, Giuseppe; Migliaccio, Carla; Ceriello, Antonio

    2013-06-01

    Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers.

  16. The Need for Guidelines in Asplenic Patients Undergoing Total Joint Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    S. R. Shaarani

    2012-01-01

    Full Text Available There are currently no guidelines for splenectomy patient undergoing total joint arthroplasty. We present a case history of a 63-year-old man with a history of splenectomy that underwent a total knee arthroplasty with standard intravenous antibiotic prophylaxis. Two weeks postoperatively, he developed a prosthetic joint infection and followed the standard antimicrobial management with intravenous and oral antibiotics prior to having revision surgery. We propose that there are guidelines to properly manage these patients in the pre- and perioperative setting following an orthopaedic procedure.

  17. Pancreatectomy and splenectomy for a splenic aneurysmassociated with segmental arterial mediolysis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Segmental arterial mediolysis (SAM) is characterizedby intra-abdominal, retroperitoneal bleeding or bowelischemia, and the etiology is unknown. A 44-year-oldman complaining of abdominal pain was admitted to ourhospital. He had been admitted for a left renal infarctionthree days earlier and had a past medical history ofcerebral aneurysm with spontaneous remission. Theruptured site of the splenic arterial aneurysm was clear viaa celiac angiography, and we treated it using trans-arterialembolization. Unfortunately, the aneurysm rerupturedafter two weeks, and we successfully treated it with distalpancreatomy and splenectomy. We recommended a closefollow-up and prompt radiological or surgical interventionbecause SAM can enlarge rapidly and rupture.

  18. Splenectomy in a patient with treatment-resistant visceral leishmaniasis: a case report

    Directory of Open Access Journals (Sweden)

    Robson Azevedo Dutra

    2012-02-01

    Full Text Available Visceral leishmaniasis (VL, also known as Kala-azar, is a systemic infection caused by a protozoan (Leishmania and, in its classic form, is a serious illness associated with malnutrition, anemia, hepatosplenomegaly, infectious processes and coagulopathies. The effect of splenectomy in patients with visceral leishmaniasis is not well defined; however, it is known that the spleen is the largest reservoir of infected cells belonging to the reticulo endothelial system. Therefore, the surgical procedure is an option for the debulking of parasites, providing a cure for refractory VL and minimizing the complications of hypersplenism.

  19. Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy

    Directory of Open Access Journals (Sweden)

    Deng-Ho Yang

    2012-01-01

    Full Text Available Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered.

  20. [Study on the Rapid Evaluation of Total Volatile Basic Nitrogen (TVB-N) of Mutton by Hyperspectral Imaging Technique].

    Science.gov (United States)

    Zhu, Rong-guang; Yao, Xue-dong; Duan, Hong-wei; Ma, Ben-xue; Tang, Ming-xiang

    2016-03-01

    Total Volatile Basic Nitrogen (TVB-N) was usually taken as the physicochemical reference value to evaluate the mutton freshness. In order to explore the feasibility of hyperspectral (HSI) imaging technique to detect mutton freshness, 71 representative mutton samples were collected and scanned using a diffuse reflectance hyperspectral imaging (HSI) system in the Visible-Near infrared (NIR) spectral region (400-1 000 nm), and the chemical values of TVB-N content were determined using the semimicro Kjeldahl method according to the modified Chinese national standard. The representative spectra of mutton samples were extracted and obtained after selection of the region of interests (ROIs). The samples of calibration set and prediction set were divided at the ratio of 3 : 1 according to the content gradient method. Optimum HSI calibration models of the mutton (TVB-N) were established and evaluated by comparing different spectral preprocessing methods and modeling methods, which included Stepwise Multiple Linear Regression (SMLR), Partial Least Squares Regression (PLSR) and Principal Component Regression (PCR) methods. The results are that through the utilization of Multiplicative Scatter Correction (MSC), first derivative, Savitzky-Golay (S-G) smoothing and mean-centering together, both PLSR and PCR were able to achieve quantitative detection of mutton TVB-N. As for the PLSR model of mutton TVB-N established, the spectral pretreatment methods chosen included MSC, first derivative, S-G (15,2) smoothing and mean-centering, and the latent variables (LVs) number used was 11. As for the calibration set of PLSR model of mutton TVB-N, the correlation coefficient (r) and root mean square error of calibration (RMSEC) were 0.92 and 3.00 mg x (100 g)(-1), respectively. As for the prediction set of PLSR model of mutton TVB-N, the correlation coefficient (r), Root Mean Square Error of Prediction (RMSEP), and ratio of standard deviation to standard error of prediction (RPD) were 0

  1. Morphometric study of gastric mucosa in dogs submitted to proximal gastric vagotomy, splenectomy or proximal gastric vagotomy associated with splenectomy Estudo morfométrico da mucosa gástrica de cães submetidos à vagotomia gástrica proximal, esplenectomia ou vagotomia gástrica proximal associada com esplenectomia

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Real Martinez

    2002-09-01

    Full Text Available OBJECTIVE: The aim of the present study was to evaluate the effects of total splenectomy and proximal gastric vagotomy (PGV isolated or associated to the vascularization of the stomach. METHODS: Twenty-eight dogs were distributed in: group A - animals undergoing laparotomy and gastric manipulation; group B - animals undergoing PGV; group C - animals undergoing PGV and splenectomy; and group D - animals undergoing splenectomy alone. All animals were sacrificed on the 7th postoperative day, and immediately followed by infusion of xanthene dye into the thoracic aorta. On the gastric mucous surface, the formation of stained areas and other areas lacking staining was measured by millimeter squares, planimetry and the computerized morphometry method. RESULTS: The formation of an area lacking in staining along the lesser gastric curvature was seen in all animals of groups B and C, which was significantly increased in group C, although in groups A and D such areas were not observed. CONCLUSION: These results showed that, in animals with splenectomy, the vascularization of the stomach was capable of perfusing the whole organ surface, but in animals with PGV alone or associated with splenectomy there was a notable decrease in blood supply throughout the area of the lesser gastric curvature, which suggests the ischemic impairment of this region.OBJETIVO: Avaliar os efeitos da esplenectomia total e da vagotomia gástrica proximal (VGP isoladas e associadas sobre a vascularização gástrica. MÉTODOS: Utilizaram-se 28 cães, distribuídos em quatro grupos: grupo A, laparotomia e manipulação gástrica; grupo B, VGP; grupo C, VGP associada à esplenectomia; grupo D, esplenectomia isolada. Todos os animais foram mortos no 7º pós-operatório e imediatamente infundiu-se o corante na aorta torácica. O estômago aberto pela grande curvatura foi fotografado. Na superfície mucosa gástrica, a formação de áreas coradas e desprovidas de coloração foi

  2. Experiences in Reducing Intra-operative Bleeding during Laparoscopic Splenectomy%减少腹腔镜脾切除术出血初步体会

    Institute of Scientific and Technical Information of China (English)

    李巍; 董晓彤; 张学军; 李剑; 贺宇宏; 康建省

    2011-01-01

    目的 探讨预防和减少腹腔镜脾切除术出血的措施.方法 选取2008年1月-2010年3月我院行腹腔镜脾切除术患者40例,超声刀离断脾周韧带,胰腺上缘结扎脾动脉,离断脾门血管,切除脾脏.结果 本组40例患者均采用腹腔镜完成手术.术中发现3例副脾,一并切除.手术时间90~210 min,平均130 min.出血50~800 ml,平均160 ml.术后12~24 h胃肠蠕动恢复,术后24 h拔胃管并进流质饮食,术后住院5~9 d.全组无手术死亡,无术后出血、门静脉血栓形成、脏器意外损伤患者.结论 结扎脾动脉,避免脾包膜撕裂,妥善处理脾蒂血管可减少腹腔镜脾切除术出血.%Objective To explore measures that can effectively prevent and reduce intraoperative bleeding during laparoscopic splenectomy. Methods Totally 40 patients who underwent laparoscopic splenectomy from January 2008 to March 2010 were enrolled in this study. The splenic surrounding ligaments were cut by ultrasound knife, splenic artery above the pancreatic tail was ligated, the vessels of splenic hilum was cut, and the then the spleen was resected. Results All surgeries were completed under laparoscope. Three accessory spleens were found during the operation and were resected. The operation duration ranged 90- 210 min ( mean: 130 min ). The intra - operative blood loss ranged 50-800 ml ( mean: 160 ml ). Gastrointestinal motility was recovered 12 ~24 hours after surgery. Gastric tube was withdrawn 24 hours after surgery, and then liquid diet was provided. The post - operative hospital stay ranged 5~ 9 days. No surgery - related death was noted. No post - operative bleeding , portal vein thrombosis, incidental organ injury was noted. Conclusion Bleeding during laparoscopic splenectomy may be reduced by ligating splenic artery, avoiding the rupture of spleenic envelope, and proper handling of vessels of splenic hilum.

  3. A case of thoracic splenosis in a post-splenectomy patient following abdominal trauma: Hello Howell-Jolly.

    Science.gov (United States)

    Viviers, Petrus J

    2014-08-01

    Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed.

  4. Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

    Energy Technology Data Exchange (ETDEWEB)

    Heumann, Thatcher R. [Emory University School of Medicine, Emory University, Atlanta, Georgia (United States); Esiashvili, Natia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States); Parker, Sareeta [Department of Dermatology, Emory University, Atlanta, Georgia (United States); Switchenko, Jeffrey M. [Biostatistics Shared Core Resource at WCI, Emory University, Atlanta, Georgia (United States); Dhabbaan, Anees [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States); Goodman, Michael [Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Lechowicz, Mary Jo; Flowers, Christopher R. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Department of Hematology and Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States)

    2015-05-01

    Purpose: To report our experience with rotational total skin electron irradiation (RTSEI) in cutaneous T-cell lymphoma (CTCL), and to examine response by disease stage and race. Methods and Materials: We reviewed our outcomes for 68 CTCL patients who received RTSEI (≥30 Gy) from 2000 to 2013. Primary outcomes were complete clinical response (CCR), recurrence-free survival (RFS), and overall survival (OS). Using log–rank tests and Cox proportional hazards, OS and RFS were compared across tumor stages at time of RTSEI with further racial subgroup analysis. Results: Median age at diagnosis and at time of radiation was 52 and 56 years, respectively. Median follow-up was 5.1 years, 49% were African American, and 49% were female. At time of treatment, 18, 37, and 13 patients were T stage 2, 3, and 4, respectively. At 6 weeks after RTSEI, overall CCR was 82% (88%, 83%, and 69% for T2, T3, and T4, respectively). Median RFS was 11 months for all patients and 14, 10, and 12 months for stage T2, T3, and T4, respectively. Tumor stage was not associated with RFS or CCR. Maintenance therapy after RTSEI was associated with improved RFS in both crude and multivariable analysis, controlling for T stage. Median OS was 76 months (91 and 59 months for T3 and T4, respectively). With the exception of improved OS in African Americans compared with whites at stage T2, race was not associated with CCR, RFS, or OS. Conclusions: These results represent the largest RTSEI clinical outcomes study in the modern era using a dual-field rotational technique. Our observed response rates match or improve upon the standard set by previous outcome studies using conventional TSEI techniques, despite a large percentage of advanced CTCL lesions in our cohort. We found that clinical response after RTSEI did not seem to be affected by T stage or race.

  5. Measuring coral calcification under ocean acidification: methodological considerations for the 45Ca-uptake and total alkalinity anomaly technique

    Directory of Open Access Journals (Sweden)

    Stephanie Cohen

    2017-09-01

    Full Text Available As the oceans become less alkaline due to rising CO2 levels, deleterious consequences are expected for calcifying corals. Predicting how coral calcification will be affected by on-going ocean acidification (OA requires an accurate assessment of CaCO3 deposition and an understanding of the relative importance that decreasing calcification and/or increasing dissolution play for the overall calcification budget of individual corals. Here, we assessed the compatibility of the 45Ca-uptake and total alkalinity (TA anomaly techniques as measures of gross and net calcification (GC, NC, respectively, to determine coral calcification at pHT 8.1 and 7.5. Considering the differing buffering capacity of seawater at both pH values, we were also interested in how strongly coral calcification alters the seawater carbonate chemistry under prolonged incubation in sealed chambers, potentially interfering with physiological functioning. Our data indicate that NC estimates by TA are erroneously ∼5% and ∼21% higher than GC estimates from 45Ca for ambient and reduced pH, respectively. Considering also previous data, we show that the consistent discrepancy between both techniques across studies is not constant, but largely depends on the absolute value of CaCO3 deposition. Deriving rates of coral dissolution from the difference between NC and GC was not possible and we advocate a more direct approach for the future by simultaneously measuring skeletal calcium influx and efflux. Substantial changes in carbonate system parameters for incubation times beyond two hours in our experiment demonstrate the necessity to test and optimize experimental incubation setups when measuring coral calcification in closed systems, especially under OA conditions.

  6. Measuring coral calcification under ocean acidification: methodological considerations for the (45)Ca-uptake and total alkalinity anomaly technique.

    Science.gov (United States)

    Cohen, Stephanie; Krueger, Thomas; Fine, Maoz

    2017-01-01

    As the oceans become less alkaline due to rising CO2 levels, deleterious consequences are expected for calcifying corals. Predicting how coral calcification will be affected by on-going ocean acidification (OA) requires an accurate assessment of CaCO3 deposition and an understanding of the relative importance that decreasing calcification and/or increasing dissolution play for the overall calcification budget of individual corals. Here, we assessed the compatibility of the (45)Ca-uptake and total alkalinity (TA) anomaly techniques as measures of gross and net calcification (GC, NC), respectively, to determine coral calcification at pHT 8.1 and 7.5. Considering the differing buffering capacity of seawater at both pH values, we were also interested in how strongly coral calcification alters the seawater carbonate chemistry under prolonged incubation in sealed chambers, potentially interfering with physiological functioning. Our data indicate that NC estimates by TA are erroneously ∼5% and ∼21% higher than GC estimates from (45)Ca for ambient and reduced pH, respectively. Considering also previous data, we show that the consistent discrepancy between both techniques across studies is not constant, but largely depends on the absolute value of CaCO3 deposition. Deriving rates of coral dissolution from the difference between NC and GC was not possible and we advocate a more direct approach for the future by simultaneously measuring skeletal calcium influx and efflux. Substantial changes in carbonate system parameters for incubation times beyond two hours in our experiment demonstrate the necessity to test and optimize experimental incubation setups when measuring coral calcification in closed systems, especially under OA conditions.

  7. SU-E-T-404: Simple Field-In-Field Technique for Total Body Irradiation in Large Patients

    Energy Technology Data Exchange (ETDEWEB)

    Chi, P; Pinnix, C; Dabaja, B; Wang, C; Aristophanous, M; Tung, S [UT MD Anderson Cancer Center, Houston, TX (United States)

    2014-06-01

    Purpose: A simple Field-in-Field technique for Total Body Irradiation (TBI) was developed for traditional AP/PA TBI treatments to improve dosimetric uniformity in patients with large separation. Methods: TBI at our institution currently utilizes an AP/PA technique at an extended source-to-surface distance (SSD) of 380cm with patients in left decubitus position during the AP beam and in right decubitus during the PA beam. Patients who have differences in thickness (separation) between the abdomen and head greater than 10cm undergo CT simulation in both left and right decubitus treatment positions. One plan for each CT is generated to evaluate dose to patient midline with both AP and PA fields, but only corresponding AP fields will be exported for treatment for patient left decubitus position and PA fields for patient right decubitus position. Subfields are added by collimating with the x-ray jaws according to separation changes at 5–7% steps to minimize hot regions to less than 10%. Finally, the monitor units (MUs) for the plans are verified with hand calculation and water phantom measurements. Results: Dose uniformity (+/−10%) is achieved with field-in-field using only asymmetric jaws. It is dosimetrically robust with respect to minor setup/patient variations inevitable due to patient conditions. MUs calculated with Pinnacle were verified in 3 clinical cases and only a 2% difference was found compared to homogeneous calculation. In-vivo dosimeters were also used to verify doses received by each patient with and confirmed dose variations less than 10%. Conclusion: We encountered several cases with separation differences that raised uniformity concerns — based on a 1% dose difference per cm separation difference assumption. This could Resultin an unintended hot spot, often in the head/neck, up to 25%. This method allows dose modulation without adding treatment complexity nor introducing radiobiological variations, providing a reasonable solution for this unique

  8. A modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique.

    Directory of Open Access Journals (Sweden)

    Changming Huang

    Full Text Available The present study introduced a modified delta-shaped gastroduodenostomy (DSG technique and assessed the safety, feasibility and clinical results of this procedure in patients undergoing totally laparoscopic distal gastrectomy (TLDG for gastric cancer (GC.A total of 102 patients with distal GC undergoing TLDG with modified DSG between January 2013 and December 2013 were enrolled. A retrospective study was performed using a prospectively maintained comprehensive database to evaluate the results of the procedure. Univariate and multivariate analyses were performed to estimate the predictive factors for postoperative morbidity.The mean operation time was 150.6±30.2 min, the mean anastomosis time was 12.2±4.2 min, the mean blood loss was 48.2±33.2 ml, and the mean times to first flatus, fluid diet, soft diet and postoperative hospital stay were 3.8±1.3 days, 5.0±1.0 days, 7.4±2.1 days and 12.0±6.5 days, respectively. Two patients with minor anastomotic leakage after surgery were managed conservatively; no patient experienced any complications around the anastomosis, such as anastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that age, gastric cancer with hemorrhage and cardiovascular disease combined were significant factors that affected postoperative morbidity (P<0.05. Multivariate analysis found that gastric cancer with hemorrhage was the independent risk factor for the postoperative morbidity (P = 0.042. At a median follow-up of 7 months, no patients had died or experienced recurrent or metastatic disease.The modified DSG was technically safe and feasible, with acceptable surgical outcomes, in patients undergoing TLDG for GC, and this procedure may be promising in these patients.

  9. New Techniques Used in Modeling the 2017 Total Solar Eclipse: Energizing and Heating the Large-Scale Corona

    Science.gov (United States)

    Downs, Cooper; Mikic, Zoran; Linker, Jon A.; Caplan, Ronald M.; Lionello, Roberto; Torok, Tibor; Titov, Viacheslav; Riley, Pete; Mackay, Duncan; Upton, Lisa

    2017-08-01

    Over the past two decades, our group has used a magnetohydrodynamic (MHD) model of the corona to predict the appearance of total solar eclipses. In this presentation we detail recent innovations and new techniques applied to our prediction model for the August 21, 2017 total solar eclipse. First, we have developed a method for capturing the large-scale energized fields typical of the corona, namely the sheared/twisted fields built up through long-term processes of differential rotation and flux-emergence/cancellation. Using inferences of the location and chirality of filament channels (deduced from a magnetofrictional model driven by the evolving photospheric field produced by the Advective Flux Transport model), we tailor a customized boundary electric field profile that will emerge shear along the desired portions of polarity inversion lines (PILs) and cancel flux to create long twisted flux systems low in the corona. This method has the potential to improve the morphological shape of streamers in the low solar corona. Second, we apply, for the first time in our eclipse prediction simulations, a new wave-turbulence-dissipation (WTD) based model for coronal heating. This model has substantially fewer free parameters than previous empirical heating models, but is inherently sensitive to the 3D geometry and connectivity of the coronal field---a key property for modeling/predicting the thermal-magnetic structure of the solar corona. Overall, we will examine the effect of these considerations on white-light and EUV observables from the simulations, and present them in the context of our final 2017 eclipse prediction model.Research supported by NASA's Heliophysics Supporting Research and Living With a Star Programs.

  10. Successful laparoscopic splenectomy after living-donor liver transplantation for thrombocytopenia caused by antiviral therapy

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Although interferon (IFN) based therapy for recurrent hepatitis C virus (HCV) infection after liver transplantation has been widely accepted, it induces various adverse effects such as thrombocytopenia, resulting in its interruption. Recently, concomitant splenectomy at the time of living donor liver transplantation (LDLT) has been tried to overcome this problem, but this procedure leads to several complications such as excessive intraoperative bleeding and serious infection. A 60-year-old female received LDLT using a left lobe graft from her second son for liver failure caused by hepatitis C-related cirrhosis. Six months after LDLT, she was diagnosed as recurrent HCV infection by liver biopsy. IFN monotherapy was started from 7 mo after LDLT and her platelet count decreased to less than 50000/μL, which thus made it necessary to discontinue the treatment. We decided to attempt laparoscopic splenectomy (LS) under general anesthesia. Since intra-abdominal findings did not show any adhesion formations around the spleen, LS could be successfully performed. After LS, since her platelet count immediately increased to 225000/μL 14 d after operation, IFN therapy was restarted and we could convert the combination therapy of IFN and ribavirin, resulting in no detectable viral marker. In conclusion, LS can be performed safely even after LDLT, and LS after LDLT is a feasible and less invasive modality for thrombocytopenia caused by antiviral therapy.

  11. Clinical Study of 3D Imaging and 3D Printing Technique for Patient-Specific Instrumentation in Total Knee Arthroplasty.

    Science.gov (United States)

    Qiu, Bing; Liu, Fei; Tang, Bensen; Deng, Biyong; Liu, Fang; Zhu, Weimin; Zhen, Dong; Xue, Mingyuan; Zhang, Mingjiao

    2017-01-25

    Patient-specific instrumentation (PSI) was designed to improve the accuracy of preoperative planning and postoperative prosthesis positioning in total knee arthroplasty (TKA). However, better understanding needs to be achieved due to the subtle nature of the PSI systems. In this study, 3D printing technique based on the image data of computed tomography (CT) has been utilized for optimal controlling of the surgical parameters. Two groups of TKA cases have been randomly selected as PSI group and control group with no significant difference of age and sex (p > 0.05). The PSI group is treated with 3D printed cutting guides whereas the control group is treated with conventional instrumentation (CI). By evaluating the proximal osteotomy amount, distal osteotomy amount, valgus angle, external rotation angle, and tibial posterior slope angle of patients, it can be found that the preoperative quantitative assessment and intraoperative changes can be controlled with PSI whereas CI is relied on experience. In terms of postoperative parameters, such as hip-knee-ankle (HKA), frontal femoral component (FFC), frontal tibial component (FTC), and lateral tibial component (LTC) angles, there is a significant improvement in achieving the desired implant position (p implantation compared against control method, which indicates potential for optimal HKA, FFC, and FTC angles.

  12. Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique.

    Directory of Open Access Journals (Sweden)

    Weiping Chen

    Full Text Available Laparoscopic sphincter-preserving low anterior resection for rectal cancer is a surgery demanding great skill. Immense efforts have been devoted to identifying factors that can predict operative difficulty, but the results are inconsistent.Our study was conducted to screen patients' factors to build models for predicting the operative difficulty using well controlled data.We retrospectively reviewed records of 199 consecutive patients who had rectal cancers 5-8 cm from the anal verge. All underwent laparoscopic sphincter-preserving low anterior resections with total mesorectal excision (TME and double stapling technique (DST. Data of 155 patients from one surgeon were utilized to build models to predict standardized endpoints (operative time, blood loss and postoperative morbidity. Data of 44 patients from other surgeons were used to test the predictability of the built models.Our results showed prior abdominal surgery, preoperative chemoradiotherapy, tumor distance to anal verge, interspinous distance, and BMI were predictors for the standardized operative times. Gender and tumor maximum diameter were related to the standardized blood loss. Temporary diversion and tumor diameter were predictors for postoperative morbidity. The model constructed for the operative time demonstrated excellent predictability for patients from different surgeons.With a well-controlled patient population, we have built a predictable model to estimate operative difficulty. The standardized operative time will make it possible to significantly increase sample size and build more reliable models to predict operative difficulty for clinical use.

  13. Use of totally implantable vascular access port with mini-invasive Seldinger technique in 12 dogs undergoing chemotherapy.

    Science.gov (United States)

    Valentini, Fabio; Fassone, Flavia; Pozzebon, Andrea; Gavazza, Alessandra; Lubas, George

    2013-02-01

    Vascular access ports (VPAs) are totally implantable devices designed to provide repeated access to the vascular system. Port access is performed by percutaneous needle insertion using a noncoring needle. VAPs have been placed in 12 dogs affected by different tumors and needing long lasting chemotherapy. Using the non-invasive Seldinger technique a silicone catheter was inserted from the jugular vein up to the junction of the cranial vena cava and the right atrium. The catheter then was connected to the port previously placed in a subcutaneous pocket over the scapula. 7/12 dogs showed no clinical complications. Port was removed in 4/12 dogs for post-operative complications as fistula formation (n.2) and infection/mal-position (n.2). One patient had mild complications shortly after implantation. VPAs were left in site until the death in the rest of patients. VAPs are useful for dogs undergoing long-lasting chemotherapy protocols as these devices allow peripheral veins to be spared and not seriously damaged for repeated infusion of vesicant drugs. In most cases VPAs are well tolerated and may be left in site for several months.

  14. A Nondestructive Real-Time Detection Method of Total Viable Count in Pork by Hyperspectral Imaging Technique

    Directory of Open Access Journals (Sweden)

    Xiaochun Zheng

    2017-02-01

    Full Text Available A nondestructive method was developed for assessing total viable count (TVC in pork during refrigerated storage by using hyperspectral imaging technique in this study. The hyperspectral images in the visible/near-infrared (VIS/NIR region of 400–1100 nm were acquired for fifty pork samples, and their VIS/NIR diffuse reflectance spectra were extracted from the images. The reference values of TVC in pork samples were determined by classical microbiological plating method. Both partial least square regression (PLSR model and support vector machine regression model (SVR of TVC were built for comparative analysis to achieve better results. Different transformation methods and filtering methods were applied to improve the models. The results show that both the optimized PLSR model and SVR model can predict the TVC very well, while the SVR model based on second derivation was better, which achieved with RP (correlation coefficient of prediction set = 0.94 and SEP (standard error of prediction set = 0.4570 log CFU/g in the prediction set. An image processing algorithm was then developed to transfer the prediction model to every pixel of the image of the entire sample; the visualizing map of TVC would be displayed in real-time during the detection process due to the simplicity of the model. The results demonstrated that hyperspectral imaging is a potential reliable approach for non-destructive and real-time prediction of TVC in pork.

  15. The Advantages of an Attenuated Total Internal Reflection Infrared Microspectroscopic Imaging Technique for the Analysis of Polymer Laminates.

    Science.gov (United States)

    Ling, Chen; Sommer, André J

    2015-06-01

    Until recently, the analysis of polymer laminates using infrared microspectroscopy involved the painstaking separation of individual layers by dissection or by obtaining micrometer thin cross-sections. The latter usually requires the expertise of an individual trained in microtomy and even then, the very structure of the laminate could affect the outcome of the spectral results. The recent development of attenuated total internal reflection (ATR) infrared microspectroscopy imaging has provided a new avenue for the analysis of these multilayer structures. This report compares ATR infrared microspectroscopy imaging with conventional transmission infrared microspectroscopy imaging. The results demonstrate that the ATR method offers improved spatial resolution, eliminates a variety of competing optical processes, and requires minimal sample preparation relative to transmission measurements. These advantages were illustrated using a polymer laminate consisting of 11 different layers whose thickness ranged in size from 4-20 μm. The spatial resolution achieved by using an ATR-FTIR (Fourier transform infrared spectroscopy) imaging technique was diffraction limited. Contrast in the ATR images was enhanced by principal component analysis.

  16. Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results.

    Science.gov (United States)

    Ryan, Nicola; Gonzalo, Nieves; Dingli, Philip; Cruz, Oscar Vedia; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Nuñez-Gil, Ivan; Trigo, María Del; Salinas, Pablo; Macaya, Carlos; Fernandez-Ortiz, Antonio; Escaned, Javier

    2017-02-14

    Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution. CTO operators with extensive IVUS experience in non-CTO cases carried out all procedures. Procedural and outcome data was prospectively entered into the institutional database and a retrospective analysis of clinical, angiographic and technical data performed. 17 (77%) of the 22 procedures were successful. The mean age was 59.8 ± 11.5 years, and 90.9% were male. The most commonly attempted lesions were located in the left anterior descending 36.4% (Soon et al. in J Intervent Cardiol 20(5):359-366, 2007) and Circumflex artery (LCx) 31.8% (Mollet et al. in Am J Cardiol 95(2):240-243, 2005). Mean JCTO score was 3.09 ± 0.75 (3.06 ± 0.68, 3.17 ± 0.98 in the successful and failed groups respectively p = 0.35). The mean contrast volume was 378.7 ml ± 114.7 (389.9 ml ± 130.5, 349.2 ml ± 52.2 p = 0.3 in the successful and failed groups respectively). There was no death, coronary artery bypass grafting or myocardial infarction requiring intervention in this series. When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO-PCI success. This series describes a good success rate in IVUS guided stumpless wiring of CTOs in consecutive patients with this complex anatomical scenario.

  17. Surgical Management of Large Spontaneous Portosystemic Splenorenal Shunts During Liver Transplantation: Splenectomy or Left Renal Vein Ligation?

    Science.gov (United States)

    Golse, N; Mohkam, K; Rode, A; Mezoughi, S; Demian, H; Ducerf, C; Mabrut, J-Y

    2015-01-01

    Management of splenorenal shunt (SRS) during whole liver transplantation is still controversial. Splenectomy (SP) permits its radical removal, at the price of a specific related morbidity. Left renal vein ligation (LRVL) performs a downstream ligation with potential renal repercussions. This study aimed to compare these techniques regarding portal revascularization and postoperative outcomes. From 1994 to 2012, 22 SPs and 7 LRVLs were performed for large SRS (>1 cm) management. There was no difference in operating times or transfusion rates. In both groups, efficient portal flow was initially obtained in all cases. After a median follow-up of 79 months, 2 patients in the SP group presented an altered portal flow owing to persistence of a not disconnected mesentericogonadic or splenorenal shunt. Postoperative morbidity, including infection and portal vein thrombosis, was not significantly different (32% vs 14%). SP allowed a faster correction of the thrombocytopenia. The LRVL group had a moderate and temporary impairment of renal function. SP and LRVL represent 2 effective procedures to avoid vascular steal in the presence of SRS, but they require a patent portal vein. SP appears to be associated to specific but acceptable intraoperative morbidity, permits treatment of associated splenic artery aneurysm, and enables a faster correction of thrombocytopenia. However, the presence of a remote hilum SRS or another large portosystemic shunt represents a cause of failure of the procedure. LRVL is a safer and less demanding procedure that can suppress portal steal whatever the location of the SRS, but at the price of moderate renal morbidity. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Modelling Gaucher disease progression: long-term enzyme replacement therapy reduces the incidence of splenectomy and bone complications.

    Science.gov (United States)

    van Dussen, Laura; Biegstraaten, Marieke; Dijkgraaf, Marcel Gw; Hollak, Carla Em

    2014-07-24

    Long-term complications and associated conditions of type 1 Gaucher Disease (GD) can include splenectomy, bone complications, pulmonary hypertension, Parkinson disease and malignancies. Enzyme replacement therapy (ERT) reverses cytopenia and reduces organomegaly. To study the effects of ERT on long-term complications and associated conditions, the course of Gaucher disease was modelled.

  19. Pulmonary arterial hypertension associated with hereditary spherocytosis and splenectomy in a patient with a mutation in the BMPR2 gene.

    Science.gov (United States)

    Baloira, Adolfo; Bastos, María; Pousada, Guillermo; Valverde, Diana

    2016-08-01

    There is some question about the relationship between hereditary spherocytosis (HS) and pulmonary arterial hypertension, even associated with splenectomy. The finding of BMPR2 mutations in our patient suggests that other factors are necessary for the development of the disease, and perhaps, the incidence of pulmonary hypertension is not increased in patients with HS.

  20. Influence of splenectomy on the biodistribution of technetium-99m dimercaptosuccinic acid (99mTc-DMSA) in rats

    Energy Technology Data Exchange (ETDEWEB)

    Acucena, Maria Kadja Meneses Torres; Pereira, Kercia Regina Santos Gomes; Villarim Neto, Arthur; Rego, Amalia Cinthia Meneses [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Centro de Ciencias da Saude; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria; Azevedo, Italo Medeiros; Araujo Filho, Irami; Medeiros, Aldo Cunha [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Dept. de Cirurgia]. E-mail: aldo@ufrnet.br

    2008-12-15

    This study aimed to evaluate if the splenectomy alters the biodistribution of 99mTc-DMSA and renal function in Wistar rats. The animals were separated in the groups: splenectomy (n = 6) and control (n = 6). After splenectomy (15 days), the administration of 0.1 ml of 99mTc-DMSA IV (0.48 MBq) was carried out. Thirty minutes later, kidney, heart, lung, thyroid, stomach, bladder and femur and samples of blood were isolated. The organs were weighed, counted and the percentage of radioactivity /g (%ATI/g) determined. Serum urea and creatinine, hematocrit, leukocytes and platelets were measured. Statistics by t test (p<0.05) was done. There was a significant reduction in %ATI/g in kidney and blood (p<0.05) of splenectomized animals, a significant increase (p<0.05) of urea (88.8 {+-} 18.6 mg/dL) and creatinine (0.56 {+-} 0.08 mg/dL), compared to the controls (51.5{+-}1.6, 0.37{+-}0.02 mg/dL, respectively), as well as increase in platelets and leucocytes, and hematocrit reduction. The analysis of the results indicates that in rats, splenectomy seems to alter the renal function and the uptake of 99mTc-DMSA. (author)

  1. Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction

    NARCIS (Netherlands)

    Pultrum, B. B.; van Bastelaar, J.; Schreurs, Liesbeth; van Dullemen, H. M.; Groen, H.; Nijsten, M. W. N.; van Dam, G. M.; Plukker, J. T. H. M.

    2008-01-01

    We aim to determine the effect of splenectomy on clinical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction (GEJ) after a curative intended resection. From January 1991 to July 2004, 210 patients underwent a potentially curative gastroesophageal resection with an

  2. Splenectomy complicated by sustained extreme thrombocytosis and extensive portosplenomesenteric vein thrombosis in pyrimidine 5′-nucleotidase deficiency

    Science.gov (United States)

    Al-Jafar, Hassan A; Taqi, Ali; Madda, John Patrick; Abdullah, Thamer A

    2013-01-01

    Reactive and redistributional thrombocytosis is a well-known postsplenectomy occurrence .Usually it is transient and it rarely reaches extreme levels. We report a rare case of haemolytic anaemia where splenectomy was carried out following trauma to a massively enlarged spleen and was followed by extreme sustained thrombocytosis associated with extensive portal, splenic and mesenteric vein thrombosis despite standard antithrombotic prophylaxis. PMID:24287477

  3. Study on the efficacies of splenic pedicle transection by using manual manipulation and Endo-GIA procedure for laparoscopic splenectomy.

    Science.gov (United States)

    Fan, Yong; Liu, Yong-Yong; Wang, Ping; Wang, Chen; Li, Xu-Sheng; Kang, Ying-Xin; Kang, Bo-Xiong; Zhao, Yan-Hui; Zhang, You-Cheng

    2015-01-01

    Laparoscopy splenectomy (LS) was adopted in surgery from 1980s, it has become the main way of exploring for treating spleen diseases. Compared with conventional open surgery, LS has been gradually accepted by physicians and patients due to its advantages, including minimal surgical injury, less intraoperative blood loss, quick postoperative recovery, shorter hospital period, better cosmetic result, less risk of postoperative infections and improved postoperative quality of life Here, we try to investigate the splenic pedicle transection by using Endo-GIA (a linear stapling device) procedure and manual manipulation of secondary splenic pedicle for LS. A retrospective study was conducted on 60 patients who underwent LS. And patients were divided into two groups. 30 patients (group A) received splenic pedicle transection with Endo-GIA procedure and in the other 30 patients (group B) underwent secondary splenic pedicle transection for LS. Perioperative outcome measures of each group were recorded, including operation duration, intraoperative blood loss, postoperative flatus pass time, postoperative complications, drainage duration, hospital cost and length of hospital stay. Surgeries were successfully achieved in 60 patients. The operative duration of group A was significantly shorter than that of group B. However, group B was significantly superior over Endo-GIA group in terms of the intraoperative blood loss, postoperative flatus pass time, drainage duration, length of hospital stay and total cost of hospital stays. No significant differences were observed in postoperative fever, ascites and hyperamylasemia between two groups. Both of these two approaches for LS are safe and feasible. However, compared with Endo-GIA procedure, manual manipulation of secondary splenic pedicle for LS may leading to less intraoperative blood loss, results in less hospital expense, and hence can be widely adopted in clinical practice.

  4. Cattle experimentally infected by Anaplasma marginale: Influence of splenectomy on disease pathogenesis, oxidative profile, and antioxidant status.

    Science.gov (United States)

    Doyle, Rovaina L; França, Raqueli T; Oliveira, Camila B; Rezer, João F P; Klafke, Guilherme M; Martins, João R; Santos, Andrea P; do Nascimento, Naíla C; Mesick, Joanne B; Lopes, Sonia T A; Leal, Daniela B R; Da Silva, Aleksandro S; Andrade, Cinthia M

    2016-06-01

    Bovine anaplasmosis is caused by the obligate intraerythrocytic bacteria Anaplasma marginale. These bacteria are transmitted by tick species such as Rhipicephalus (Boophilus) microplus, blood-sucking insects, and fomites (needles, clippers, and other blood contaminated equipment). During the acute phase of infection, animals may develop fever, anemia, jaundice, and hepatosplenomegaly. The aims of this study are to quantify the bacteremia by quantitative PCR in eight naïve calves experimentally infected by A. marginale [splenectomized (n = 4), and intact/non-splenectomized (n = 4)], and to correlate these findings with markers of oxidative stress on days 0, 8, 15, 21 and 23 post-infection. Complete blood counts (CBC) were performed in both groups. Lipid peroxidation was estimated by quantifying thiobarbituric acid reactive substances (TBARS); and non-enzymatic antioxidants were assessed by erythrocyte content of non-protein thiols (NPSH). There were no significant differences in complete blood counts (CBC) between the two groups. However, both groups had a slight decrease on packet cell volume (PCV), erythrocytes and hemoglobin concentration, as well as an increase in total leukocyte counts due to elevated lymphocytes when comparing pre and post-infection with A. marginale. Progressive increase on TBARS levels and concomitant decrease on NPSH content were observed in all animals, without significant differences between splenectomized and intact animals. A positive correlation between bacteremia and TBARS, and a negative correlation between bacteremia and NPSH were observed in both groups with higher correlation for NPSH in splenectomized animals. A negative correlation between TBARS and NPSH levels was observed in both groups indicating lipid peroxidation without a non-enzymatic antioxidant response. The results of experimental infection by A. marginale in cattle showed that bacteremia has an impact on lipid peroxidation regardless of the splenectomy.

  5. Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization

    Institute of Scientific and Technical Information of China (English)

    Yu Zhang; Tian-Fu Wen; Lu-Nan Yan; Hong-Ji Yang; Xiao-Fan Deng; Chuan Li; Chuan Wang; Guan-Lin Liang

    2012-01-01

    AIM:To evaluate the predictive value of preoperative predictors for portal vein thrombosis (PVT) after splenectomy with periesophagogastric devascularization.METHODS:In this prospective study,69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010.The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography.The hepatic congestion index and the ratio of velocity and diameter were calculated before operation.The prothrombin time (PT) and platelet (PLT) levels were measured before and after operation.The patients' spleens were weighed postoperatively.RESULTS:The diameter of portal vein was negatively correlated with the portal vein flow velocity (P < 0.05).Thirty-three cases (47.83%) suffered from postoperative PVT.There was no statistically significant difference in the Child-Pugh score,the spleen weights,the PT,or PLT levels between patients with PVT and without PVT.Receiver operating characteristic curves showed four variables (portal vein flow velocity,the ratio of velocity and diameter,hepatic congestion index and diameter of portal vein) could be used as preoperative predictors of postoperative portal vein thrombosis.The respective values of the area under the curve were 0.865,0.893,0.884 and 0.742,and the respective cut-off values (24.45 cm/s,19.4333/s,0.1138 cm/s-1 and 13.5 mm)were of diagnostically efficient,generating sensitivity values of 87.9%,93.9%,87.9% and 81.8%,respectively,specificities of 75%,77.8%,86.1% and 63.9%,respectively.CONCLUSION:The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.

  6. Effects of corticosteroids and splenectomy on the immune clearance and destruction of erythrocytes.

    Science.gov (United States)

    Atkinson, J P; Schreiber, A D; Frank, M M

    1973-06-01

    Corticosteroids and splenectomy constitute two important therapeutic modalities in the treatment of autoimmune hemolytic anemia. Each of these may affect both the rate of synthesis of autoantibody and the clearance of antibody sensitized cells. The latter possibility has been examined in an experimental model which allows evaluation of the role of antibody and complement in the immune clearance of erythrocytes in molecular terms. The in vivo clearance of (51)Cr-labeled guinea pig erythrocytes sensitized with purified rabbit IgG or IgM antibody to produce a known number of complement-fixing sites per cell was studied. Corticosteroid therapy increased the survival of both IgG and IgM sensitized erythrocytes by decreasing sequestration in the reticuloendothelial system (RES). 5 days of therapy prior to injection of antibody coated cells were required for a maximal effect. It appeared that the RES of cortisone-treated animals had a lowered sensitivity to erythrocytes coated with antibody and complement and the cells were removed as though they were coated with fewer complement sites/cell. The general pattern and kinetics of clearance and the localization of sequestered cells were not modified by corticosteroids. As the number of IgG C1-fixing sites was increased, the difference betwen cortisone treated and control animals was less marked. Splenectomy led to an increased survival of IgG-coated cells and a sixfold increase in IgG C1-fixing sites was necessary in order to obtain similar rates of clearance in splenectomized and control animals. The liver was responsible for this much less efficient clearance of cells in splenectomized animals: the clearance pattern was typical of that noted for IgG. No effect at all was noted on the clearance of IgM sensitized cells in splenectomized animals. These experiments clearly demonstrate that both corticosteroid therapy and splenectomy act to decrease the in vivo clearance of IgG-sensitized cells: only corticosteroids alter the

  7. Topological Structures and Membrane Nanostructures of Erythrocytes after Splenectomy in Hereditary Spherocytosis Patients via Atomic Force Microscopy.

    Science.gov (United States)

    Li, Ying; Lu, Liyuan; Li, Juan

    2016-09-01

    Hereditary spherocytosis is an inherited red blood cell membrane disorder resulting from mutations of genes encoding erythrocyte membrane and cytoskeletal proteins. Few equipments can observe the structural characteristics of hereditary spherocytosis directly expect for atomic force microscopy In our study, we proved atomic force microscopy is a powerful and sensitive instrument to describe the characteristics of hereditary spherocytosis. Erythrocytes from hereditary spherocytosis patients were small spheroidal, lacking a well-organized lattice on the cell membrane, with smaller cell surface particles and had reduced valley to peak distance and average cell membrane roughness vs. those from healthy individuals. These observations indicated defects in the certain cell membrane structural proteins such as α- and β-spectrin, ankyrin, etc. Until now, splenectomy is still the most effective treatment for symptoms relief for hereditary spherocytosis. In this study, we further solved the mysteries of membrane nanostructure changes of erythrocytes before and after splenectomy in hereditary spherocytosis by atomic force microscopy. After splenectomy, the cells were larger, but still spheroidal-shaped. The membrane ultrastructure was disorganized and characterized by a reduced surface particle size and lower than normal Ra values. These observations indicated that although splenectomy can effectively relieve the symptoms of hereditary spherocytosis, it has little effect on correction of cytoskeletal membrane defects of hereditary spherocytosis. We concluded that atomic force microscopy is a powerful tool to investigate the pathophysiological mechanisms of hereditary spherocytosis and to monitor treatment efficacy in clinical practices. To the best of our knowledge, this is the first report to study hereditary spherocytosis with atomic force microscopy and offers important mechanistic insight into the underlying role of splenectomy.

  8. Determination of lead in clay enameled by X-ray fluorescence technique in Total reflection and by Scanning Electron Microscopy; Determinacion de plomo en esmaltado de barro por Fluorescencia de rayos X en reflexion total y Microscopia Electronica de Barrido

    Energy Technology Data Exchange (ETDEWEB)

    Zarazua O, G.; Carapia M, L. [Instituto Nacional de Investigaciones Nucleares, C.P. 52045 Estado de Mexico (Mexico)

    2000-07-01

    This work has the objective of determining lead free in the glazed commercial stewing pans using the X-ray fluorescence technique in Total reflection (FRX) and the observation and semiquantitative determination of lead by Analytical Scanning Electron Microscopy (ASEM). (Author)

  9. The "open branch" technique: A new way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm.

    Science.gov (United States)

    Krajcer, Zvonimir; Echeverria, Angela

    2016-03-01

    Spinal cord ischemia (SCI) has been one of the most concerning complications after surgical and endovascular thoracoabdominal aortic aneurysm repair "Open Branch" is an innovative technique to reduce the incidence of SCI Further studies in a larger number of patients with varying pathologies are needed to confirm the advantages of this technique.

  10. Anaesthetic management of splenectomy in Evan′s syndrome during pregnancy with pregnancy induced hypertension.

    Directory of Open Access Journals (Sweden)

    Sherke R

    2001-07-01

    Full Text Available The management of idiopathic thrombocytopenic purpura (ITP during pregnancy, especially with ongoing bleeding diathesis, has not been highlighted sufficiently in the literature. Aortocaval compression and reduction in uteroplacental circulation resulting in foetal hypoxia and acidosis, Mendelson′s syndrome due to gravid uterus, trauma to airway with resultant haemorrhage and aspiration into lungs, compromised airway due to short neck, anasarca and heavy breast, limitation in using invasive monitoring and regional anaesthesia and uncontrolled bleeding leading to placental hypoperfusion and foetal hypoxia are some of the important risks. In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.

  11. [Splenectomy in chronic idiopathic thrombopenic purpura in adults. Apropos of 49 cases].

    Science.gov (United States)

    Melki, J; Dauce, J P; Kunlin, A; Tilly, H; Julien, J P; Monconduit, M; Piguet, H

    1989-01-01

    The authors reviewed the case files of 49 adult patients undergoing splenectomy for chronic idiopathic thrombocytopenic purpura at the Centre Henri Becquerel between 1970 and 1987. Although the postoperative course was straightforward in 83.7% of cases, one reoperation for subphrenic abscess was necessary and there was one postoperative death. Remission from thrombocytopenia was obtained in 87.5% of the patients, but only transiently in 8.5% of them. No preoperative predictive factors could be demonstrated. An early postoperative rise in the platelet count to more than 500 G/litre appears to ensure a good subsequent result. Secondary infectious complications are not exceptional and can be fatal (one death in our series); they require prophylaxis by anti-pneumococcal vaccination. The place of prophylactic antibiotic therapy has yet to be defined.

  12. Biodistribution of the radiopharmaceutical technetium-99m-sodium phytate in rats after splenectomy

    Directory of Open Access Journals (Sweden)

    Kércia Regina Santos Gomes Pereira

    2008-12-01

    Full Text Available Drugs and surgery can interfere with the biodistribution of radiopharmaceuticals and data about the effect of splenectomy on the metabolism of phytate-Tc-99m are scarce. This study aimed at evaluating the interference of splenectomy on phytate-Tc-99m biodistribution and liver function in rats. The SP group rats (n=6 underwent splenectomy. In group C (control the animals were not operated on. After 15 days, all rats were injected with 0.1mL of Tc-99m-phytate via orbital plexus (0.66MBq. After 30 minutes, liver samples were harvested, weighed and the percentage of radioactivity per gram (%ATI/g was determined by a Wizard Perkin-Elme gama counter. The ATI%/g in splenectomized rats (0.99±0.02 was significantly higher than in controls (0.4±0.02, (p=0.034. ALT, AST and HDL were significantly lower in SP rats (p= 0.001 and leukocytosis was observed in SP rats. In conclusion, splenectomy in rats changed the hepatic biodistribution of Tc-99m-phytate and liver enzimatic activity.O radiofármaco fitato-Tc-99m é usado no diagnóstico através de exames de imagem, na dependência de sua biodistribuição. O objetivo do trabalho foi avaliar efeito da esplenectomia na biodistribuição do fitato-Tc-99m e função hepática em ratos Wistar. Sob anestesia e técnica asséptica, os animais do grupo SP (n=6 foram esplenectomizados. Grupo C(controle; n=6 não operado. Após 15 dias, injeção de 0,1ml de fitato-Tc-99m via plexo orbital (0,66MBq. Após 30 minutos, retiradas biópsias hepáticas para determinação do percentual de radioatividade/grama (% ATI/g, usando-se contador gama WizardPerkin-Elmer®. Realizada dosagem de ALT, AST e HDL, e leucometria. Estatística pelo teste t, significância 0,05. O %ATI/g nos ratos esplenectomizados foi 0,99 ± 0,2 e nos controles 0,40 ± 0,2 (p=0,034. ALT, AST e HDL tiveram dosagens significativamente menores nos esplenectomizados (p=0,01, com leucocitose, comparando com controles. Em conclusão, em ratos a esplenectomia

  13. Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Chen Jiang; Ma Rui; Yang Shouzhang; Lin Shuang; He Shilin; Cai Xiujun

    2014-01-01

    Background Surgical treatment has become the standard treatment for nontreumatic diseases of the spleen.This metaanalysis compared the relative merits of laparoscopic splenectomy (LS) with open splenectomy (OS) for nontraumatic splenic diseases.Methods A literature search was performed to identify studies comparing perioperative outcomes in patients who underwent LS or OS for nontraumatic diseases.Pooled odds ratios (ORs) and weighted mean differences (WMD) with 95% confidence intervals (C/s) were calculated using a fixed-or random-effects model.Results Thirty-five studies matched the selection criteria.Of the 7 269 patients included 3 981 underwent LS and 3 288 underwent OS for nontraumatic diseases.OS was associated with shorter operation time (WMD=42.65,95% CI:25.58-59.73),whereas LS was associated with reduced operative blood loss (WMD=-133.95,95% CI:-229.02 to-38.88),need for blood transfusion requirement (OR=0.53,95% CI:0.39-0.72),overall postoperative morbidity rate (OR=0.44,95% CI:0.38-0.51),postoperative mortality rate (OR=0.38,95% CI:0.24-0.59),and length of hospital stay (WMD =-2.73,95%CI:-3.34 to-2.12).Conclusions LS is superior to OS for nontraumatic diseases,with reduced operative blood loss,need for blood transfusion,postoperative morbidity and mortality rates,and length of hospital stay,although OS is associated with reduced operation time.LS may be a good alternative to OS for patients with nontraumatic splenic diseases.

  14. Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty?

    Science.gov (United States)

    Meneghini, R Michael; Daluga, Andrew T; Sturgis, Lindsey A; Lieberman, Jay R

    2013-09-01

    Established for lateral release in TKA, the pie-crusting technique has not been studied for the medial collateral ligament (MCL). In cadaveric knees the MCL was release with a pie-crusting technique in one and traditional technique in the contralateral knee. Along with a control group, each MCL was subjected to mechanical testing. The stiffness, force and stress required to cause ligament elongation were less in the pie-crusting group (p pie-crusting group demonstrated a characteristic "stair-step" failure mode at the joint line, whereas the traditional group failed elastically at the tibial insertion. MCL pie-crusting is likely technique dependent since failure occurs within the ligament itself and further study is warranted.

  15. Characterization of unconventional electron fields for the treatment of mycosis fungoides using the total skin irradiation technique

    Science.gov (United States)

    Pagnan González, M. A.; Hernández Oviedo, J. O.; Mitsoura, E.; Ruesga Vázquez, D. R.

    2014-11-01

    Mycosis fungoides is a cutaneous lymphoma that accounts for 2-3% of all lymphomas. Several clinical studies have demonstrated the effectiveness of TSEBT (Total Skin Electron Beam Therapy) in patients with mycosis fungoides. It is important to develop this technique and make it available to a larger number of patients in Mexico. Because large fields for electron TSEBT are required in order to cover the entire body of the patient, beam characterization at conventional treatment distances is not sufficient and a calibration distance of 500cm or higher is required. Materials and methods: Calibration of radiochromic Gafchromic® EBT2 film (RCF) for electrons was performed in a solid water phantom (Scanditronix Wellhöfer) at a depth of 1.4cm and a Source Axis Distance (SAD) of 100cm. A polynomial fit was applied to the calibration curve, in order to obtain the equation relating dose response with optical density. The spatial distribution is obtained in terms of percentage of the dose, placing 3×3cm samples of RCF on the acrylic screen, which is placed in front of the patient in order to obtain maximum absorbed dose on the skin, covering an area of 200×100cm2. The Percentage Depth Dose (PDD) curve was obtained placing RCF samples at depths of 0, 1, 1.2, 1.4, 1.5, 2, 3, 4, 5, 6, 7, 8 and 9cm in the solid water phantom, irradiated with an ELEKTA SINERGY Linear Accelerator electron beam, with an energy of 6 MeV, at a Source Skin Distance (SSD) of 500cm, with 1000MU = 100Gy, with a cone of 40×40cm and gantry angle of 90°. The RCFs were scanned on a flatbed scanner (EPSON EXPRESSION 10000 XL) and the images were processed with the ImageJ program using a region of interest (ROI) of 1×1cm2. Results: The relative spatial dose distribution and the percentage depth dose for a SSD of 500±0.5cm, over an area of 200×100cm2 was obtained, resulting to an effective maximum dose depth (Zref) for electrons of 1.4±0.05cm. Using the same experimental data, horizontal and vertical

  16. Characterization of unconventional electron fields for the treatment of mycosis fungoides using the total skin irradiation technique

    Energy Technology Data Exchange (ETDEWEB)

    González, M. A. Pagnan, E-mail: miguelangel.pagnan@hotmail.com; Mitsoura, E., E-mail: meleni@uaemex.mx [Medical Physics Graduate Programme, Universidad Autónoma del Estado de México, Facultad de Medicina, Paseo Tollocan esquina Jesús Carranza Colonia Moderna de la Cruz, C.P. 50180, Toluca, Estado de México (Mexico); Oviedo, J.O. Hernández [The American British Cowdray Medical Center, Centro de Cáncer, Calle Sur 136, no. 116, Colonia las Américas, C.P. 01120, México, D.F. (Mexico); Vázquez, D. R. Ruesga, E-mail: druesga@yahoo.com.mx [Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Colonia Doctores, C.P. 06726, México, D.F. (Mexico)

    2014-11-07

    Mycosis fungoides is a cutaneous lymphoma that accounts for 2–3% of all lymphomas. Several clinical studies have demonstrated the effectiveness of TSEBT (Total Skin Electron Beam Therapy) in patients with mycosis fungoides. It is important to develop this technique and make it available to a larger number of patients in Mexico. Because large fields for electron TSEBT are required in order to cover the entire body of the patient, beam characterization at conventional treatment distances is not sufficient and a calibration distance of 500cm or higher is required. Materials and methods: Calibration of radiochromic Gafchromic® EBT2 film (RCF) for electrons was performed in a solid water phantom (Scanditronix Wellhöfer) at a depth of 1.4cm and a Source Axis Distance (SAD) of 100cm. A polynomial fit was applied to the calibration curve, in order to obtain the equation relating dose response with optical density. The spatial distribution is obtained in terms of percentage of the dose, placing 3×3cm samples of RCF on the acrylic screen, which is placed in front of the patient in order to obtain maximum absorbed dose on the skin, covering an area of 200×100cm{sup 2}. The Percentage Depth Dose (PDD) curve was obtained placing RCF samples at depths of 0, 1, 1.2, 1.4, 1.5, 2, 3, 4, 5, 6, 7, 8 and 9cm in the solid water phantom, irradiated with an ELEKTA SINERGY Linear Accelerator electron beam, with an energy of 6 MeV, at a Source Skin Distance (SSD) of 500cm, with 1000MU = 100Gy, with a cone of 40×40cm and gantry angle of 90°. The RCFs were scanned on a flatbed scanner (EPSON EXPRESSION 10000 XL) and the images were processed with the ImageJ program using a region of interest (ROI) of 1×1cm{sup 2}. Results: The relative spatial dose distribution and the percentage depth dose for a SSD of 500±0.5cm, over an area of 200×100cm{sup 2} was obtained, resulting to an effective maximum dose depth (Z{sub ref}) for electrons of 1.4±0.05cm. Using the same experimental data

  17. No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients

    Directory of Open Access Journals (Sweden)

    Heuer M

    2010-06-01

    Full Text Available Abstract Objective Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. Methods 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score > 16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I and conservative managed patients (II. Results From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3% of the patients with splenectomy and 102 (18.5% without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2% in both groups. After massive transfusion of red blood cells (> 10 non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40% and sepsis (38% vs. 25%. Conclusions Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3 and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.

  18. Ultrasound-Guided Suprainguinal Fascia Iliaca Technique Provides Benefit as an Analgesic Adjunct for Patients Undergoing Total Hip Arthroplasty.

    Science.gov (United States)

    Bullock, W Michael; Yalamuri, Suraj M; Gregory, Stephen H; Auyong, David B; Grant, Stuart A

    2017-02-01

    Analgesia after total hip arthroplasty is often accomplished by the fascia iliaca compartment block, traditionally performed below the inguinal ligament, to anesthetize both femoral and lateral femoral cutaneous nerves. The course of the lateral femoral cutaneous nerve below the inguinal ligament is variable as opposed to consistent above the inguinal ligament in the pelvis. In this case series including 5 patients, we demonstrate that an ultrasound-guided suprainguinal fascia iliaca approach would consistently anesthetize the lateral femoral cutaneous nerve along with anterior cutaneous femoral nerve branches and provide cutaneous analgesia after total hip arthroplasty, as shown by decreased opioid consumption.

  19. Measurement of total angular momentum values of high-lying even-parity atomic states of samarium by spectrally resolved laser-induced fluorescence technique

    Indian Academy of Sciences (India)

    A K Pulhani; M L Shah; G P Gupta; B M Suri

    2010-12-01

    Spectrally resolved laser-induced fluorescence technique was used to uniquely assign total angular momentum () values to high-lying even-parity energy levels of atomic samarium. Unique value assignment was done for seven energy levels in the energy region 34,800–36,200 cm-1 , recently observed and reported in the literature.

  20. Numerical analysis of variations in posterior cruciate ligament properties and balancing techniques on total knee arthroplasty loading.

    NARCIS (Netherlands)

    Zelle, J.; Heesterbeek, P.J.; De Waal Malefijt, M.; Verdonschot, Nicolaas Jacobus Joseph

    2010-01-01

    Total knee arthroplasty (TKA) is a widely used and successful orthopaedic procedure. During TKA, the posterior cruciate ligament (PCL) can either be retained or substituted by a post-cam mechanism. One of the main functions of the PCL is to facilitate femoral rollback during knee flexion. For adequa

  1. 巨脾切除术的技术要点%Key points in splenectomy for massive splenomegaly

    Institute of Scientific and Technical Information of China (English)

    姜洪池; 陆朝阳

    2009-01-01

    The spleen whose size reaches or exceeds third degree should be regarded as massive splenomegaly.Splenectomy for massive splenomegaly demands precise procedures.First,median incision on upper abdomen(or vertical rectus muscle splitting incision)and incision under left costal arch are preferred.Second,the spleen was freed and then 0.33 mg of epinephrine was injected via the splenic artery before splenic artery ligation.During the process,a cell saver helps to minimize blood loss and makes autoinfusion possible for patients with benign lesions.Third,preoperative administration of fibrinogen,platelet and essential styptieum combined with the cooperation between surgeons and anesthesi010gists are the key points of bloodless surgery which is important for the recovery of patients.Four common problems of splenectomy for massive splenomegaly should also be addressed,including operation discontinuance,perioperative hemorrhage,accessory injury and postoperative intractable fever.

  2. Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Bo Liu; Mei-Hai Deng; Nan Lin; Wei-Dong Pan; Yun-Biao Ling; Rui-Yun Xu

    2006-01-01

    AIM:To detect the hemodynamic alterations in collateral circulation before and after combined endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization by ultrasonography,and to evaluate their effect using hemodynamic parameters.METHODS: Forty-three patients with esophageal varices received combined EVL and splenectomy with pericardial devascularization for variceal eradication. The esophageal vein structures and azygos blood flow (AZBF) were detected by endoscopic ultrasonography and color Doppler ultrasound. The recurrence and rebleeding of esophageal varices were followed up.RESULTS:Patients with moderate or severe varices in the esophageal wall and those with severe periesophageal collateral vein varices had improvements after treatment, while the percentage of patients with severe para-esophageal collateral vein varices decreased from 54.49% to 2.33%, and the percentage of patients with detectable perforating veins decreased from 79.07% to 4.65% (P < 0.01). Color Doppler flowmetry showed a significant decrease both in AZBF (43.00%,P < 0.05) and in diameter of the azygos vein (28.85%, P < 0.05), while the blood flow rate was unchanged. The recurrence rate of esophageal varices was 2.5% (1/40,mild), while no re-bleeding cases were recorded.CONCLUSION:EVL in combination with splenectomy with pericardial devascularization can block the collateral veins both inside and outside of the esophageal wall, and is more advantagious over splenectomy in combination with pericardial devascularization or EVL in preventing recurrence and re-bleeding of varices.

  3. Epidemiological profile and vaccination coverage in splenectomy patients in a health area of Murcia (1993-2012).

    Science.gov (United States)

    Molina-Salas, Yolanda; Romera-Guirado, Francisco José; Pérez-Martín, Jaime Jesús; Peregrín-González, María Nieves; Góngora-Soria, David

    2017-03-22

    Splenectomy patients have a high risk of suffering severe infections, many of them preventable by vaccination. The aim of the study was to analyse the clinical epidemiological characteristics and vaccine coverage of these patients in Health Area III of the Region of Murcia. A cross-sectional study was conducted on a population of patients that were splenectomised during the period 1993-2012, according to the Register of the Basic Minimum Data Set. Patients were classified on the basis of splenectomy (neoplasm, haematological diseases, trauma, and others), vaccination, and vital status, using official records of health data. Statistical analysis was performed using SPSS 21.0 statistics program. The sample consisted of 196 patients, of which 68.4% (n=134) were male. The mean age at which they underwent splenectomy was 50.1 years (SD: 22.2). The most common reason for removal of the spleen was neoplasia in 39.1% (n=59). Splenectomy due to trauma reasons was associated with lower patient age (p<.001) and male gender (p=.03). Vaccination coverage for Streptococcus pneumoniae was 23.8%, 5.7% for Neisseria meningitidis C, and 8.6% for Haemophilus influenzae B. Only 2.9% of patients were correctly vaccinated for all three. Vaccination coverage was insufficient for this fragile patient profile. It should be taken into account in the early detection and counselling in this group so susceptible to disease, with nurses being a decisive part in the process. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  4. Patients with Fever of Unknown Origin and Splenomegaly: Diagnostic Value of Splenectomy and Preoperative Risk Factors Suggestive of Underlying Lymphomas.

    Science.gov (United States)

    Zhang, Lu; Zhang, Wei; Cai, Huacong; Cao, Xinxin; Chen, Miao; Li, Jian; Zhu, Tienan; Duan, Minghui; Wang, Shujie; Han, Bing; Zhou, Daobin

    2017-01-01

    We reviewed patients with fever of unknown origin (FUO) and splenomegaly and assessed the diagnostic value of splenectomy and measured risk factors suggestive of an underlying lymphoma. FUO patients (n = 83) who had splenomegaly and underwent splenectomy were enrolled into this retrospective single-center study. Clinical presentations were documented and risk factors suggestive of an underlying lymphoma were tested. Seventy-four patients (89.2%) had a diagnosis of lymphoma or not after splenectomy and follow-up. Of those (55.4%) diagnosed with lymphoma, 29 had B-cell non-Hodgkin lymphoma and 12 had T-cell non-Hodgkin lymphoma. The remaining 33 (44.6%) had diseases other than lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: age (continuous) (HR 1.086; 95% CI 1.033-1.141; p = 0.001), massively enlarged spleen (HR 7.797; 95% CI 1.267-47.959; p = 0.027), and enlarged intra-abdominal lymph nodes (HR 63.925; 95% CI 7.962-513.219; p < 0.001). The calibration of the model was satisfactory (p = 0.248 using the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.925; 95% CI 0.863-0.987). Splenectomy is an effective diagnostic procedure for patients with FUO and splenomegaly and lymphoma is a common cause. Older age, a massively enlarged spleen, and enlarged intra-abdominal lymph nodes are risk factors suggesting an underlying lymphoma, and surgery for high-risk patients should be considered. © 2017 S. Karger AG, Basel.

  5. Splenectomy in a Nigerian Teaching Hospital: A comparison of sonographic correlation with intra-operative findings in trauma

    Directory of Open Access Journals (Sweden)

    Oludolapo Afuwape

    2013-01-01

    Full Text Available Background: Missed or inappropriately-treated splenic injury is a significant cause of preventable trauma-related death. Physical examination and abdominal ultrasonography are essential tools for early diagnosis of splenic injury. However, some injuries may not be accurately diagnosed by ultrasonography at initial evaluation. Aim: The aim of this study was to audit indications for splenectomy at the University College Hospital, Ibadan and to compare the intra-operative findings in trauma-related cases with the sonographic findings. Materials and Methods: We retrospectively reviewed all adult (12 years and older patients′ records who had splenectomy between July 2003 and June 2010. The data extracted included patient demographics and indications for splenectomy. In trauma cases, the mode of injury and vital signs at presentation, sonographic findings, and operation findings were recorded. The intervals between injury and sonography and duration to surgery were also noted respectively. Results: Eighty-four patients were reviewed in the 7-year review period. The male to female ratio was approximately 2:1. The ages ranged from 14 to 76 years with a peak incidence in the third decade. Elective indications for splenectomy were 14 (16.6%, while 70 (83.3% were emergency cases. Forty-four of the trauma-related patients had pre-operative abdominal ultrasound, of which 31 (70% was reported as sonographically normal prior to surgery, while the rest of the trauma-related cases were considered too ill for ultrasonography. Conclusion: Potentially significant injuries may be missed with screening sonography. For this reason, a physician must maintain a high index of suspicion and consider the patient′s clinical status or an alternative imaging modality in excluding a diagnosis of splenic injury.

  6. Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis

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    ZHANG Lei

    2015-03-01

    Full Text Available ObjectiveTo investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis, and to provide a certain basis for reducing the incidence of digestive tract re-hemorrhage for these patients. MethodsA retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group (n=32 and non-bleeding group (n=206. Univariate analysis (t test or chi-square test and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. ResultsOf the 32 patients with postoperative rebleeding, 17 had esophagogastric variceal bleeding, 11 had bleeding due to portal hypertensive gastropathy, and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, pathological changes of the gastric mucosa, platelet count, prothrombin time (PT, activated partial thromboplastin time (APTT, and presence of diabetes (all P<0.05. The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes, Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, diffuse lesion of the gastric mucosa, PT, and APTT. ConclusionFor cirrhotic patients with portal hypertension, the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.

  7. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention - a step by step practical approach and an observational study.

    Science.gov (United States)

    Fang, Hsiu-Yu; Lee, Wei-Chieh; Fang, Chih-Yuan; Wu, Chiung-Jen

    2016-10-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the "snare technique."We retrospectively examined the use of "snare technique" among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015."Snare technique" was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without "snare technique" were similar. The "snare technique" group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P technique" group (285.0 ± 68.5 vs 379.2 ± 144.0, P = 0.04). The incidence of major complications, retrograde success, or final success did not differ between the groups.The "snare technique" is safe and feasible in retrograde CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter.

  8. Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses

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    Lior Menasherian-Yaccobe

    2013-01-01

    Full Text Available A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses.

  9. Reduction of virus burden-induced splenectomy in patients with liver cirrhosis related to hepatitis C virus infection

    Institute of Scientific and Technical Information of China (English)

    Tetsuro Sekiguchi; Takeaki Nagamine; Hitoshi Takagi; Masatomo Mori

    2006-01-01

    AIM: To examine the hepatitis C virus (HCV) levels and immunological markers in cirrhotic patients after splenectomy.METHODS: HCV RNA titers as well as cellular and humoral immune markers were determined in 20 cirrhotic patients after splenectomy and in 32 cirrhotic controls with an intact spleen. RESULTS: Serum HCV RNA titers were lower in the spienectomized patients than in the controls (186 ± 225 x 103copies/mL vs 541 ± 417x 103 copies/mL, P<0.01). HCV RNA was judged to have been spontaneously eradicated in 4 splenectomized patients, but in none of the controls.Natural killer cell activity was higher in the splenectomized patients than in the controls (41.2 ± 19.3% vs 24.7 ± 15.3%, P< 0.01), and natural killer cell activity was negatively correlated to HCV RNA titers in the spienectomized patients except in those with serotype 2-related infection. The CD4/CD8 ratio was significantly lower in the splenectomized patients than in the controls.CONCLUSION: The findings suggest that splenectomy may diminish virus burden in cirrhotic patients with HCV infection at least in part, through augmentation of natural killer cell activity.

  10. Elemental concentration in normal skin and fibroepithelial polip lesions by synchrotron radiation total reflection X-ray fluorescence technique

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Julio C.A.C.R.; Canellas, Catarine G.L.; Lopes, Ricardo T., E-mail: ricardo@lin.ufrj.br, E-mail: jcorsini@lin.ufrj.br [Nuclear Laboratory Instrumentation/COPPE, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Anjos, Marcelino J., E-mail: marcelin@lin.ufrj.br [Physics Institute, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ (Brazil)

    2011-07-01

    In this work, the concentrations of trace elements were measured in acrochordon, a skin lesion also known as skin tag or fibroepithelial polyp, as well as in normal skin from the same patient. The samples were analysed by Synchrotron Radiation Total Reflection X- ray Fluorescence (SRTXRF) in the Synchrotron Light National Laboratory (LNLS) in Campinas/Sao Paulo-Brazil. The collection of lesion and healthy skin samples, including papillary dermis and epidermis, has involved 17 patients. It was evaluated the presence of P, S, Cl, K, Ca, Cr, Mn, Fe, Cu, Zn, Br and Rb in the paired samples, which were compared, and significant differences were found in some of them. (author)

  11. Surgical and pathomorphological results of total mesorectumectomy by using waterjet dissection technique in patients with rectal cancer

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    D. V. Sidorov

    2016-01-01

    Full Text Available Background. The paper presents our own experience of using a waterjet dissector ERBEJET2® in the course of surgical interventions for colorectal cancer. This experience is unique for Russia.Materials and methods. Waterjet dissection method associated with total  mesorectumectomy was used by us in 20 patients suffering from rectal cancer. An average age of patients was 59.2 ± 13.9 years. In all the patients surgeries were performed for adenogenic colorectal cancer, morphologically verified at the preoperative stage. Resected preparations were studied on morphological level. For comparison, two control groups of 20 patients were selected, in which the rectum mobilization was performed by using monopolar coagulator and harmonic scalpel. The studied groups were matched by gender, age, location and the tumor extent. All the surgeries were performed by one surgical team.Results. Results of the study demonstrated advantages of waterjet dissection when performing total mesorectumectomy due to a minimum depth of tissue damage on the lateral margin of resection.Conclusion. Waterjet dissectors have taken their place in the extensive list of tools used when performing surgical interventions for colorectal cancer, that allows to expect an improvement of functional and oncological results of the surgical treatment.

  12. Stabilization of the total force in multi-finger pressing tasks studied with the ‘inverse piano’ technique

    Science.gov (United States)

    Martin, J.R.; Budgeon, M.K.; Zatsiorsky, V.M.; Latash, M.L.

    2010-01-01

    When one finger changes its force, other fingers of the hand can show unintended force changes in the same direction (enslaving) and in the opposite direction (error compensation). We tested a hypothesis that externally imposed changes in finger force predominantly lead to error compensation effects in other fingers thus stabilizing the total force. A novel device, the “inverse piano”, was used to impose controlled displacements to one of the fingers over different magnitudes and at different rates. Subjects (n =10) pressed with four fingers at a constant force level and then one of the fingers was unexpectedly raised. The subjects were instructed not to interfere with possible changes in the finger forces. Raising a finger caused an increase in its force and a drop in the force of the other three fingers. Overall, total force showed a small increase. Larger force drops were seen in neighbors of the raised finger (proximity effect). The results show that multi-finger force stabilizing synergies dominate during involuntary reactions to externally imposed finger force changes. Within the referent configuration hypothesis, the data suggest that the instruction “not to interfere” leads to adjustments of the referent coordinates of all the individual fingers. PMID:21450360

  13. Stabilization of the total force in multi-finger pressing tasks studied with the 'inverse piano' technique.

    Science.gov (United States)

    Martin, J R; Budgeon, M K; Zatsiorsky, V M; Latash, M L

    2011-06-01

    When one finger changes its force, other fingers of the hand can show unintended force changes in the same direction (enslaving) and in the opposite direction (error compensation). We tested a hypothesis that externally imposed changes in finger force predominantly lead to error compensation effects in other fingers thus stabilizing the total force. A novel device, the "inverse piano", was used to impose controlled displacements to one of the fingers over different magnitudes and at different rates. Subjects (n=10) pressed with four fingers at a constant force level and then one of the fingers was unexpectedly raised. The subjects were instructed not to interfere with possible changes in the finger forces. Raising a finger caused an increase in its force and a drop in the force of the other three fingers. Overall, total force showed a small increase. Larger force drops were seen in neighbors of the raised finger (proximity effect). The results showed that multi-finger force stabilizing synergies dominate during involuntary reactions to externally imposed finger force changes. Within the referent configuration hypothesis, the data suggest that the instruction "not to interfere" leads to adjustments of the referent coordinates of all the individual fingers. Published by Elsevier B.V.

  14. A method optimization study for atomic absorption spectrophotometric determination of total zinc in insulin using direct aspiration technique

    Directory of Open Access Journals (Sweden)

    Sadia Ata

    2015-03-01

    Full Text Available A sensitive, reliable and relative fast method has been developed for the determination of total zinc in insulin by atomic absorption spectrophotometer. This designed study was used to optimize the procedures for the existing methods. Spectrograms of both standard and sample solutions of zinc were recorded by measuring the absorbance at 213.9 nm for determination of total zinc. System suitability parameters were evaluated and were found to be within the limits. Linearity was evaluated through graphical representation of concentration versus absorbance. Repeatability (intra-day and intermediate precision (inter-day were assessed by analyzing working standard solutions. Accuracy and robustness were experimented from the standard procedures. The percentage recovery of zinc was found to be 99.8%, relative standard deviation RSD 1.13%, linearity of determination LOD 0.0032 μg/mL, and limit of quantization LOQ 0.0120 μg/mL. This developed and proposed method was then validated in terms of accuracy, precision, linearity and robustness which can be successfully used for the quantization of zinc in insulin.

  15. Recanalization strategy for chronic total occlusions with tapered and stiff-tip guidewire. The results of CTO new techniQUE for STandard procedure (CONQUEST) trial.

    Science.gov (United States)

    Mitsudo, Kazuaki; Yamashita, Takehiro; Asakura, Yasushi; Muramatsu, Toshiya; Doi, Osamu; Shibata, Yoshisato; Morino, Yoshihiro

    2008-11-01

    The success rate of percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) lesions varies depending on the guidewire manipulation skills of the operator. The standardization of guidewire technique is very important. A new technique with a new tapered wire (Conquest, Confianza Pro) was tested to verify effectiveness for higher initial success rates and standardization of PCI for CTO. A prospective, multicenter registry was conducted at 6 investigational sites. In the CONQUEST trial, The CTO lesions were treated by using an intermediate guidewire to cross the lesion. If it did not cross, the guidewire was changed to the Conquest guidewire. If it did not cross, "seesaw-wiring" or the "parallel-wire technique" was performed. The primary endpoint was the initial procedural success rate. A total of 110 patients representing 116 CTO lesions were treated from July 2003 through March 2004. The procedural success rate was 86.2% on the first try, and 88.8% on the second try, respectively. The guidewire success rate on the second try was 90.5% during the hospital stay; no deaths, or acute myocardial infarctions were confirmed. Two patients deteriorated into tamponade, and surgical or percutaneous drainage was performed in each patient without any sequelae. A guidewire technique in PCI for CTOs that starts with the intermediate guidewire and moves to the Confianza Pro tapered guidewire, either alone or by performing a see-saw or parallel-wire technique, can achieve a high initial success rate with an acceptably low major complication rate.

  16. Relationship between wheat characteristics and nutrient digestibility in broilers: comparison between total collection and marker (titanium dioxide) technique.

    Science.gov (United States)

    Smeets, N; Nuyens, F; Van Campenhout, L; Delezie, E; Pannecoucque, J; Niewold, T

    2015-07-01

    Three wheat cultivars (Orpheus, Rustic, and Viscount) were used to formulate 3 test feeds (62.4% wheat) in a broiler digestibility trial. The diets were fed to male Ross 308 broiler chickens. The wheat cultivars mainly differed in their amount of non-starch polysaccharides ( NSP: ). The cultivar Orpheus was chosen to represent a high amount of NSP (102 g/kg DM), whereas the cultivars Rustic and Viscount represented low amounts of NSP (83.4 g/kg DM and 73.9 g/kg DM, respectively). Furthermore, the cultivars Orpheus and Viscount were feed quality wheat, whereas Rustic was a milling quality wheat. Nutrient digestibilities and AMEn contents of the diets were measured from 18 to 22-days-old by total excreta collection, or with the use of the indigestible marker titanium dioxide. In addition, the ileal viscosity was measured when the broilers were 25-days-old. Wheat cultivar affected N retention, DM digestibility, and AMEn. In general, the feed formulated with the high NSP wheat cultivar Orpheus resulted in the least favorable nutrient digestibilities and AMEn, whereas the results were better when the feed was formulated with the low NSP cultivars Viscount and Rustic. Feeding the Rustic cultivar caused the highest intestinal viscosity, although this was not reflected in the animal responses. Nutrient digestibilities and AMEn content of the diets were lower when calculated with the titanium dioxide marker than with the total excreta collection procedure. Moreover, the P-values of the effect of wheat cultivar on DM digestibility, N retention, crude fat digestibility and AMEn were lower with the use of the titanium dioxide marker. It can be concluded that wheat cultivar affected nutrient digestibility and AMEn, and that the observed differences were related to the amount of NSP. Furthermore, both the titanium dioxide marker and the total excreta collection methods showed the same trends despite the different values obtained. The titanium dioxide marker method was the

  17. Subintimal TRAnscatheter Withdrawal (STRAW) of hematomas compressing the distal true lumen: a novel technique to facilitate distal reentry during recanalization of chronic total occlusion (CTO).

    Science.gov (United States)

    Smith, Elliot J; Di Mario, Carlo; Spratt, James C; Hanratty, Colm G; de Silva, Ranil; Lindsay, Alistair C; Grantham, J Aaron

    2015-01-01

    The development of a large hematoma impairing visualization of the distal true lumen is a recognized complication of antegrade recanalization of chronic total occlusions, often forcing the operator to abort the procedure or switch to a retrograde approach. We describe a novel technique utilizing an over-the-wire balloon inflated in the proximal occluded vessel to block inflow and allow aspiration of the blood from the subintimal space. This decompressed the true lumen, restored distal visualization, and allowed successful reentry using a dedicated technology. Utilization of this novel technique may rescue antegrade recanalization attempts complicated by large subintimal hematomas.

  18. Intercomparison of the comparative reactivity method (CRM) and pump-probe technique for measuring total OH reactivity in an urban environment

    Science.gov (United States)

    Hansen, R. F.; Blocquet, M.; Schoemaecker, C.; Léonardis, T.; Locoge, N.; Fittschen, C.; Hanoune, B.; Stevens, P. S.; Sinha, V.; Dusanter, S.

    2015-10-01

    The investigation of hydroxyl radical (OH) chemistry during intensive field campaigns has led to the development of several techniques dedicated to ambient measurements of total OH reactivity, which is the inverse of the OH lifetime. Three techniques are currently used during field campaigns, including the total OH loss rate method, the pump-probe method, and the comparative reactivity method. However, no formal intercomparison of these techniques has been published so far, and there is a need to ensure that measurements of total OH reactivity are consistent among the different techniques. An intercomparison of two OH reactivity instruments, one based on the comparative reactivity method (CRM) and the other based on the pump-probe method, was performed in October 2012 in a NOx-rich environment, which is known to be challenging for the CRM technique. This study presents an extensive description of the two instruments, the CRM instrument from Mines Douai (MD-CRM) and the pump-probe instrument from the University of Lille (UL-FAGE), and highlights instrumental issues associated with the two techniques. It was found that the CRM instrument used in this study underestimates ambient OH reactivity by approximately 20 % due to the photolysis of volatile organic compounds (VOCs) inside the sampling reactor; this value is dependent on the position of the lamp within the reactor. However, this issue can easily be fixed, and the photolysis of VOCs was successfully reduced to a negligible level after this intercomparison campaign. The UL-FAGE instrument may also underestimate ambient OH reactivity due to the difficulty to accurately measure the instrumental zero. It was found that the measurements are likely biased by approximately 2 s-1, due to impurities in humid zero air. Two weeks of ambient sampling indicate that the measurements performed by the two OH reactivity instruments are in agreement, within the measurement uncertainties for each instrument, for NOx mixing ratios

  19. Evaluation of media for simultaneous enumeration of total coliform and Escherichia coli in drinking water supplies by membrane filtration techniques

    Institute of Scientific and Technical Information of China (English)

    WANG Dunling; FIESSEL Wanda

    2008-01-01

    This study evaluated three different dehydrated media for simultaneous detection and enumeration of total coliform (TC) and Escherichia coil in drinking water samples with a standard membrane filtration procedure.The experiment indicated that the differential coliform agar (DCA) medium was the most effective among the tested media in enumerating TC and E.coli,without the need for extensive accompanying confirmation tests.The results for DCA medium were highly reproducible for both TC and E.coli with standard deviation of 6.0 and 6.1,respectively.A high agreement (82%) was found between DCA and m-Endo media on 152 drinking water samples in terms of TC positive.The DCA medium also reduced concealment of background bacteria.

  20. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis.

    Science.gov (United States)

    Qin, Charles D; Helfrich, Mia M; Fitz, David W; Hardt, Kevin D; Beal, Matthew D; Manning, David W

    2017-09-01

    Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes. The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ(2) tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest. A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12). Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Removal of total and antibiotic resistant bacteria in advanced wastewater treatment by ozonation in combination with different filtering techniques.

    Science.gov (United States)

    Lüddeke, Frauke; Heß, Stefanie; Gallert, Claudia; Winter, Josef; Güde, Hans; Löffler, Herbert

    2015-02-01

    Elimination of bacteria by ozonation in combination with charcoal or slow sand filtration for advanced sewage treatment to improve the quality of treated sewage and to reduce the potential risk for human health of receiving surface waters was investigated in pilot scale at the sewage treatment plant Eriskirch, Baden-Wuerttemberg/Germany. To determine the elimination of sewage bacteria, inflowing and leaving wastewater of different treatment processes was analysed in a culture-based approach for its content of Escherichia coli, enterococci and staphylococci and their resistance against selected antibiotics over a period of 17 month. For enterococci, single species and their antibiotic resistances were identified. In comparison to the established flocculation filtration at Eriskirch, ozonation plus charcoal or sand filtration (pilot-scale) reduced the concentrations of total and antibiotic resistant E. coli, enterococci and staphylococci. However, antibiotic resistant E. coli and staphylococci apparently survived ozone treatment better than antibiotic sensitive strains. Neither vancomycin resistant enterococci nor methicillin resistant Staphylococcus aureus (MRSA) were detected. The decreased percentage of antibiotic resistant enterococci after ozonation may be explained by a different ozone sensitivity of species: Enterococcus faecium and Enterococcus faecalis, which determined the resistance-level, seemed to be more sensitive for ozone than other Enterococcus-species. Overall, ozonation followed by charcoal or sand filtration led to 0.8-1.1 log-units less total and antibiotic resistant E. coli, enterococci and staphylococci, as compared to the respective concentrations in treated sewage by only flocculation filtration. Thus, advanced wastewater treatment by ozonation plus charcoal or sand filtration after common sewage treatment is an effective tool for further elimination of microorganisms from sewage before discharge in surface waters.

  2. Emergency Splenectomy in a patient with primary immune thrombocytopenia and hemoperitoneum

    Directory of Open Access Journals (Sweden)

    Liermis Michael Dita Salabert

    2013-08-01

    Full Text Available Primary immune thrombocytopenia is an acquired autoimmune disease, with a very variable clinical course, which causes an accelerated destruction by antibodies and an impaired platelet production. A case of a 40 year-old female patient of rural origin with a history of mitral stenosis and atrial fibrillation, diagnosed two months prior to her admission to the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos, is presented. She attended the hospital with ecchymosis and petechiae on the lower and upper limbs. After confirming a severe thrombocytopenia (5x109/ l, she was admitted to the Hematology Department. Possible primary immune thrombocytopenia was found. During her stay in the hospital, her clinical condition was complicated by hemoperitoneum. The patient underwent surgery which confirmed the presence of four liters of blood in the abdominal cavity with few clots, bleeding and fissure in the left ovary and adherent clots. An early clamping of the splenic artery, evacuation of the hemoperitoneum, left adnexectomy, splenectomy and resection of accessory spleen were performed. The patient progressed satisfactorily.

  3. Impact of preoperative platelet count on perioperative outcome after laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

    Science.gov (United States)

    Martin Arnau, Belén; Turrado Rodriguez, Víctor; Tartaglia, Ernesto; Bollo Rodriguez, Jesús; Targarona, Eduardo M; Trias Folch, Manuel

    2016-01-01

    Laparoscopic splenectomy (LS) is the preferred treatment of idiopathic thrombocytopenic purpura (ITP) when medical treatment fails. The objective was to evaluate the feasibility and safety of LS according to the preoperative platelet count. This study is a retrospective analysis of a series of 199 patients who underwent LS for ITP from 1993 to 2015. The patients were divided into 3 groups according to platelet count: group i ( 50×10(9)/L). Operative time was significantly lower in Group III compared to Group I and II (100±53 and 105±61min, P<.025)). Intraoperative blood loss was statistically higher in group i (263±551ml) with respect to the other 2: group ii (128±352ml) and group iii (24±62ml) (P<.003). Hospital stay was 6.4±5.8 days in group i, significantly higher compared to groups ii and iii (3.8±2.3 and 3.2±1.8 days, respectively (P<.003)). Conducting a LS in ITP patients with low platelet counts is effective and safe. Publicado por Elsevier España, S.L.U.

  4. Pharmacokinetic detection of penicillin excreted in urine using a totally internally reflected resonance light scattering technique with cetyltrimethylammonium bromide.

    Science.gov (United States)

    Huang, Cheng Zhi; Feng, Ping; Li, Yuan Fang; Tan, Ke Jun

    2005-05-01

    A quantitative analysis method for penicillins including ampicillin (AmP), benzyl penicillin (BP), oxacillin (OA) and amoxycillin (AmO) is proposed that makes use of the totally internally reflected resonance light scattering (TIR-RLS) signal from the penicillin at the H2O/CCl4 interface in the presence of cetyltrimethylammonium bromide (CTMAB), and enables the pharmacokinetics of penicillin taken orally and excreted through urine to be monitored. Penicillin is coadsorbed with CTMAB at the H2O/CCl4 interface in neutral solution, resulting in the formation of ion associates that display greatly enhanced TIR-RLS signals (maximum at 368-372 nm). This enhanced TIR-RLS intensity was found to be proportional to the penicillin concentration over the range 0.2 x 10(-6) to 2.2 x 10(-6) mol L(-1), with limits of determination (3sigma) of 5.0 x 10(-8) to 7.0 x 10(-8) mol L(-1). Pharmacokinetics studies performed using the present method show that the excretion of orally-taken ampicillin through urine has a half-time of 1.05 h and an excremental quantum over 8 h of 49.3%, respectively.

  5. The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery

    Directory of Open Access Journals (Sweden)

    Müge Koşucu

    2014-01-01

    Full Text Available Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA, ischemia-modified albumin (IMA and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1, 30 min after tourniquet inflation (t2, immediately before (t3, and 5 min (t4, 15 min (t5, 30 min (t6, 1 h (t7, 2 h (t8, and 6 h (t9 after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t2–t9 and t2–t7. MDA levels in Group T and Group I were significantly lower than those in Group S at t2–t8 and t2–t9. IMA levels in Group T were significantly lower than those in Group S at t2–t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

  6. Technique in linear accelerator total body irradiation%直线加速器全身照射技术

    Institute of Scientific and Technical Information of China (English)

    张九堂; 伍志红; 鲁旭蔚; 何金莲

    2001-01-01

    This article describes the physical, technical, and dosimetric aspects of total body irradiation (TBI) that was carried out by using 6MV X-Ray from Varian 2300 C/D Linear Accelerator at a distance of 450 cm from target to the treatment table and at a gantry angle of 270°.The dose to lung tissue was limit by setting the individual lead compensators customized before, and using DPD-510 to monitor the absorbed dose of the reference point the absorbed dose in depth of half of body will be (Din+Dout)/2 after taking treatment in both AP position and PA position.%本文介绍了在直线加速器上实行全身照射的方法,包括治疗床的设计、测量装置的制作、实验参数的测定和照射方法。SSD=450 cm,机架角为270度,患者取侧卧位,前后野和后前野对穿照射,采用分段肺屏蔽办法控制肺的吸收剂量。用多通道半导体剂量仪进行剂量全程监测作为质量控制手段进行质量控制和实现质量保证,用入射表面剂量Din与出射表面剂量Dout之和的一半即(Din+Dout)/2作为对应入射方向上体中层面的吸收剂量。

  7. Total hip wear assessment: a comparison between computational and in vitro wear assessment techniques using ISO 14242 loading and kinematics.

    Science.gov (United States)

    Matsoukas, George; Willing, Ryan; Kim, Il Yong

    2009-04-01

    In the present study a direct comparison was made between in vitro total hip wear testing and a computational analysis considering the effects of time and a nonlinear stress-strain relationship for ultrahigh molecular weight polyethylene (UHMWPE) at 37 degrees C. The computational simulation was made correct through calibration to experimental volumetric wear results, and the predicted damage layout on the acetabular liner surface was compared with results estimated from laser scanning of the actual worn specimens. The wear rates for the testing specimens were found to be 17.14+/-1.23 mg/10(6) cycles and 19.39+/-0.79 mg/10(6) cycles, and the cumulative volumetric wear values after 3x10(6) cycles were 63.70 mm(3) and 64.02 mm(3) for specimens 1 and 2, respectively. The value of the calibrated wear coefficient was found to be 5.32(10(-10)) mm(3)/N mm for both specimens. The major difference between the computational and experimental wear results was the existence of two damage vectors in the experimental case. The actual location of damage was virtually the same in both cases, and the maximum damage depth of the computational model agreed well with the experiment. The existence of multiple wear vectors may indicate the need for computational approaches to account for multidirectional sliding or strain hardening of UHMWPE. Despite the limitation in terms of describing the overall damage layout, the present computational model shows that simulation can mimic some of the behavior of in vitro wear.

  8. On-line technique for preparingand measuring stable carbon isotopeof total dissolved inorganic carbonin water samples ( d13CTDIC

    Directory of Open Access Journals (Sweden)

    S. Inguaggiato

    2005-06-01

    Full Text Available A fast and completely automated procedure is proposed for the preparation and determination of d13C of total inorganic carbon dissolved in water ( d13CTDIC. This method is based on the acidification of water samples transforming the whole dissolved inorganic carbon species into CO2. Water samples are directly injected by syringe into 5.9 ml vials with screw caps which have a pierciable rubber septum. An Analytical Precision «Carbonate Prep System» was used both to flush pure helium into the vials and to automatically dispense a fixed amount of H3PO4. Full-equilibrium conditions between produced CO2 and water are reached at a temperature of 70°C (± 0.1°C in less than 24 h. Carbon isotope ratios (13C/ 12C were measured on an AP 2003 continuous flow mass spectrometer, connected on-line with the injection system. The precision and reproducibility of the proposed method was tested both on aqueous standard solutions prepared using Na2CO3 with d13C=-10.78 per mil versus PDB (1 s= 0.08, n = 11, and at five different concentrations (2, 3, 4, 5 and 20 mmol/l and on more than thirty natural samples. Mean d13CTDIC on standard solution samples is ?10.89 < per mil versus PDB (1 s= 0.18, n = 50, thus revealing both a good analytical precision and reproducibility. A comparison between average d13CTDIC values on a quadruplicate set of natural samples and those obtained following the chemical and physical stripping method highlights a good agreement between the two analytical methods.

  9. TH-C-12A-04: Dosimetric Evaluation of a Modulated Arc Technique for Total Body Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Tsiamas, P; Czerminska, M; Makrigiorgos, G; Karen, M; Zygmanski, P [Brigham and Women' s Hospital/ Dana-Farber Institute/ Harvard Medical School, Boston, MA (United States)

    2014-06-15

    Purpose: A simplified Total Body Irradiation (TBI) was developed to work with minimal requirements in a compact linac room without custom motorized TBI couch. Results were compared to our existing fixed-gantry double 4 MV linac TBI system with prone patient and simultaneous AP/PA irradiation. Methods: Modulated arc irradiates patient positioned in prone/supine positions along the craniocaudal axis. A simplified inverse planning method developed to optimize dose rate as a function of gantry angle for various patient sizes without the need of graphical 3D treatment planning system. This method can be easily adapted and used with minimal resources. Fixed maximum field size (40×40 cm2) is used to decrease radiation delivery time. Dose rate as a function of gantry angle is optimized to result in uniform dose inside rectangular phantoms of various sizes and a custom VMAT DICOM plans were generated using a DICOM editor tool. Monte Carlo simulations, film and ionization chamber dosimetry for various setups were used to derive and test an extended SSD beam model based on PDD/OAR profiles for Varian 6EX/ TX. Measurements were obtained using solid water phantoms. Dose rate modulation function was determined for various size patients (100cm − 200cm). Depending on the size of the patient arc range varied from 100° to 120°. Results: A PDD/OAR based beam model for modulated arc TBI therapy was developed. Lateral dose profiles produced were similar to profiles of our existing TBI facility. Calculated delivery time and full arc depended on the size of the patient (∼8min/ 100° − 10min/ 120°, 100 cGy). Dose heterogeneity varied by about ±5% − ±10% depending on the patient size and distance to the surface (buildup region). Conclusion: TBI using simplified modulated arc along craniocaudal axis of different size patients positioned on the floor can be achieved without graphical / inverse 3D planning.

  10. Poster — Thur Eve — 38: Feasibility of a Table-Top Total Body Irradiation Technique using Robotic Couch Motion

    Energy Technology Data Exchange (ETDEWEB)

    Chin, Erika; Otto, Karl; Hoppe, Richard; Hsu, Annie; Loo, Billy; Million, Lynn; Xing, Lei; Fahimian, Benjamin [Department of Radiation Oncology, Stanford University (United States)

    2014-08-15

    Purpose: To develop and test the feasibility of a table-top implementation for total body irradiation (TBI) via robotic couch motion and coordinated monitor unit modulation on a standard C-arm linac geometry. Methods: To allow for collision free delivery and to maximize the effective field size, the couch was rotated to 270° IEC and dropped to 150 cm from the vertical radiation source. The robotic delivery was programmed using the TrueBeam STx Developer Mode using custom XML scripting. To assess the dosimetry of a sliding 30×20 cm{sup 2} field, irradiation on a solid water phantom of varying thickness was analyzed using EDR2 radiographic film and OSLDs. Beam modulation was achieved by dividing the couch path into multiple segments of varying dose rates and couch speeds in order to deliver 120 cGy to the midline. Results: The programmed irradiation in conjunction with coordinated couch motion was successfully delivered on a TrueBeam linac. When no beam modulation was employed, the dose difference between two different phantom sections was 17.0%. With simple beam modulation via changing dose rates and couch speeds, the desired prescription dose can be achieved at the centre of each phantom section within 1.9%. However, dose deviation at the junction was 9.2% due to the nonphysical change in the phantom thickness. Conclusions: The feasibility of robotic table-top TBI on a C-arm linac geometry was experimentally demonstrated. To achieve a more uniform dose distribution, inverse-planning allowing for a combination of dose rate modulation, jaw tracking and MLC motion is under investigation.

  11. Acute Type A Aortic Dissection Successfully Managed with One-stage Surgery of Total Aortic Arch Replacement with Supra-aortic Transposition Plus Frozen Elephant Trunk Technique

    Directory of Open Access Journals (Sweden)

    Meng-Lin Lee

    2014-09-01

    Full Text Available Acute type A aortic dissection has long been a challenging issue. The surgical techniques traditionally vary with the anatomic extent of the aortic dissection. Simple ascending aortic grafting can be lifesaving, but the lesions beyond the aorta, which include the arch vessels and descending aorta, remain potential hazards. In this paper, we present a patient in which acute type A aortic dissection with lesions extending into descending thoracic aorta was successfully managed by total arch replacement with supra-aortic transposition plus the frozen elephant trunk technique to the descending aorta. A 67-year-old gentleman presented with severe tearing pain from the anterior to posterior chest. Computed tomography confirmed the diagnosis of acute type A dissection extending to the level of the right common iliac artery. An emergent operation was performed as in the aforementioned technique. The surgery went well and the patient was discharged without comorbidities on postoperative day 25. The patient had regular outpatient clinical follow-up. The follow-up computed tomography images showed adequate results with the obliteration of the false lumen. In conclusion, total aortic arch replacement with supra-aortic transposition plus frozen elephant trunk technique is a safe and feasible operative method for patients with detrimental acute type A aortic dissection.

  12. Development of a tunable diode laser absorption sensor for online monitoring of industrial gas total emissions based on optical scintillation cross-correlation technique.

    Science.gov (United States)

    Zhang, Zhirong; Pang, Tao; Yang, Yang; Xia, Hua; Cui, Xiaojuan; Sun, Pengshuai; Wu, Bian; Wang, Yu; Sigrist, Markus W; Dong, Fengzhong

    2016-05-16

    We report the first application of gas total emission using a DFB diode laser for gas concentration measurements combined with two LEDs for gas velocity measurements. In situ gas total emissions and particle density measurements in an industrial pipeline using simultaneous tunable diode laser absorption spectroscopy (TDLAS) and optical scintillation cross-correlation technique (OSCC) are presented. Velocity mean values obtained are 7.59 m/s (OSCC, standard deviation is 1.37 m/s) and 8.20 m/s (Pitot tube, standard deviation is 1.47 m/s) in a steel plant pipeline for comparison. Our experiments demonstrate that the combined system of TDLAS and OSCC provides a new versatile tool for accurate measurements of total gas emissions.

  13. Spontaneous splenic rupture due to uremic coagulopathy and mortal sepsis after splenectomy.

    Science.gov (United States)

    Gazel, Eymen; Açıkgöz, Gazel; Kasap, Yusuf; Yiğman, Metin; Güneş, Zeki Ender

    2015-01-01

    Nontraumatic spontaneous splenic rupture (NSSR) has been encountered much more rarely compared with the traumatic splenic rupture. Although NSSR generally emerges in dialysis patients on account of such causes as the use of heparin during hemodialysis, uremic coagulopathy, infections, and secondary amyloidosis. Herein, we aimed to present a case of spontaneous splenic rupture which had developed soon after the inclusion of the case suffering from end-stage renal disease in routine hemodialysis program in the absence of any trauma or other prespecified risk factors for splenic rupture. A 55-year-old male patient was admitted to our hospital to have the ureteral double J stent removed. The operation was completed without any complication. Complaining an abdominal pain more prominent in the left upper abdominal quadrant in the first postoperative day, the patient underwent a through physical examination which disclosed abdominal distension, widespread tenderness, and rebound and defense positivity. The abdominal tomography depicted 122 × 114 × 95 mm lesion compatible with a hematoma. On the basis of these findings, an emergency exploratory operation was decided to be performed. Following clearance of the retroperitoneal hematoma, splenectomy was implemented. Experiencing progressive deterioration in his clinical status despite antibiotherapy, the patient unfortunately died of sepsis with multiorgan failure on the 25(th) postoperative day. In conclusion, NSSR is such an entity that may be missed out, can pursue variable clinical courses, and requires emergency therapy upon definitive diagnosis. The possibility of spontaneous bleedings should be kept in mind in any case with the history of hyperuricemia even in the absence of overt trauma, no matter if they are included in routine hemodialysis or not.

  14. Microbial quality of lamb carcasses during processing and the acridine orange direct count technique (a modified DEFT) for rapid enumeration of total viable counts.

    Science.gov (United States)

    Sierra, M L; Sheridan, J J; McGuire, L

    1997-04-29

    This study was designed to set up a hazard analysis and critical control points (HACCP) system for sheep slaughtering operations at four different plants in Ireland and to determine the differences between plants in terms of microbial contamination. A single carcass area, the abdomen, was examined by swabbing and a microbiological profile was determined at different stages along the slaughter line. The level of contamination was assessed from the total bacteria counts, Enterobacteriaceae and Listeria spp. For the total counts, a modified direct epifluorescent filter technique (acridine orange direct count technique (AODC)) was developed and tested. No significant differences were found among plants in the levels of bacterial contamination. This was observed for all groups of organisms. The rapid direct technique (AODC) was found to be very successful. A correlation coefficient of 0.87 was obtained for this method and the standard plate count. Each test could be carried out in about 10-15 min and could be used to predict the standard plate count.

  15. A New Total Digital Smile Planning Technique (3D-DSP to Fabricate CAD-CAM Mockups for Esthetic Crowns and Veneers

    Directory of Open Access Journals (Sweden)

    F. Cattoni

    2016-01-01

    Full Text Available Purpose. Recently, the request of patients is changed in terms of not only esthetic but also previsualization therapy planning. The aim of this study is to evaluate a new 3D-CAD-CAM digital planning technique that uses a total digital smile process. Materials and Methods. Study participants included 28 adult dental patients, aged 19 to 53 years, with no oral, periodontal, or systemic diseases. For each patient, 3 intra- and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Digital Smile System software and the scanner stereolithographic (STL file was matched into the 3D-Digital Smile System to obtain a virtual previsualization of teeth and smile design. Then, the mockups were milled using a CAM system. Minimally invasive preparation was carried out on the enamel surface with the mockups as position guides. Results. The patients found both the digital smile design previsualization (64.3% and the milling mockup test (85.7% very effective. Conclusions. The new total 3D digital planning technique is a predictably and minimally invasive technique, allows easy diagnosis, and improves the communication with the patient and helps to reduce the working time and the errors usually associated with the classical prosthodontic manual step.

  16. A New Total Digital Smile Planning Technique (3D-DSP) to Fabricate CAD-CAM Mockups for Esthetic Crowns and Veneers.

    Science.gov (United States)

    Cattoni, F; Mastrangelo, F; Gherlone, E F; Gastaldi, G

    2016-01-01

    Purpose. Recently, the request of patients is changed in terms of not only esthetic but also previsualization therapy planning. The aim of this study is to evaluate a new 3D-CAD-CAM digital planning technique that uses a total digital smile process. Materials and Methods. Study participants included 28 adult dental patients, aged 19 to 53 years, with no oral, periodontal, or systemic diseases. For each patient, 3 intra- and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Digital Smile System software and the scanner stereolithographic (STL) file was matched into the 3D-Digital Smile System to obtain a virtual previsualization of teeth and smile design. Then, the mockups were milled using a CAM system. Minimally invasive preparation was carried out on the enamel surface with the mockups as position guides. Results. The patients found both the digital smile design previsualization (64.3%) and the milling mockup test (85.7%) very effective. Conclusions. The new total 3D digital planning technique is a predictably and minimally invasive technique, allows easy diagnosis, and improves the communication with the patient and helps to reduce the working time and the errors usually associated with the classical prosthodontic manual step.

  17. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  18. Anaesthetic management of beta thalassemia major with hypersplenism for splenectomy in pediatric age group: Report of four cases

    OpenAIRE

    Jyothi, B.; K S Sushma; Syeda, Seham; Raza, Syed Owais

    2015-01-01

    Beta thalassemia is the most common cause of hemolytic anemia in India. Hereby we are reporting four cases of beta thalassemia major aged between 5 and 10 years posted for splenectomy over a period of 2 months. These patients were on repeated blood transfusions since the day of diagnosis, and two patients had a history of cardiac failure. In addition to emphasizing the anesthetic challenges, the purpose of reporting such cases is to raise the awareness of the disease and prevention of the sam...

  19. Anaesthetic management of beta thalassemia major with hypersplenism for splenectomy in pediatric age group: Report of four cases.

    Science.gov (United States)

    Jyothi, B; Sushma, K S; Syeda, Seham; Raza, Syed Owais

    2015-01-01

    Beta thalassemia is the most common cause of hemolytic anemia in India. Hereby we are reporting four cases of beta thalassemia major aged between 5 and 10 years posted for splenectomy over a period of 2 months. These patients were on repeated blood transfusions since the day of diagnosis, and two patients had a history of cardiac failure. In addition to emphasizing the anesthetic challenges, the purpose of reporting such cases is to raise the awareness of the disease and prevention of the same by aggressive screening and prenatal diagnosis.

  20. Field in field technique in two-dimensional planning for whole brain irradiation; Tecnica field in field em planejamentos bidimensionais para irradiacao de cerebro total

    Energy Technology Data Exchange (ETDEWEB)

    Castro, A.L.S.; Campos, T.P.R., E-mail: radioterapia.andre@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (Brazil). Departamento de Engenharia Nuclear

    2016-11-01

    Radiotherapy is the most used clinical method used for brain metastases treatment, the most frequent secondary tumors provided by breast, lung and melanomas as primary origin. The protocols often use high daily doses and, depending on the irradiation technique there is high probability of complications in health tissues. In order to minimize adverse effects, it is important the dosimetric analysis of three-dimensional radiotherapy planning through tomographic images or, concerning to the 2D simulations, by the application of techniques that optimize dose distribution by increasing the homogeneity. The study aimed to compare the 2D and 3D conformal planning for total brain irradiation in a individual equivalent situation and evaluate the progress of these planning applying the field in field technique. The methodology consisted of simulating a two-dimensional planning, reproduce it on a set of tomographic images and compare it with the conformal plan for two fields and four fields (field in field). The results showed no significant difference between 2D and 3D planning for whole brain irradiation, and the field in field technique significantly improved the dose distribution in brain volume compared with two fields for the proposal situation. As conclusion, the two-dimensional plane for the four fields described was viable for whole brain irradiation in the treatment of brain metastases at the proposal situation. (author)

  1. Attenuated total reflectance FT-IR imaging and quantitative energy dispersive-electron probe X-ray microanalysis techniques for single particle analysis of atmospheric aerosol particles.

    Science.gov (United States)

    Ryu, JiYeon; Ro, Chul-Un

    2009-08-15

    This work demonstrates the practical applicability of the combined use of attenuated total reflectance (ATR) FT-IR imaging and low-Z particle electron probe X-ray microanalysis (EPMA) techniques for the characterization of individual aerosol particles. These two single particle analytical techniques provide complementary information on the physicochemical characteristics of the same individual particles, that is, the low-Z particle EPMA for the information on the morphology and elemental concentration and the ATR-FT-IR imaging on the functional group, molecular species, and crystal structure. It was confirmed that the ATR-FT-IR imaging technique can provide sufficient FT-IR absorption signals to perform molecular speciation of individual particles of micrometer size when applied to artificially generated aerosol particles such as ascorbic acid and NaNO(3) aerosols. An exemplar indoor atmospheric aerosol sample was investigated to demonstrate the practical feasibility of the combined application of ATR-FT-IR imaging and low-Z particle EPMA techniques for the characterization of individual airborne particles.

  2. Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

    Science.gov (United States)

    Rosich-Medina, Anais; Bouloumpasis, Serafeim; Di Candia, Michele; Malata, Charles M.

    2015-01-01

    Introduction The total ‘rib’-preservation method of dissecting out the internal mammary vessels (IMV) during microvascular breast reconstruction aims to reduce free flap morbidity at the recipient site. We review our five-year experience with this technique. Patients & methods An analysis of a prospectively collected free flap data cohort was undertaken to determine the indications, operative details and reconstructive outcomes in all breast reconstruction patients undergoing IMV exposure using the total ‘rib’-preservation method by a single surgeon. Results 178 consecutive breast free flaps (156 unilateral, 11 bilateral) were performed from 1st June 2008 to 31st May 2013 in 167 patients with a median age of 50 years (range 28–71). There were 154 DIEP flaps, 14 SIEA flaps, 7 muscle-sparing free TRAMs, 2 IGAP flaps and one free latissimus dorsi flap. 75% of the reconstructions (133/178) were immediate, 25% (45/178) were delayed. The mean inter-costal space distance was 20.9 mm (range 9–29). The mean time taken to expose and prepare the recipient IMV's was 54 min (range 17–131). The mean flap ischaemia time was 95 min (range 38–190). Free flap survival was 100%, although 2.2% (4 flaps) required a return to theatre for exploration and flap salvage. No patients complained of localised chest pain or tenderness at the recipient site and no chest wall contour deformity has been observed. Discussion & conclusion The total ‘rib’-preservation technique of IMV exposure is a safe, reliable and versatile method for microvascular breast reconstruction and should be considered as a valid alternative to the ‘rib’-sacrificing techniques. PMID:26468373

  3. SU-E-T-515: Field-In-Field Compensation Technique Using Multi-Leaf Collimator to Deliver Total Body Irradiation (TBI) Dose

    Energy Technology Data Exchange (ETDEWEB)

    Lakeman, T [The State University of New York at Buffalo (United States); Wang, IZ [The State University of New York at Buffalo (United States); Roswell Park Cancer Institute, Buffalo, NY (United States)

    2014-06-01

    Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient's immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has been used conventionally to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern field-in-field (FIF) technique with the multi-leaf collimator (MLC) to more accurately and efficiently deliver dose to patients in need of TBI. Method: Treatment plans utilizing the FIF technique to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Treatment fields include one pair of opposed open large fields (collimator=45°) with a specific weighting and a succession of smaller fields (collimator=90°) each with their own weighting. The smaller fields are shaped by moving MLC to block the sections of the patient which have already received close to 100% of the prescribed dose. The weighting factors for each of these fields were calculated using the attenuation coefficient of the initial lead compensators and the separation of the patient in different positions in the axial plane. Results: Dose-volume histograms (DVH) were calculated for evaluating the FIF compensation technique. The maximum body doses calculated from the DVH were reduced from the non-compensated 179.3% to 148.2% in the FIF plans, indicating a more uniform dose with the FIF compensation. All calculated monitor units were well within clinically acceptable limits and exceeded those of the original lead compensation plan by less than 50 MU (only ~1.1% increase). Conclusion: MLC FIF technique for TBI will not significantly increase the beam on time while it can substantially reduce the compensator setup time and the potential risk of errors in manually placing lead compensators.

  4. Safety and Effectiveness of Everolimus-Eluting Stents in Chronic Total Coronary Occlusion Revascularization: Results From the EXPERT CTO Multicenter Trial (Evaluation of the XIENCE Coronary Stent, Performance, and Technique in Chronic Total Occlusions).

    Science.gov (United States)

    Kandzari, David E; Kini, Annapoorna S; Karmpaliotis, Dimitri; Moses, Jeffrey W; Tummala, Pradyumna E; Grantham, J Aaron; Orr, Charles; Lombardi, William; Nicholson, William J; Lembo, Nicholas J; Popma, Jeffrey J; Wang, Jin; Larracas, Cristina; Rutledge, David R

    2015-05-01

    This study sought to evaluate procedural and clinical outcomes among patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using contemporary methods and everolimus-eluting stents (EES). Limited studies have detailed the procedural and late-term safety and efficacy of CTO revascularization among multiple centers applying modern techniques and with newer-generation drug-eluting stents. Among 20 centers, 250 consecutive patients were enrolled for attempted CTO PCI. Procedural and in-hospital clinical outcomes were examined in addition to the 1-year primary endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events [MACE]). Demographic, lesion, and procedural characteristics included prior bypass surgery: 9.9%; diabetes: 40.1%; lesion length: 36.1 ± 18.5 mm; and stent length: 51.7 ± 27.2 mm. Procedural success, defined as guidewire recanalization with no in-hospital MACE, was 96.4%. Success with antegrade-only methods was 97.9% and 86.2% by retrograde/combined methods, respectively. Compared with a pre-specified performance goal derived from 6 prior CTO drug-eluting stent trials (1-year MACE: 24.4%), treatment with EES was associated with significantly lower composite adverse events for both intent-to-treat (18.5%, 1-sided upper confidence interval: 23.4%, p = 0.025) and per-protocol populations (8.2%, 1-sided upper confidence interval: 12.3%, p CTO PCI in a patient population with high lesion complexity. (EXPERT CTO: Evaluation of the XIENCE PRIME LL and XIENCE Nano Everolimus Eluting Coronary Stent Coronary Stents, Performance, and Technique in Chronic Total Occlusions; NCT01435031). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. 肘关节置换术操作技术的进展%The progress of the surgical technique of total elbow replacement

    Institute of Scientific and Technical Information of China (English)

    查晔军; 蒋协远

    2016-01-01

    Total elbow replacement is designed for the elbow joint articular surface damage and degenerative joint changes, but in recent years, it is widely used in the treatment of the distal humeral articular comminuted fracture in elderly patients. The purpose is to provide a stable, painless elbow joint with good functions. Total elbow replacement is a dififcult operation with its special surgical indications, requiring rich surgical experience. Even if the surgical technique is mature, there are still a lot of controversies in the surgical indication, prosthesis selection, surgical approach, condylar management and the disposal of the ulnar nerve. Based on the literature reviewed and the author’s experience, this paper analyzes some disputes. Although many scholars have conducted many prospective controlled studies, there are still some authors with different views, requiring prospective randomized controlled studies with a greater number of cases to clarify.

  6. Reconstruction of esophagojejunostomy by robot-sewing technique in totally robotic total gastrectomy%应用手术机器人系统行食管空肠吻合可行性观察

    Institute of Scientific and Technical Information of China (English)

    江志伟; 赵坤; 王刚; 刘凤涛; 周俊杰; 张小磊; 李宁; 黎介寿

    2012-01-01

    Objective To analyze the feasibility of reconstruction of esophagojejunostomy by robot-sewing technique in totally robotic total gastrectomy for gastric cancer. Methods The clinical data of 20 cases of gastric cancer performed da Vinci robotic total gastrectomy including robot-sewn esophagojejunal Roux-en-Y anastomosis between May 2011 and November 2011 at Nanjing General Hospital of Nanjing Military Command were analyzed retrospectively. Results All robotic surgeries were accomplished in 20 cases successfully. Among them, 13 cases were men and 7 were women; the mean age (±SD) was (57.8±6.5) years. The mean (±SD) operation time was (245.5±53.0) mins with a mean (±SD) blood loss of (75.5 ± 50.3) mL. There was neither intraoperative complication nor postoperative complication such as stoma leakage, bleeding, abdominal cavity infection and so on in all cases. Only one case was readmitted for complication of afferent loop intestinal obstruction and received reoperation. The mean (±SD) postoperative hospital stay was (6.4±2.5) days. Conclusion A robot-sewn anastomosis for esophagojejunostomy reconstruction in robotic total gastrectomy for gastric cancer is simple, safe and feasible. It may be a standard surgical technique for totally robotic total gastrectomy for gastric cancer.%目的 分析应用手术机器人系统进行胃癌全胃切除与食管空肠Roux-en-Y吻合术的安全性及有效性.方法 回顾性分析2011年5~11月南京军区南京总医院对20例胃癌病人应用达芬奇手术机器人系统进行胃癌全胃根治切除与食管空肠Roux-en-Y吻合术的临床资料.结果 20例胃癌病人施行了全机器人全胃切除及食管空肠吻合术,其中男13例,女7例;年龄平均(57.8±6.5)岁.手术时间平均(245.5±53.0)min,出血量平均(75.5±50.3) mL.无术中并发症发生,术后无吻合口漏、出血、腹腔感染等并发症,仅1例病人术后发生输入袢肠梗阻,经再手术治疗后

  7. Evidence-based mini-review: Is indium-labeled autologous platelet scanning predictive of response to splenectomy in patients with chronic immune thrombocytopenia?

    Science.gov (United States)

    Cuker, Adam; Cines, Douglas B

    2010-01-01

    Clinical scenario: An otherwise healthy 25-year-old woman returns to your office for management of chronic primary immune thrombocytopenia. She was diagnosed 6 months earlier and continues to require prednisone 15 mg daily and periodic infusions of intravenous immunoglobulin to maintain a hemostatic platelet count. You discuss second-line treatment options, including splenectomy. The patient asks if there are any means by which to predict likelihood of response to splenectomy. You have heard about the use of indium-labeled autologous platelet scanning for this purpose and wonder what the evidence shows.

  8. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials.

    Directory of Open Access Journals (Sweden)

    G G Koning

    Full Text Available BACKGROUND: Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared with Lichtenstein's technique is needed. METHODOLOGY/PRINCIPAL FINDINGS: The review was performed according to the 'Cochrane Handbook for Systematic Reviews'. Searches were conducted until January 2012. Patients with primary uni- or bilateral inguinal hernias were included. Only trials randomising patients to TEP and Lichtenstein were included. Bias evaluation and trial sequential analysis (TSA were performed. The error matrix was constructed to minimise the risk of systematic and random errors. Thirteen trials randomized 5404 patients. There was no significant effect of the TEP compared with the Lichtenstein on the number of patients with chronic pain in a random-effects model risk ratio (RR 0.80; 95% confidence interval (CI 0.61 to 1.04; p = 0.09. There was also no significant effect on number of patients with recurrences in a random-effects model (RR 1.41; 95% CI 0.72 to 2.78; p = 0.32 and the TEP technique may or may not be associated with less severe adverse events (random-effects model RR 0.91; 95% CI 0.73 to 1.12; p = 0.37. TSA showed that the required information size was far from being reached for patient important outcomes. CONCLUSIONS/SIGNIFICANCE: TEP versus Lichtenstein for inguinal hernia repair has been evaluated by 13 trials with high risk of bias. The review with meta-analyses, TSA and error matrix approach shows no conclusive evidence of a difference between TEP and Lichtenstein on the primary outcomes chronic pain, recurrences, and severe adverse events.

  9. CART and Reverse CART Technique in the Retrograde Percutaneous Coronary Intervention of Chronic Total Occlusion%CART和反向CART技术在逆向PCI中的应用

    Institute of Scientific and Technical Information of China (English)

    孙党辉; 李悦

    2011-01-01

    控制性正向-逆向内膜下寻径(CART)和反向CART技术是近年来慢性完全闭塞病变介入治疗重要的技术进展,大大提高了慢性完全闭塞病变经皮冠状动脉介入治疗(PCI)成功率.CART和反向CART技术的开展要求术者具有较丰富的正向PCI操作经验,根据自身技术能力、设备条件和患者病变特点合理选择恰当的PCI治疗技术.在血管内超声指导下反向CART技术的应用进一步提高了手术的成功率和安全性.%CART and reverse CART technique are considered as the important current techniques in percutaneous coronary interven-tion for chronic total occlusion, and have great improved success rates of the recanalization of the chronic total occlusion. IVUS-guided re-verse CART could further elevate the success rate and safety of CTO recanalization. Because of the learning-carve, the operator should per-form antegrade recanalization well first, and choose best way according to the skill of the operator,and the facilities and the lesion condition.

  10. Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers.

    Science.gov (United States)

    Straatman, Jennifer; van der Wielen, Nicole; Nieuwenhuijzen, Grard A P; Rosman, Camiel; Roig, Josep; Scheepers, Joris J G; Cuesta, Miguel A; Luyer, Misha D P; van Berge Henegouwen, Mark I; van Workum, Frans; Gisbertz, Suzanne S; van der Peet, Donald L

    2017-01-01

    Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and gastroesophageal junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL). A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and gastroesophageal junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications. In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response. Minimally invasive Ivor Lewis esophagectomy for distal esophageal and gastroesophageal junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.

  11. Medial Protrusio Technique in Cementless Total Hip Arthroplasty for Developmental Dysplasia of the Hip: A Prospective 6- to 9-Year Follow-Up of 43 Consecutive Patients.

    Science.gov (United States)

    Zha, Guo-Chun; Sun, Jun-Ying; Guo, Kai-Jin; Zhao, Feng-Chao; Pang, Yong; Zheng, Xin

    2016-08-01

    The medial protrusio technique may be used during total hip arthroplasty (THA) on patients with developmental dysplasia. However, studies have yet to determine whether a cementless cup can be sufficiently stable to withstand loading forces. This study aimed to assess the clinical and radiographic outcomes of this technique. Furthermore, we sought to determine the relationship between the rate of medial protrusion and the incidence of cup loosening. Thirty-nine patients (43 hips) underwent cementless THA between April 2006 and March 2009 by using the medial protrusio technique. These patients participated in a 6- to 9-year follow-up. Their clinical and radiographic data were gathered prospectively. The average Harris Hip Score improved from 43.1 ± 15.4 points preoperatively to 91.9 ± 12.8 points at the final follow-up (P hip center and the distance of hip center medialization were 2.4 ± 0.6 and 2.5 ± 0.9 cm, respectively. The rate of medial protrusion and the rate of cup coverage were 42.1 ± 12.4% and 96.8 ± 5.1%, respectively. The rate of medial protrusion ranged from 18.3% to 58.3% in 38 hips (group A) and from 61.3% to 68.9% in 5 hips (group B). None of the cups in group A loosened or failed, 2 failures occurred in group B (0% vs 40.0%; P = .011). Developmental dysplasia was treated through THA using the medial protrusio technique, which easily achieves a sufficient superolateral host bony coverage of the cup and promotes socket reconstruction at the true acetabulum. The rate of medial protrusion of <60% may be necessary to obtain excellent clinical and radiographic midterm results. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Retrievals of aerosol optical depth and total column ozone from Ultraviolet Multifilter Rotating Shadowband Radiometer measurements based on an optimal estimation technique

    Science.gov (United States)

    Liu, Chaoshun; Chen, Maosi; Shi, Runhe; Gao, Wei

    2014-12-01

    A Bayesian optimal estimation (OE) retrieval technique was used to retreive aerosol optical depth (AOD), aerosol single scattering albedo (SSA), and an asymmetry factor ( g) at seven ultraviolet wavelengths, along with total column ozone (TOC), from the measurements of the UltraViolet Multifilter Rotating Shadowband Radiometer (UV-MFRSR) deployed at the Southern Great Plains (SGP) site during March through November in 2009. The OE technique specifies appropriate error covariance matrices and optimizes a forward model (Tropospheric ultraviolet radiative transfer model, TUV), and thus provides a supplemental method for use across the network of the Department of Agriculture UV-B Monitoring and Research Program (USDA UVMRP) for the retrieval of aerosol properties and TOC with reasonable accuracy in the UV spectral range under various atmospheric conditions. In order to assess the accuracy of the OE technique, we compared the AOD retreivals from this method with those from Beer's Law and the AErosol RObotic Network (AERONET) AOD product. We also examine the OE retrieved TOC in comparison with the TOC from the U.S. Department of Agriculture UV-B Monitoring and Research Program (USDA UVMRP) and the Ozone Monitoring Instrument (OMI) satellite data. The scatterplots of the estimated AOD from the OE method agree well with those derived from Beer's law and the collocated AERONETAOD product, showing high values of correlation coefficients, generally 0.98 and 0.99, and large slopes, ranging from 0.95 to 1.0, as well as small offsets, less than 0.02 especially at 368 nm. The comparison of TOC retrievals also indicates the promising accuracy of the OE method in that the standard deviations of the difference between the OE derived TOC and other TOC products are about 5 to 6 Dobson Units (DU). Validation of the OE retrievals on these selected dates suggested that the OE technique has its merits and can serve as a supplemental tool in further analyzing UVMRP data.

  13. Splenic vessels thread ligature in laparoscopic splenectomy%内结扎法腹腔镜脾切除术的应用解剖及技术要点

    Institute of Scientific and Technical Information of China (English)

    李索林; 徐伟立; 张晓博; 李萌; 于增文; 时保军

    2009-01-01

    Objective To study the anatomy of splenic hilum blood vessels in order to thread ligature(endoligature)instead of using stapler during the process of laparoscopic splenectomy and to evaluate the prelimnary clinical results.Methods 41 children patients underwent laparoscopic splenectomy with this technique(endoligature)for various hematologic and autoimmune disorders,including 25 cases of hereditary spherocytosis,13 idiopathic thrombocytopenia purpura,and 3 hypersplenic granulocytopenia.The anatomy of splenic pedicle,the adjacent relation between splenic vessel and pancreas were detected by color Doppler ultrasonography preoperatively.The above-mentioned parameters were compared with that found intraoperatively.Results The relationships of splenic vessel and pancreas was of type Ⅰ in 24 cases and type Ⅱ in 17.In 31 cases,the major splenic blood vessels were ramified into branches 2 cm away from the hilum and in 10 it was within 2 cm as detected by preoperative ultrasonography.These characters were largerly identified by laparoscopic laparotomy,and in all the 41 cases laparoscopic splenectomy was successfully accomplished using this endoligature instead of vasculature stapler.There was no serious complication.The mean operating time was(114 ±31)min,the estimated blood loss was(51 ±23)ml.Conclusions Ultrasonography could identify the anatomic type of splenic vessel,and its relation with the pancreas.Endoligature in the management of splenic pedicles during laparoscopic splenectomy is safe and reliable.%目的 探讨内结扎法腹腔镜脾切除术的应用解剖及其手术要点.方法 对41例相关血液病儿采用内结扎法进行腹腔镜脾切除术,其中遗传性球形红细胞增多症25例,特发性血小板减少性紫癜13例,脾性粒细胞减少症3例.术前用彩色多普勒血流显像探测脾蒂血管解剖类型、走行及其与胰腺的关系,并与术中所见做对比.结果 彩色多普勒血流显像显示脾蒂血管走

  14. Methods and Techniques Used to Convey Total System Performance Assessment Analyses and Results for Site Recommendation at Yucca Mountain, Nevada, USA

    Energy Technology Data Exchange (ETDEWEB)

    P. D. Mattie; J. A. McNeish; D. S. Sevougian; R. W. Andrews

    2001-04-13

    Total System Performance Assessment (TSPA) is used as a key decision-making tool for the potential geologic repository for high level radioactive waste at Yucca Mountain, Nevada, USA. Because of the complexity and uncertainty involved in a post-closure performance assessment, an important goal is to produce a transparent document describing the assumptions, the intermediate steps, the results, and the conclusions of the analyses. An important objective for a TSPA analysis is to illustrate confidence in performance projections of the potential repository given a complex system of interconnected process models, data, and abstractions. The methods and techniques used for the recent TSPA analyses demonstrate an effective process to portray complex models and results with transparency and credibility.

  15. Methods and Techniques Used to Convey Total System Performance Assessment Analyses and Results for Site Recommendation at Yucca Mountain, Nevada, USA

    Energy Technology Data Exchange (ETDEWEB)

    Mattie, Patrick D.; McNeish, Jerry A.; Sevougian, S. David [Duke Engineering and Services, Las Vegas, NV (United States); Andrews, Robert W. [Bechtel SAIC Company, Las Vegas, NV (United States)

    2001-07-01

    Total System Performance Assessment (TSPA) is used as a key decision-making tool for the potential geologic repository of high level radioactive waste at Yucca Mountain, Nevada USA. Because of the complexity and uncertainty involved in a post-closure performance assessment, an important goal is to produce a transparent document describing the assumptions, the intermediate steps, the results, and the conclusions of the analyses. An important objective for a TSPA analysis is to illustrate confidence in performance projections of the potential repository given a complex system of interconnected process models, data, and abstractions. The methods and techniques used for the recent TSPA analyses demonstrate an effective process to portray complex models and results with transparency and credibility.

  16. Interpretation of Source Parameters from Total Gradient of Gravity and Magnetic Anomalies Caused by Thin Dyke using Nonlinear Global Optimization Technique

    Science.gov (United States)

    Biswas, A.

    2016-12-01

    A proficient way to deal with appraisal model parameters from total gradient of gravity and magnetic data in light of Very Fast Simulated Annealing (VFSA) has been exhibited. This is the first run through of applying VFSA in deciphering total gradient of potential field information with another detailing estimation brought on because of detached causative sources installed in the subsurface. The model parameters translated here are the amplitude coefficient (k), accurate origin of causative source (x0) depth (z0) and the shape factor (q). The outcome of VFSA improvement demonstrates that it can exceptionally decide all the model parameters when shape variable is fixed. The model parameters assessed by the present strategy, for the most part the shape and depth of the covered structures was observed to be in astounding concurrence with the genuine parameters. The technique has likewise the capability of dodging very uproarious information focuses and enhances the understanding results. Investigation of Histogram and cross-plot examination likewise proposes the translation inside the assessed ambiguity. Inversion of noise-free and noisy synthetic data information for single structures and field information shows the viability of the methodology. The procedure has been carefully and adequately connected to genuine field cases (Leona Anomaly, Senegal for gravity and Pima copper deposit, USA for magnetic) with the nearness of mineral bodies. The present technique can be to a great degree material for mineral investigation or ore bodies of dyke-like structure rooted in the shallow and more deep subsurface. The calculation time for the entire procedure is short.

  17. Laparoscopic Splenectomy in a Child with Moyamoya Syndrome, Hereditary Spherocytosis, and Interstitial Lung Disease: A Mere Coincidence or Partnership Based on Genetic Similarities

    Directory of Open Access Journals (Sweden)

    Kasra Karvandian

    2011-01-01

    Full Text Available A case of moyamoya syndrome and spherocytosis with concurrent interstitial lung disease who underwent laparoscopic splenectomy is being reported. A theory regarding their coexistence is being forwarded together with their anesthetic management. According to our search, this is the fourth case of moyamoya syndrome and the first case with an associated interstitial lung disease in a 10-year-old child.

  18. Concurrent gall bladder, liver lobe torsion, and bile peritonitis in a German shepherd dog 2 months after gastric dilatation/volvulus gastropexy and splenectomy

    OpenAIRE

    Tubby, Kurtis G.

    2013-01-01

    Postmortem examination of a 7-year-old German shepherd dog which had gastric dilatation/volvulus and splenectomy 2 months earlier revealed that the right middle and quadrate liver lobes were diffusely congested and torsed. The gall bladder was grossly distended and torsed along its long axis and there was evidence of bile peritonitis.

  19. The role of laparoscopy in the identification and management of missing accessory spleens after primary splenectomy: A case report and literature review

    Science.gov (United States)

    Vaos, George; Mantadakis, Elpis; Gardikis, Stefanos; Pitiakoudis, Michael

    2016-01-01

    We present a 7-year-old boy with recurrent thrombocytopenia after primary laparoscopic splenectomy for immune thrombocytopenia (ITP). Imaging modalities (ultrasound, computed tomography scan, and scintigraphy) revealed two accessory spleens while the subsequent second laparoscopy revealed 11, which were successfully removed. The relevant medical literature is reviewed, and the value of laparoscopy for chronic ITP is highlighted. PMID:27695216

  20. A simple, sensitive and non-destructive technique for characterizing bovine dental enamel erosion: attenuated total reflection Fourier transform infrared spectroscopy.

    Science.gov (United States)

    Kim, In-Hye; Son, Jun Sik; Min, Bong Ki; Kim, Young Kyoung; Kim, Kyo-Han; Kwon, Tae-Yub

    2016-03-30

    Although many techniques are available to assess enamel erosion in vitro, a simple, non-destructive method with sufficient sensitivity for quantifying dental erosion is required. This study characterized the bovine dental enamel erosion induced by various acidic beverages in vitro using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Deionized water (control) and 10 acidic beverages were selected to study erosion, and the pH and neutralizable acidity were measured. Bovine anterior teeth (110) were polished with up to 1 200-grit silicon carbide paper to produce flat enamel surfaces, which were then immersed in 20 mL of the beverages for 30 min at 37 °C. The degree of erosion was evaluated using ATR-FTIR spectroscopy and Vickers' microhardness measurements. The spectra obtained were interpreted in two ways that focused on the ν1, ν3 phosphate contour: the ratio of the height amplitude of ν3 PO4 to that of ν1 PO4 (Method 1) and the shift of the ν3 PO4 peak to a higher wavenumber (Method 2). The percentage changes in microhardness after the erosion treatments were primarily affected by the pH of the immersion media. Regression analyses revealed highly significant correlations between the surface hardness change and the degree of erosion, as detected by ATR-FTIR spectroscopy (PFTIR spectroscopy is potentially advantageous over the microhardness test as a simple, non-destructive, sensitive technique for the quantification of enamel erosion.

  1. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention – a step by step practical approach and an observational study

    Science.gov (United States)

    Fang, Hsiu-Yu; Lee, Wei-Chieh; Fang, Chih-Yuan; Wu, Chiung-Jen

    2016-01-01

    Abstract Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the “snare technique.” We retrospectively examined the use of “snare technique” among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015. “Snare technique” was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without “snare technique” were similar. The “snare technique” group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter. PMID:27741138

  2. Estudo comparativo entre técnicas de superposições cefalométricas totais Comparative study among total cephalometric superimposition techniques

    Directory of Open Access Journals (Sweden)

    Ricardo Fernando Zampieri

    2005-12-01

    Full Text Available OBJETIVOS: o presente trabalho propôs-se a verificar se existem diferenças entre os resultados propiciados por métodos de superposições totais. METODOLOGIA: utilizou-se uma amostra de 50 telerradiografias de pacientes entre as idades de 8,25 a 16,25 anos, avaliando-se as alterações provenientes do crescimento e desenvolvimento craniofacial e do tratamento ortodôntico, por meio de variáveis cefalométricas representativas da direção e da magnitude dos deslocamentos dos componentes faciais esqueléticos. RESULTADOS E CONCLUSÕES: constatou-se que as técnicas de superposições podem produzir informações significantemente diferentes.AIM: this study was aimed at verifying whether there are differences among the results obtained by total superimposition techniques. METHODS: a sample of 50 cephalometric X-rays from patients aged 8.25-16.25 years was used to assess the alterations that derive from craniofacial growth and development, as well as from orthodontic treatment. Cephalometric variables representative of direction and magnitude of displacements of facial-skeletal components were used to assess those alterations. RESULTS AND CONCLUSION: we concluded that superimposition techniques can produce significantly different results.

  3. SU-C-213-04: Application of Depth Sensing and 3D-Printing Technique for Total Body Irradiation (TBI) Patient Measurement and Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Lee, M; Suh, T [Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Han, B; Xing, L [Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA (United States); Jenkins, C [Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA (United States); Department of Mechanical Engineering, Stanford University, Palo Alto, CA (United States)

    2015-06-15

    Purpose: To develop and validate an innovative method of using depth sensing cameras and 3D printing techniques for Total Body Irradiation (TBI) treatment planning and compensator fabrication. Methods: A tablet with motion tracking cameras and integrated depth sensing was used to scan a RANDOTM phantom arranged in a TBI treatment booth to detect and store the 3D surface in a point cloud (PC) format. The accuracy of the detected surface was evaluated by comparison to extracted measurements from CT scan images. The thickness, source to surface distance and off-axis distance of the phantom at different body section was measured for TBI treatment planning. A 2D map containing a detailed compensator design was calculated to achieve uniform dose distribution throughout the phantom. The compensator was fabricated using a 3D printer, silicone molding and tungsten powder. In vivo dosimetry measurements were performed using optically stimulated luminescent detectors (OSLDs). Results: The whole scan of the anthropomorphic phantom took approximately 30 seconds. The mean error for thickness measurements at each section of phantom compare to CT was 0.44 ± 0.268 cm. These errors resulted in approximately 2% dose error calculation and 0.4 mm tungsten thickness deviation for the compensator design. The accuracy of 3D compensator printing was within 0.2 mm. In vivo measurements for an end-to-end test showed the overall dose difference was within 3%. Conclusion: Motion cameras and depth sensing techniques proved to be an accurate and efficient tool for TBI patient measurement and treatment planning. 3D printing technique improved the efficiency and accuracy of the compensator production and ensured a more accurate treatment delivery.

  4. Comparison of minimally invasive surgery and mini-incision technique for total hip arthroplasty: a sub-group meta-analysis

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xiang; LIN Tiao; CAI Xun-zi; YAN Shi-gui

    2011-01-01

    Background It is well accepted that the minimally invasive surgery (MIS) for total hip arthroplasty (THA) should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery.The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true.Methods A computerized literature search was applied to find any data concerning MIS or mini-incision THAs.A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis.The data were extracted,and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out.The P(sub) value for difference between MIS sub-group and mini-incision sub-group was also calculated.Results Eleven studies that fulfilling the inclusion criteria were included,with 472 cases in the study group (MIS or mini-incision) and 492 cases in the conventional group.The overall analysis showed the study group would achieve less surgical duration (P=0.037),intraoperative blood (P <0.001) and incision length (P <0.001) than conventional group.The difference between sub-groups showed,the MIS would achieve shorter incision length (P(sub) <0.05) and bigger cup abduction angle (P(sub) <0.05),and cause more blood loss (P (sub) <0.05) than mini-incision technique.Other indexeswere comparable between the two sub-groups.Conclusions Though further high quality studies are still needed,the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique.The exact definition of MIS still needs to be improved.

  5. Attenuated Total Reflectance Fourier transform infrared spectroscopy for determination of Long Chain Free Fatty Acid concentration in oily wastewater using the double wavenumber extrapolation technique.

    Science.gov (United States)

    Hao, Zisu; Malyala, Divya; Dean, Lisa; Ducoste, Joel

    2017-04-01

    Long Chain Free Fatty Acids (LCFFAs) from the hydrolysis of fat, oil and grease (FOG) are major components in the formation of insoluble saponified solids known as FOG deposits that accumulate in sewer pipes and lead to sanitary sewer overflows (SSOs). A Double Wavenumber Extrapolative Technique (DWET) was developed to simultaneously measure LCFFAs and FOG concentrations in oily wastewater suspensions. This method is based on the analysis of the Attenuated Total Reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) spectrum, in which the absorbance of carboxyl bond (1710cm(-1)) and triglyceride bond (1745cm(-1)) were selected as the characteristic wavenumbers for total LCFFAs and FOG, respectively. A series of experiments using pure organic samples (Oleic acid/Palmitic acid in Canola oil) were performed that showed a linear relationship between the absorption at these two wavenumbers and the total LCFFA. In addition, the DWET method was validated using GC analyses, which displayed a high degree of agreement between the two methods for simulated oily wastewater suspensions (1-35% Oleic acid in Canola oil/Peanut oil). The average determination error of the DWET approach was ~5% when the LCFFA fraction was above 10wt%, indicating that the DWET could be applied as an experimental method for the determination of both LCFFAs and FOG concentrations in oily wastewater suspensions. Potential applications of this DWET approach includes: (1) monitoring the LCFFAs and FOG concentrations in grease interceptor (GI) effluents for regulatory compliance; (2) evaluating alternative LCFFAs/FOG removal technologies; and (3) quantifying potential FOG deposit high accumulation zones in the sewer collection system.

  6. Influence of splenectomy on the biodistribution of technetium-99m dimercaptosuccinic acid (99mTc-DMSA in rats

    Directory of Open Access Journals (Sweden)

    Maria Kadja Meneses Torres Açucena

    2008-12-01

    Full Text Available This study aimed to evaluate if the splenectomy alters the biodistribution of 99mTc-DMSA and renal function in Wistar rats. The animals were separated in the groups: splenectomy (n = 6 and control (n = 6. After splenectomy (15 days, the administration of 0.1ml of 99mTc-DMSA IV (0.48 MBq was carried out. Thirty minutes later, kidney, heart, lung, thyroid, stomach, bladder and femur and samples of blood were isolated. The organs were weighed, counted and the percentage of radioactivity /g (%ATI/g determined. Serum urea and creatinine, hematocrit, leukocytes and platelets were measured. Statistics by t test (pEstudo com objetivo de avaliar se a esplenectomia altera a biodistribuição do 99mTc-DMSA e alguns parâmetros bioquímicos e hematológicos em ratos Wistar. Os animais forma divididos em 2 grupos: esplenectomizados (n=6 e controle(n=6. Após 15 dias, administração de 0,1 ml de 99mTc-DMSA via plexo orbital (0,48 MBq foi realizada. Rim, coração, pulmão, tireóide, estômago, bexiga e fêmur e amostras de sangue foram separadas. Após pesagem e contagem da radioatividade foi determinado o percentual de radioatividade/g (% ATI/g. Dosadas uréia e creatinina sérica, hematócrito, plaquetas e leucócitos. Estatística pelo teste t, significância 0,05 foi realizada. Foi observada redução significante no %ATI/g no rim e sangue (p<0,05 dos animais esplenectomizados, aumento significante (p<0.05 da uréia (88,8±18,6 mg/dL e creatinina (0,56±0,08, comparado aos controles (51,5±1,6; 0,37±0,02mg/dL, respectivamente assim como aumento de leucócitos e plaquetas e redução de hematócrito. Conclui-se que em ratos, a esplenectomia alterou a captação de 99mTc-DMSA pelo rim, e a função renal.

  7. The experimental determination of the temperature dependence of the total emissivity of GaAs using a new temperature measurement technique

    Science.gov (United States)

    Timans, P. J.

    1992-07-01

    Temperature measurement and control are key issues in many technologically important areas of semiconductor processing, including rapid thermal annealing, molecular-beam epitaxy, and plasma processing. As a result, the development of accurate techniques for the characterization of thermal cycles is a problem of great practical interest. In this study, the total emissivity of specimens of GaAs was determined using a technique which combines isothermal electron-beam heating with a temperature measurement method which exploits the temperature dependence of the band gap of GaAs. Emission spectra from the GaAs specimens were recorded for a range of heating power densities. These spectra display a maximum near the semiconductor absorption edge, because the blackbody radiation rises with increasing wavelength but the spectral emissivity decreases rapidly once the photon energy falls below the band gap. The temperature was determined by fitting the Planck radiation function to the high-energy side of the maximum. This allowed a self-consistent determination of the temperature dependence of the position of the absorption edge. The results were used to calibrate a second set of experiments in which a corresponding set of reflection spectra were recorded. The reflection spectra exhibit a large change in reflectivity at the absorption edge, because light starts being reflected from the back surface of the wafer as well as from the front when it becomes transparent. The reflection spectra provide a convenient method of temperature measurement because the intensity of the reflected light can be much larger than that of the emitted light. The large signal levels should permit temperature measurements to be made with good spatial and temporal resolution, even for samples at low temperatures. The temperature measurements can be performed with a precision of about 2 °C, and in this study the accuracy was ±5 °C. As a result of these measurements the total hemispherical emissivity

  8. Efficacy and surgical procedures of preoperative splenic artery embolization for laparoscopic splenectomy of a massive splenomegaly: A case report

    Directory of Open Access Journals (Sweden)

    Toshikatsu Nitta

    2015-01-01

    Full Text Available Here, we describe the case of a 58-year-old woman diagnosed with massive splenomegaly with a malignant lymphoma that had a maximum diameter of 24 cm. Splenectomy was indicated because of thrombocytopenia and abdominal distention. Therefore, a balloon catheter was inserted preoperatively through the splenic artery for embolization and continuous infusion to reduce the spleen volume. It enabled easy handling of the spleen and minimized bleeding. The volume of the spleen was estimated at 1896 g through the skin incision, as measured by volumetric computed tomography; thus, laparoscopy seemed difficult. However, the surgery was successfully performed only with laparoscopic surgery, and the volume of the resected spleen was 1020 g. This preoperative preparation is an effective alternative to laparoscopic removal of a huge splenomegaly.

  9. Splenectomy and proximal lieno-renal shunt in a factor five deficient patient with extra-hepatic portal vein obstruction

    Directory of Open Access Journals (Sweden)

    Sahni Peush

    2006-05-01

    Full Text Available Abstract Background The clinico-surgical implication and successful management of a rare case of factor five (V deficiency with portal hypertension and hypersplenism due to idiopathic extra-hepatic portal venous obstruction is presented. Case presentation A 16-year old boy had gastro-esophageal variceal bleeding, splenomegaly and hypersplenism. During preoperative workup prolonged prothrombin time and activated partial thromboplastin time were detected, which on further evaluation turned out to be due to factor V deficiency. Proximal lieno-renal shunt and splenectomy were successfully performed with transfusion of fresh frozen plasma during and after the surgical procedure. At surgery there was no excessive bleeding. The perioperative course was uneventful and the patient is doing well on follow up. Conclusion Surgical portal decompressive procedures can be safely undertaken in clotting factor deficient patients with portal hypertension if meticulous surgical hemostasis is achieved at operation and the deficient factor is adequately replaced in the perioperative period.

  10. A case of successful management with splenectomy of intractable ascites due to congenital dyserythropoietic anemia type Ⅱ-induced cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Themistoklis Vassiliadis; Ioannis Tsitouridis; Antonios Antoniadis; Panagiotis Semertzidis; Anna Kioumi; Evangelos Premetis; Nikolaos Eugenidis; Vassilia Garipidou; Vassilios Perifanis; Konstantinos Tziomalos; Olga Giouleme; Kalliopi Patsiaoura; Michalis Avramidis; Nikolaos Nikolaidis; Sofia Vakalopoulou

    2006-01-01

    The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis,characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type Ⅱ is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type Ⅱ. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.

  11. Reduction of rainbow trout spleen size by splenectomy does not alter resistance against bacterial cold water disease.

    Science.gov (United States)

    Wiens, Gregory D; Marancik, David P; Zwollo, Patty; Kaattari, Stephen L

    2015-03-01

    In lower vertebrates, the contribution of the spleen to anti-bacterial immunity is poorly understood. We have previously reported a phenotypic and genetic correlation between resistance to Flavobacterium psychrophilum, the causative agent of bacterial cold water disease (BCWD) and spleen somatic index (spleen weight normalized to body weight, SI). Fish families with larger pre-challenge SI values were found to have greater BCWD survival (resistance) following intraperitoneal injection of a lethal dose of F. psychrophilum. Since the mammalian spleen is known to be crucial for capture and destruction of encapsulated bacteria, we tested the hypothesis that reduction of spleen size, by surgical splenectomy, should reduce the survival advantage of the larger-spleen, disease-resistant fish. Experiments were performed using two separate lines of fish that had previously been selected either based on BCWD survival (resistant and susceptible), or selected based on spleen size (high and low SI). Following 65 to 81 days post-surgical recovery, fish were challenged with F. psychrophilum and mortality monitored for a minimum of 21 days. No significant difference in the relative survival was detected between splenectomized or sham-operated groups, while SI of splenectomized fish was reduced to an average of 8-12% of control animals. A positive correlation was observed between the SI, measured at the time of splenectomy, and time-to-death post-challenge. In summary, these experiments argue that larger spleen size alone is not sufficient for greater BCWD resistance, but rather it is an indirect indicator of immunological status.

  12. A simple, sensitive and non-destructive technique for characterizing bovine dental enamel erosion:attenuated total reflection Fourier transform infrared spectroscopy

    Institute of Scientific and Technical Information of China (English)

    In-Hye Kim; Jun Sik Son; Bong Ki Min; Young Kyoung Kim; Kyo-Han Kim; Tae-Yub Kwon

    2016-01-01

    Although many techniques are available to assess enamel erosion in vitro, a simple, non-destructive method with sufficient sensitivity for quantifying dental erosion is required. This study characterized the bovine dental enamel erosion induced by various acidic beverages in vitro using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Deionized water (control) and 10 acidic beverages were selected to study erosion, and the pH and neutralizable acidity were measured. Bovine anterior teeth (110) were polished with up to 1 200-grit silicon carbide paper to produce flat enamel surfaces, which were then immersed in 20 mL of the beverages for 30 min at 37 °C. The degree of erosion was evaluated using ATR-FTIR spectroscopy and Vickers’ microhardness measurements. The spectra obtained were interpreted in two ways that focused on the ν1, ν3 phosphate contour: the ratio of the height amplitude of ν3 PO4 to that of ν1 PO4 (Method 1) and the shift of the ν3 PO4 peak to a higher wavenumber (Method 2). The percentage changes in microhardness after the erosion treatments were primarily affected by the pH of the immersion media. Regression analyses revealed highly significant correlations between the surface hardness change and the degree of erosion, as detected by ATR-FTIR spectroscopy (Po0.001). Method 1 was the most sensitive to these changes, followed by surface hardness change measurements and Method 2. This study suggests that ATRFTIR spectroscopy is potentially advantageous over the microhardness test as a simple, non-destructive, sensitive technique for the quantification of enamel erosion.

  13. Remote sensing estimation of the total phosphorus concentration in a large lake using band combinations and regional multivariate statistical modeling techniques.

    Science.gov (United States)

    Gao, Yongnian; Gao, Junfeng; Yin, Hongbin; Liu, Chuansheng; Xia, Ting; Wang, Jing; Huang, Qi

    2015-03-15

    Remote sensing has been widely used for ater quality monitoring, but most of these monitoring studies have only focused on a few water quality variables, such as chlorophyll-a, turbidity, and total suspended solids, which have typically been considered optically active variables. Remote sensing presents a challenge in estimating the phosphorus concentration in water. The total phosphorus (TP) in lakes has been estimated from remotely sensed observations, primarily using the simple individual band ratio or their natural logarithm and the statistical regression method based on the field TP data and the spectral reflectance. In this study, we investigated the possibility of establishing a spatial modeling scheme to estimate the TP concentration of a large lake from multi-spectral satellite imagery using band combinations and regional multivariate statistical modeling techniques, and we tested the applicability of the spatial modeling scheme. The results showed that HJ-1A CCD multi-spectral satellite imagery can be used to estimate the TP concentration in a lake. The correlation and regression analysis showed a highly significant positive relationship between the TP concentration and certain remotely sensed combination variables. The proposed modeling scheme had a higher accuracy for the TP concentration estimation in the large lake compared with the traditional individual band ratio method and the whole-lake scale regression-modeling scheme. The TP concentration values showed a clear spatial variability and were high in western Lake Chaohu and relatively low in eastern Lake Chaohu. The northernmost portion, the northeastern coastal zone and the southeastern portion of western Lake Chaohu had the highest TP concentrations, and the other regions had the lowest TP concentration values, except for the coastal zone of eastern Lake Chaohu. These results strongly suggested that the proposed modeling scheme, i.e., the band combinations and the regional multivariate

  14. Antioxidant activity, the content of total phenols and flavonoids in the ethanol extracts of Mentha longifolia (L. Hudson dried by the use of different techniques

    Directory of Open Access Journals (Sweden)

    Stanisavljević Dragana M.

    2012-01-01

    Full Text Available In this study, we have examined the yield of extracted substances obtained by means of extraction using 70 % ethanol (v/v, the content of total phenols and flavonoids, as well as the antioxidant activity of the extracts obtained from the samples of the herbs dried by means of different techniques. Wild mint Mentha longifolia (L. Hudson was dried naturally in a laboratory oven at a temperature of 45 °C and in an absorptive low temperature condensation oven at 35°C. The highest yield of extracts was obtained from the naturally dried herbs and the lowest from the herbs dried in the low temperature condensation drying oven. The content of total phenols and flavonoids was determined by spectrophotometric methods with an FC reagent and by the complexation reaction with aluminium-chloride, respectively. The extract of the naturally dried herbs had the highest overall content of phenols (113.8±2.0 mg of gallic acid/g of the dry extract and flavonoids (106.7±0.3 mg of rutin/g of the dry extract. The highest antioxidant activity determined by the FRAP and DPPH assay was determined in the extracts obtained from naturally dried herbs (2.76±0.15 mmol Fe2+/mg of the dry extract and EC50=0.022±0.001 mg/ml, while the lowest was obtained from the extracts of herbs dried in the laboratory oven (1.13±0.11 mmol Fe2+/mg of the dry extract and EC50=0.033±0.001 mg/ml. The HPLC-DAD analysis result show that the greatest content of phenolic compounds show extract obtained from naturally dried plant material. The dominant phenolic component in the all extracts is Kaempferol 3-O-glucoside. The content of all phenolic compound strongly depend on the drying conditions.

  15. Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

    Science.gov (United States)

    Al Furajii, Hazar; Kennedy, Niall; Cahill, Ronan A.

    2017-01-01

    PURPOSE: Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature. METHODS: Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed. All cases commenced laparoscopically with initial medial to lateral mobilisation of any left colon and upper rectum. The lower anorectal dissection started via an intersphincteric or extrasphincteric incision for benign and malignant pathology, respectively, and following suture closure and circumferential mobilisation of the anorectum, a single port (GelPOINT Path, Applied Medical) was positioned allowing the procedure progress endoscopically in all quadrants up to the cephalad dissection level. Standard laparoscopic instrumentation was used. Specimens were removed perineally. RESULTS: Of the 13 patients (median age 55 years, median BMI 28.75 kg/m2, median follow-up 17 months, 6 males), ten needed completion proctectomy for ulcerative colitis following prior total colectomy (three with concomitant parastomal hernia repair) while three required abdominoperineal resection for locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Median operative time was 190 min, median post-operative discharge day was 7. Eleven specimens were of high quality. Four patients developed perineal wound complications (one chronic sinus, two abscesses needing drainage) within median 17-month follow-up. CONCLUSION: Convergence of transabdominal and transanal technology and technique allows accuracy in combination operative performance. Nuanced appreciation of transperineal operative access should allow specified standardisation and

  16. In vivo dosimetry study of semi-conductors EPD-20 in total body irradiation technique; Etude de la dosimetrie in vivo par semi-conducteurs EPD-20 dans les conditions de l'irradiation corporelle totale

    Energy Technology Data Exchange (ETDEWEB)

    Besbes, M.; Kochbati, L.; Ben Abdennabi, A.; Abdessaied, S.; Salem, L.; Frikha, H.; Nasr Ben Ammar, C.; Hentati, D.; Gargouri, W.; Messai, T.; Benna, F.; Maalej, M. [Institut Salah-Azaiz, Service de radiotherapie oncologique, Tunis (Tunisia); Mahjoubi, H. [Institut superieur des technologies medicales de Tunis, Dept. de biophysique, Tunis (Tunisia); Farhat, L. [CHU Habib-Bourguiba, Service de radiotherapie oncologique, Sfax (Tunisia)

    2010-01-15

    Purpose: The objective of this work was the study of in vivo dosimetry performed in a series of 54 patients receiving total body irradiation (T.B.I.) at the Salah-Azaiz Institute of Tunis since 2004. In vivo dosimetry measurements were compared to analytically calculated doses from monitor units delivered. Patients and method: The irradiation was conducted by a linear accelerator (Clinac 1800, Varian, Palo Alto, USA) using nominal X-rays energies of 6 MV and 18 MV, depending on the thickness of the patient at the abdomen. The dose was measured by semi-conductors p-type E.P.D.-20. These diodes were calibrated in advance with an ionization chamber 'P.T.W. Farmer' type of 0.6 cm{sup 3} and were placed on the surface of plexiglas phantom in the same T.B.I. conditions. A study of dosimetric characteristics of semi-conductors E.P.D.-20 was carried out as a function of beam direction and temperature. Afterwards, we conducted a comparative analysis of doses measured using these detectors during irradiation to those calculated retrospectively from monitor units delivered to each patient conditioned by T.B.I.. Results: Experience showed that semi-conductors are sensitive to the angle of beam radiation (0-90 degrees) and the temperature (22-40 Celsius degrees). The maximum variation is respectively 5 and 7%, but in our irradiation conditions these correction factors are less than 1%. The analysis of the results of the in vivo dosimetry had shown that the ratio of the average measured doses and analytically calculated doses at the abdomen, mediastinum, right lung and head are 1.005, 1.007, 1.0135 and 1.008 with a standard deviation 'type A' respectively of 3.04, 2.37, 7.09 et 4.15%. Conclusion: In vivo dosimetry by semi-conductors is in perfect agreement with dosimetry by calculation. However, in vivo dosimetry using semiconductors is the only technique that can reflect the dose actually received instantly by the patient during T.B.I. given the many factors

  17. Behaviour of total surface charge in SiO{sub 2}-Si system under short-pulsed ultraviolet irradiation cycles characterised by surface photo voltage technique

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ban-Hong [Material Characterization Department, Shin Etsu Handotai (M) Sdn. Bhd., Ulu Klang, Selangor (Malaysia); Lee, Wah-Pheng [Faculty of Engineering, Multimedia University, Persiaran Multimedia, Cyberjaya, 63100 Selangor (Malaysia); Yow, Ho-Kwang, E-mail: hkyow@mmu.edu.my [Faculty of Engineering, Multimedia University, Persiaran Multimedia, Cyberjaya, 63100 Selangor (Malaysia); Tou, Teck-Yong [Faculty of Engineering, Multimedia University, Persiaran Multimedia, Cyberjaya, 63100 Selangor (Malaysia)

    2009-04-15

    Effects of time-accumulated ultraviolet (UV) irradiation and surface treatment on thermally oxidized p-type silicon wafers were investigated by using the surface photo voltage (SPV) technique via the direct measurement of the total surface charge, Q{sub SC}. The rise and fall times of Q{sub sc} curves, as a function of accumulated UV irradiation, depended on the thermal oxide thickness. A simple model was proposed to explain the time-varying characteristics of Q{sub sc} based on the UV-induced bond breaking of SiOH and SiH, and photoemission of bulk electrons to wafer surface where O{sub 2}{sup -} charges were formed. While these mechanisms resulted in charge variations and hence in Q{sub sc}, these could be removed by rinsing the silicon wafers in de-ionized water followed by spin-dry or blow-dry by an ionizer fan. Empirical parameters were used in the model simulations and curve-fitting of Q{sub SC}. The simulated results suggested that initial changes in the characteristic behaviour of Q{sub sc} were mainly due to the net changes in the positive and negative charges, but subsequently were dominated by the accumulation of O{sub 2}{sup -} during the UV irradiation.

  18. In situ evaluation of net nitrification rate in Terra rossa soil using a Fourier transform infrared attenuated total reflection 15N tracing technique.

    Science.gov (United States)

    Du, Changwen; Linker, Raphael; Shaviv, Avi; Zhou, Jianmin

    2009-10-01

    Nitrification and mineralization of organic nitrogen (N) are important N transformation processes in soil, and mass spectrometry is a suitable technique for tracing changes of (15)N isotopic species of mineral N and estimating the rates of these processes. However, mass spectrometric methods for tracing N dynamics are costly, time consuming, and require long and laborious preparation procedures. This study investigates mid-infrared attenuated total reflection (ATR) spectroscopy as an alternative method for detecting changes in (14)NO(3)-N and (15)NO(3)-N concentrations. There is a significant shift of the nu(3) absorption band of nitrate according to N species, namely from the 1275 to 1460 cm(-1) region for (14)NO(3)(-) to the 1240-1425 cm(-1) region for (15)NO(3). This shift makes it possible to quantify the N isotopes using multivariate calibration methods. Partial least squares regression (PLSR) models with five factors yielded a determination error of 6.7-9.2 mg N L(-1) for aqueous solutions and 5.9-7.8 mg N kg(-1) (dry soil) for pastes of a Terra rossa soil. These PLSR models were used to monitor the changes of (15)NO(3)-N and (14)NO(3)-N content in the same Terra rossa soil during an incubation experiment in which [(15)NH(4)](2)SO(4) was applied to the soil, allowing the estimation of the contributions of applied N and mineralized N to the net nitrification rate, the potential losses of the applied (15)NH(4)-N, and the net mineralization of soil organic N.

  19. Scintigraphic determination of the spleen volume in case of partial splenectomy for a Minkowski-Chauffard disease. About 15 cases; Determination scintigraphique du volume splenique en cas de splenectomie partielle pour une maladie de Minkowski-Chauffard. A propos de 15 cas

    Energy Technology Data Exchange (ETDEWEB)

    Berehou, F.; Ben Rais, N. [CHU Ibn Sina, Rabat, Service de medecine nucleaire (Morocco); Calzada, M.; Keller, I.; Devaux, J. [Hopital Saint-Antoine, service de medecine nucleaire, 75 - Paris (France)

    2010-07-01

    Splenic scintigraphy with labeled and fragile red blood cells is a simple, reliable, noninvasive and low radiating method to assess at long-term residual splenic volume after partial splenectomy, it is the only treatment for a good quality of life with fewer infections, fewer transfusions and without use of lifelong vaccinations for a chronic illness. (N.C.)

  20. CT diagnosis of subphrenic abscess after splenectomy for trauma; Ruolo della tomografia computerizzata nella valutazione degli ascessi subfrenici dopo splenectomia post-traumatica

    Energy Technology Data Exchange (ETDEWEB)

    Salzano, A. [Ospedale Loreto-Mare, Neaples (IT). Serv. di Radiologia] [and others

    1999-09-01

    The paper studies subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with computerized tomography, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. It has been also investigates the diagnostic accuracy of the CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. [Italian] Scopo del lavoro e' di valutare il ruolo della tomografia computerizzata nelle flogrosi subfreniche secondarie a splenectomia d'urgenza per rottura traumatica della milza, documentando come tale metodica risulti accurata nel diagnosticare e monitorare in modo semplice e rapido l'evoluzione e il controllo degli ascessi subfrenici trattati con drenaggio percutaneo.

  1. [Architectonics of gastric arterial bed in norm, after Nissen fundoplication, and its different combination with splenectomy and left gastric artery ligation].

    Science.gov (United States)

    Alekseyev, V S; Gaivoronskiy, I V; Kotiv, B N; Kuz'min, A A; Nichiporuk, G I

    2014-01-01

    A comparative study of the effect of the combination of Nissen fundoplication, different variants of splenectomy ligation of left gastric artery on stomach wall arterial bed blood fillability was carried out on 40 human corpses in 6 research series. The red lead paint suspension was used for the injection of arterial bed. It was shown that combination of Nissen operation andligation of stomach short arteries during splenectomy and left gastric artery trunk in its intraligamental part resulted in the impairment of the stomach wall blood supply. In the gastric fundus area avascular zones measuring from 2.5 x 3.0 to 5.0 x 10.0 cm and larger, were detected. The stomach wall of the given areas is potentially prone to necrosis. Avascular zones in the stomach wall were not observed when short gastric arteries were preserved.

  2. Prevention and Treatment of Vein Thrombosis after Splenectomy%脾切除术后静脉血栓形成防治的研究

    Institute of Scientific and Technical Information of China (English)

    李永浩

    2014-01-01

    目的:探讨脾脏切除术后血栓形成防治策略。方法:回顾分析2003年以来收治脾切除术患者的临床资料。结果:98例脾脏切除术后患者中,84例有不同程度血小板升高,需要预防性治疗的67例,门静脉血栓形成的1例,脾静脉血栓形成的3例,肠系膜血管血栓形成的1例。结论:脾脏切除术后复查血常规、超声或 CT 及随访对静脉血栓形成的早期发现和及时治疗有着重要意义。%Objective:To explore the preventive strategy of vein thrombosis after splenectomy. Methods:The clinical data of the patients treated with splenectomy since 2003 were analyzed retrospectively. Results:Of 98 patients of splenectomy,84 pa-tients suffered from the increased platelet count of different degrees,67 patients were in need of preventive treatment,1 patient got portal vein thrombosis,3 patients had splenic vein thrombosis and 1 patient had mesenteric vascular thrombosis. Conclusion:Blood routine examination,ultrasound or CT and follow - up are of great significance to early discovery and timely treatment of venous thrombosis after splenectomy.

  3. 联合脾切除治疗进展期胃上部癌的预后分析%Prognostic analysis of splenectomy in patients with advanced proximal gastric cancer

    Institute of Scientific and Technical Information of China (English)

    黄昌明; 王家镔; 卢辉山; 郑朝辉; 李平; 谢建伟; 张祥福

    2009-01-01

    Objective To evaluated the prognostic impact of splenectomy on patients with advanced proximal gastric cancer. Methods The clinical records of 237 patients with advanced proximal gastric cancer who underwent D2 curative resection combined with splenectomy from January 1980 to June 2003 were analyzed retrospectively. Seventy-five patients presented with No.10 lymph nodes metastasis, while 162 patients did not. Potential patient prognostic factors were evaluated by univariate and multivariate analysis.The independent prognostic factors of patients were performed subgroup analysis. Results The 5-year survival rate was 27.7% for patients with No.10 lymph nodes metastasis and 35.4% for patients without,the difference was statistically significant between the two groups (P0.05).For patients undergoing total gastrectomy, survival rates were 31.2% and 36.7%, respectively (P>0.05).Conclusions To improve patient prognosis, total gastrectomy with splenectomy should be recommended for patients with T3 proximal gastric cancer with No.10 lymph node metastasis.%目的 探讨联合脾切除对进展期胃上部癌患者预后的影响.方法 1980年1月至2003年6月对237例进展期胃上部癌患者施行了胃癌D2根治术联合脾切除,其中N0.10淋巴结转移患者75例,No.10淋巴结无转移患者162例.对影响患者的预后因素进行单因素及多因素分析;对影响患者预后的独立因素进行分层分析.结果 237例患者中No.10淋巴结转移和无转移患者术后5年生存率分别为27.7%和35.4%,二者差异有统计学意义(P0.05);全胃切除No.10淋巴结转移和无转移患者术后5年生存率分别为31.2%和36.7%,二者差异无统计学意义(P>0.05).结论 对于T3期胃上部癌No.10淋巴结转移的患者,施行全胃联合脾切除能够提高患者远期疗效.

  4. Splenectomy modifies hyperactive states of the dopaminergic system induced by morphine in C57BL/6J-bg(J)/bg(J) (beige-J) mice.

    Science.gov (United States)

    Funada, Masahiko; Mori, Tomohisa; Maeda, Jun; Tsuda, Yuko; Komiya, Sachiko; Shimizu, Norifumi; Kamei, Junzo; Suzuki, Tsutomu

    2014-11-05

    Genetic factors affect the locomotor activity induced by morphine, which mainly depends on the activation of dopaminergic systems, and morphine has distinct pharmacological activities in C57BL/6J-bg(J)bg(J) (beige-J) mice, which have genetic deficiencies in immunological function. We previously showed that beige-J mice exhibited greater locomotor activity and dopamine turnover, whereas splenectomy reduced this hyperlocomotion and dopamine turnover, which suggests that beige-J mice could be an experimental animal model for investigating hyperactivation of the dopaminergic system, and that the spleen may contribute to the susceptibility to activation of the dopaminergic system. Furthermore, morphine can induce hyperlocomotion mediated by activation of the dopaminergic system. Therefore, we examined the effects of splenectomy on the hyperlocomotion and regulation of the dopaminergic system induced by morphine in beige-J mice. Morphine induced hyperlocomotion, which was accompanied by activation of the dopaminergic system, in beige-J mice. Furthermore, splenectomy enhanced the hyperlocomotion and activation of the mesolimbic dopaminergic system induced by morphine in beige-J mice. Our findings indicate that substances originating from the spleen may regulate both spontaneous activation of the mesolimbic dopaminergic system and the µ-opioidergic system-mediated activation of the mesolimbic dopaminergic system by morphine through different modes of action. These results imply that beige-J mice could be a practical animal model for investigating the interactions between immune-modulation and the µ-opioidergic system and/or dopaminergic system.

  5. Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignment.

    Science.gov (United States)

    Kuwashima, Umito; Mizu-Uchi, Hideki; Okazaki, Ken; Hamai, Satoshi; Akasaki, Yukio; Murakami, Koji; Nakashima, Yasuharu

    2017-09-06

    It is questionable that the accuracies of patient-matched instrumentation (PMI) have been controversial, even though many surgeons follow manufacturers' recommendations. The purpose of this study was to evaluate the accuracy of intraoperative procedures and the postoperative alignment of the femoral side using PMI with 3-dimensional (3D) analysis. Eighteen knees that underwent total knee arthroplasty using MRI-based PMI were assessed. Intraoperative alignment and bone resection errors of the femoral side were evaluated with a CT-based navigation system. A conventional adjustable guide was used to compare cartilage data with that derived by PMI intraoperatively. Postoperative alignment was assessed using a 3D coordinate system with a computer-assisted design software. We also measured the postoperative alignments using conventional alignment guides with the 3D evaluation. Intraoperative coronal alignment with PMI was 90.9° ± 1.6°. Seventeen knees (94.4%) were within 3° of the optimal alignment. Intraoperative rotational alignment of the femoral guide position of PMI was 0.2° ± 1.6°compared with the adjustable guide, with 17 knees (94.4%) differing by 3° or less between the two methods. Maximum differences in coronal and rotation alignment before and after bone cutting were 2.0° and 2.8°, respectively. Postoperative coronal and rotational alignments were 89.4° ± 1.8° and -1.1° ± 1.3°, respectively. In both alignments, 94.4% of cases were within 3° of the optimal value. The PMI group had less outliers than conventional group in rotational alignment (p = 0.018). Our 3D analysis provided evidence that PMI system resulted in reasonably satisfactory alignments both intraoperatively and postoperatively. Surgeons should be aware that certain surgical techniques including bone cutting, and the associated errors may affect postoperative alignment despite accurate PMI positioning. Copyright © 2017 The Japanese Orthopaedic Association. Published by

  6. Técnicas de análisis de tendencias en mediciones espectrales y de nivel total de parámetros de diagnóstico // Trend analysis techniques in spectral and total level mensurations

    Directory of Open Access Journals (Sweden)

    L. Penabad Sanz

    2000-01-01

    Full Text Available En el presente artículo se muestra la implementación del análisis de tendencia, como tecnología predictiva, a través de laestadística matemática y su utilización en mediciones de parámetros de diagnóstico tanto espectral como de nivel total. Elempleo de esta tecnología resulta de gran importancia debido a que permite pronosticar el momento de fallo, según elcomportamiento de los niveles de los parámetros medidos, lo cual facilita la gestión del mantenimiento.Palabras claves: mantenimiento, análisis de tendencia, medición espectral, medición de nivel total, pronósticode fallo, vibraciones.______________________________________________________________________AbstractIn this article is shown the implementation of the trend analysis, as predictive technology, through the mathematical statisticand its use in spectral and total level mensurations of diagnosis parameters. The use of this technology has a great importancebecause it allows to predict the failure moment, according to the behavior of the levels of measured parameters, that whichfacilitates the administration of the maintenance.Key words: maintenance, tendency analysis, spectral mensuration, total level mensuration, failure presage,vibrations, diagnosis.

  7. Total hip replacement using hemi-circumferential interposition acetabuloplasty for acetabular deficiency in post-Perthes deformities: technique and long-term results

    NARCIS (Netherlands)

    D. Haverkamp; H. Eijer; R.K. Marti

    2006-01-01

    We describe a technique of hemi-circumferential interposition grafting that allows placement of the cup in the anatomical position of the original acetabulum in the rare cases of post-Perthes or Perthes-like deformities of the femoral head combined with a steep and shallow acetabulum. This technique

  8. Robotic digestive tract reconstruction after total gastrectomy for gastric cancer: a simple way to do it.

    Science.gov (United States)

    Barchi, Leandro Cardoso; Jacob, Carlos Eduardo; Franciss, Maurice Youssef; Kappaz, Guilherme Tommasi; Rodrigues Filho, Edison Dias; Zilberstein, Bruno

    2016-12-01

    Intracorporeal digestive tract reconstruction after minimally invasive total gastrectomy may be challenging, even when using the da Vinci® Surgical System. This may be due to intrinsic difficulties during oesophago-jejunal anastomosis (EJA). The aim of this study was to describe a simple way to perform digestive tract reconstruction after robotic total gastrectomy (RTG) for gastric cancer and the results of its application in a small series of cases. In the last 2 years, six patients with gastric adenocarcinoma have been treated by RTG, four male and two female, with mean age of 59.8 (range 48-74) years. The tumour was located in the gastric body in three patients, the gastric antrum in two patients and the fundus in one patient with no need of splenectomy. In all cases, D2 lymphadenectomy was completed. A modified robotic reconstruction technique proposed by the authors was used in these operations, which consists in a latero-lateral EJA using a linear stapler. An entero-enterostomy is also performed in the upper abdomen. The mean operative time was 408 (range 340-481) min. The mean time for digestive tract reconstruction was 57 (range 47-68) min. There were no conversions to open or laparoscopic surgery. The number of lymph nodes removed varied in the range 28-52 (average 40). There was no mortality. Postoperative staging showed three T1N0M0s, one T2N0M0, one T3N0M0 and one T3N2M0. This series, which despite being small, demonstrates that this robotic reconstruction technique is safe, with no major complications, demands a relatively short time for its accomplishment, even when dealing with initial experience. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  9. Spirulina can increase total-body vitamin A stores of Chinese school-age children determined by a paired isotope dilution technique

    Science.gov (United States)

    Spirulina is an alga rich in high-quality protein and carotenoids. It is unclear whether spirulina can improve the total-body vitamin A stores of school-age children in China with a high prevalence of vitamin A malnutrition. We aimed to evaluate the efficacy of spirulina in improving the total-body ...

  10. Pancreatic tail pseudocyst of type II treated with resection of the tail of the pancreas and splenectomy

    Directory of Open Access Journals (Sweden)

    Latinčić Stojan

    2011-01-01

    Full Text Available Introduction. Pancreatic pseudocysts of type II are postnecrotic cysts that appear during an acute-on-chronic pancreatitis. In case that surgical treatment is necessary, as a rule it is performed using internal drainage operations. Pancreatic resections are rarely indicated. Case Outline. The authors present a 34 year-old man with a long-lasting history of moderate alcohol consumption in whom an episode of drinking caused an acute-on-chronic pancreatitis so that a 7 cm in diameter cyst was developed inside the tail of the pancreas causing left subcostal pain, mild pleural effusion and pain in the left shoulder. At operation almost entirely inside the tail of the pancreas a cyst of type II unsuitable for internal drainage operation was found so that a spared resection of the tail of the pancreas and splenectomy were carried out. The post-operative recovery was prolonged due to recurrent left pleural effusion requiring punctions, mild suppurative secretion from the splenic fossa and transient postsplenectomy thrombocytosis. Six months after surgery the patient is in good condition and with normal findings. Conclusion. Although rare, pancreatic cysts of type II may be unsuitable for internal drainage operations so that resection of the effected part of the pancreas could be a much better solution than external drainage.

  11. Recurrent neck abscesses due to cervical tuberculous lymphadenopathy in an elderly woman post-splenectomy: a case report

    Directory of Open Access Journals (Sweden)

    Niblock Aaron L

    2011-12-01

    Full Text Available Abstract Introduction There are approximately 7000 new cases of tuberculosis every year in the UK, the majority of which are pulmonary. Approximately 5% affect the lymph nodes in immunocompetent patients. Scrofula is an old term used to describe lymph nodes of the neck infected with tuberculosis Case presentation In the elderly population, growing neck lumps are always treated as red flags until a diagnosis is confirmed. Here, the case of an 89-year-old Caucasian woman is presented. She was reluctant to seek medical help as she feared the cause was sinister and did not want surgical intervention. Conclusion It is difficult to culture tuberculosis from superficial swabs, resulting in a high proportion of false negative results. Where there is a high degree of clinical suspicion for tuberculosis, it is important to consider a biopsy with culture. Patients over the age of 65 have waning immunity and are therefore a vulnerable group for acute infections as well as the re-activation of indolent organisms. Post-splenectomy patients are at a major disadvantage during sepsis and when a cellular immune response is required, such as when faced with a Mycobacterium tuberculosis infection. Scrofula is treated with a similar regime as pulmonary tuberculosis and has a near 100% success rate.

  12. A rare and successfully managed case of idiopathic thrombocytopenic purpura (ITP with previous caesarean with splenectomy with hepatitis C positive

    Directory of Open Access Journals (Sweden)

    Rajshree Dayanand Katke

    2014-08-01

    Full Text Available ITP occurs in approximately 2 of 1000 pregnant women. ITP may develop at any time during pregnancy, but is often initially recognized in the first trimester and is the most common cause of isolated thrombocytopenia in this time period. A 33 year old, married since 6 years, G2p1l1 with 33 weeks gestation referred to our tertiary centre. She was a known case of ITP with splenectomy done. She had a 5 year old male child, delivered by LSCS. She was diagnosed as having ITP at the age of 12 years. HCV antibody was weakly positive. ANA was positive. Emergency LSCS was done in view of scar tenderness. Post op she developed epistaxis, bleeding gums and per vaginum. Patient received multiple FFP, platelet transfusions and responded to treatment with methylprednisolone. The diagnosis and management of ITP in pregnancy is similar to that in the non-pregnant adult patient, but the risks to the developing fetus must be taken into account when choosing treatment and the maintenance of a safe platelet count, rather than prolonged remission, is the goal. Mode of delivery must be guided by obstetrical indications. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1119-1121

  13. Assessment of splanchnic hemodynamics in patients with cirrhosis after splenectomy in comparison with non-operated patients at the decompensated stage

    Directory of Open Access Journals (Sweden)

    Алий Саитович Тугушев

    2015-10-01

    Full Text Available Splenectomy in patients with cirrhosis presupposes an increase of blood inflow into portal system to decrease the portal pressure. At the same time there are different opinions about splenectomy. So it is actual to study the character of changes of blood flow in vessels of abdominal cavity in pre- and postsurgical periods and assessment of an influence of these changes on the clinical course of cirrhosis.Aim of research: To assess an influence of splenectomy on the character of changes of splanchnic hemodynamics in patients with cirrhosis comparing to non-operated patients with compensated and decompensated clinical course.Materials and methods: There were examined 190 patients with cirrhosis: gastrointestinal bleeding from oesophagus varicose veins took place in 133 patients, diuretic resistant ascites – in 57 ones. 19 patients underwent splenectomy: 7 – in association with sewing of the left gastric vein and artery, 6 – with “skeletonization” of the lesser curvature of stomach with Nessen’s operation, 2 – with Patsiora’s operation, 2 – with application of selective porto-caval shunt between the low mesenteric vein and the left vein of an ovary. 84 patients died during observation. The duration of observation was from 0.5 to 3.5 years. All patients underwent fibrogastroscopy every 3–4 month. Hemodynamics was assessed on the base of repeated ultrasound of abdominal cavity. There were assessed diameter of hepatic and splenic vessels; qualitative and quantitative characteristics of blood flow in hepatic and splenic arteries, portal and splenic veins.Results of research: Changes of hemodynamics in patients after splenectomy as opposed to non-operative patients are characterized with the decrease of diameter of portal vein at almost stable speed of the linear blood flow in it. The result is some decrease of the volume of portal blood and index of portal blood congestion that indirectly indicates the decrease of portal pressure

  14. Spirulina can increase total-body vitamin A stores of Chinese school-age children as determined by a paired isotope dilution technique

    OpenAIRE

    Li, Lei; Zhao, Xianfeng; Wang, Jie; Muzhingi, Tawanda; Suter, Paolo M.; Tang, Guangwen; Yin, Shi-an

    2012-01-01

    Spirulina is an alga rich in high-quality protein and carotenoids. It is unclear whether spirulina can improve the total-body vitamin A stores of school-age children in China with a high prevalence of vitamin A malnutrition. We aimed to evaluate the efficacy of spirulina in improving the total-body vitamin A stores of school-age children in rural areas of China when they consumed spirulina in their daily meals. A total of 228 children (6–11 years) were recruited and randomly divided into thre...

  15. Clinical efficacy of complex splenectomy in 235 patients%235例复杂性脾切除术的临床疗效

    Institute of Scientific and Technical Information of China (English)

    关蛟; 周尊强; 佟大年; 张正筠; 周光文

    2016-01-01

    术风险的关键环节.%Objective To explore the clinical efficacy and safety of complex splenectomy.Methods The retrospective cohort study was adopted.The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,67 from Shanghai Jiaotong University Affiliated First People's Hospital,26 from Shanghai Jiaotong University Affiliated Sixth People's Hospital,7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected.All the patients received total splenectomy after splenic artery ligation.The observation indexes included:(1) surgical situations,(2) major complications including intraperitoneal hemorrhage,pulmonary complication,left subphrenic abscess and peritoneal effusion,(3) follow-up situations:portal vein (PV) complications (splenic venous thrombophlebitis,thrombosis of splenic vein and main portal vein thrombosis),survival of patients.The follow-up using outpatient examination and telephone interview was performed up to March 2016,and patients received regularly ultrasound reexamination,computed tomography (CT) rescan,routine blood retest and coagulation function.Measurement data with normal distribution were presented as-x ± s,and count data were analyzed using the chisquare test.Results (1) Surgical situations:of 235 patients,200 patients underwent secondary spleen pedicle severance and 35 patients underwent non-secondary spleen pedicle severance.Volume of intraoperative blood loss and duration of splenic resection were (268 ± 103) mL and (82 ± 29) minutes.(2) Major complications:of 31 patients with postoperative complications,intraperitoneal hemorrhage was detected in 12 patients,pulmonary complication in 17 patients,left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients.Some patients were combined with multiple symptoms.The patients with above complications were cured after reoperations and non-operative treatments.(3) Follow-up situations

  16. Total protein

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...

  17. Total Thyroidectomy

    Directory of Open Access Journals (Sweden)

    Lopez Moris E

    2016-06-01

    Full Text Available Total thyroidectomy is a surgery that removes all the thyroid tissue from the patient. The suspect of cancer in a thyroid nodule is the most frequent indication and it is presume when previous fine needle puncture is positive or a goiter has significant volume increase or symptomes. Less frequent indications are hyperthyroidism when it is refractory to treatment with Iodine 131 or it is contraindicated, and in cases of symptomatic thyroiditis. The thyroid gland has an important anatomic relation whith the inferior laryngeal nerve and the parathyroid glands, for this reason it is imperative to perform extremely meticulous dissection to recognize each one of these elements and ensure their preservation. It is also essential to maintain strict hemostasis, in order to avoid any postoperative bleeding that could lead to a suffocating neck hematoma, feared complication that represents a surgical emergency and endangers the patient’s life.It is essential to run a formal technique, without skipping steps, and maintain prudence and patience that should rule any surgical act.

  18. Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques

    NARCIS (Netherlands)

    van de Groes, S.A.W.; De Waal Malefijt, M.C.; Verdonschot, Nicolaas Jacobus Joseph

    2014-01-01

    Background: Some follow-up studies of highflexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implantfixation is dependant on two interfaces: the cement–implant and the cement–bone interface. The present finite-element model (FEM) is the first

  19. Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques

    NARCIS (Netherlands)

    Groes, S.A.W. van de; Waal Malefijt, M.C. de; Verdonschot, N.J.J.

    2014-01-01

    BACKGROUND: Some follow-up studies of high flexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implant fixation is dependant on two interfaces: the cement-implant and the cement-bone interface. The present finite-element model (FEM) is the

  20. Spirulina can increase total-body vitamin A stores of Chinese school-age children as determined by a paired isotope dilution technique.

    Science.gov (United States)

    Li, Lei; Zhao, Xianfeng; Wang, Jie; Muzhingi, Tawanda; Suter, Paolo M; Tang, Guangwen; Yin, Shi-An

    2012-01-01

    Spirulina is an alga rich in high-quality protein and carotenoids. It is unclear whether spirulina can improve the total-body vitamin A stores of school-age children in China with a high prevalence of vitamin A malnutrition. We aimed to evaluate the efficacy of spirulina in improving the total-body vitamin A stores of school-age children in rural areas of China when they consumed spirulina in their daily meals. A total of 228 children (6-11 years) were recruited and randomly divided into three groups supplemented with 4 g (containing 4·18 µg β-carotene), 2 g (containing 2·54 µg β-carotene) or 0 g spirulina 5 d/week for 10 weeks, respectively. Before and after the intervention period, each child was given 0·5 mg [(2)H4]retinyl acetate and [(2)H8]retinyl acetate, respectively. To assess vitamin A stores, blood samples (3 ml) were collected on the third and the twenty-first day after each labelled retinyl acetate dose for a retinol enrichment analysis using a GC mass spectrometer. The concentrations of retinol and β-carotene in serum samples were also determined by using HPLC. After the 10-week intervention, serum β-carotene concentrations of children with 2 or 4 g spirulina supplement increased by 0·160 and 0·389 µmmol/l, respectively. Total-body vitamin A stores increased significantly, with a median increase of 0·160 mmol in children taking 2 g spirulina and of 0·279 mmol in children taking 4 g spirulina. Spirulina is a good dietary source of β-carotene, which may effectively increase the total-body vitamin A stores of Chinese school-age children.

  1. Esplenectomia laparoscópica nas doenças hematológicas Laparoscopic splenectomy in hematological disorders

    Directory of Open Access Journals (Sweden)

    Antônio Aldo Melo-Filho

    2003-10-01

    Full Text Available OBJETIVO: Relatar a experiência inicial do Centro Infantil Boldrini com a esplenectomia laparoscópica (EL em crianças e adultos jovens. MÉTODO: Foram revisados os prontuários de 40 pacientes (mediana da idade de 6,6 anos; 1 a 22,8 submetidos à EL entre Julho de 2000 e Maio de 2002. As principais indicações de acordo com a doença de base foram: doença falciforme (DF em 20 pacientes (50%, esferocitose hereditária em 10 (25 %, púrpura trombocitopência idiopática em oito (20 %, doença de Hodgkin em um e anemia hemolítica a esclarecer em um. RESULTADOS: Trinta e oito esplenectomias foram completadas por via laparoscópica (duas conversões e em doze foi realizada adicionalmente a colecistectomia. A mediana do tempo operatório foi de 127,5 minutos (90-240 min e sete (17,5 % baços acessórios foram encontrados. Sangramento intra-operatório foi significativo apenas nas duas conversões, mas não houve necessidade de transfusões. A mediana do peso dos baços foi de 250 g (106-1000; n=36. Complicações pós-operatórias ocorreram em sete (17,5 % pacientes e, nos portadores de DF, 35% desenvolveram síndrome torácica aguda. A mediana da permanência hospitalar pós-operatória foi de dois dias (2 - 14. O seguimento variou de 23 dias a dois anos (mediana de 11 meses. CONCLUSÕES: A EL pode ser realizada de modo seguro mesmo em baços de grande tamanho e é opção atrativa que pode substituir o procedimento aberto. Em pacientes com DF, a taxa de complicações permanece alta, sugerindo mecanismos outros que vão além da escolha da via de acesso cirúrgica.BACKGROUND: Laparoscopic splenectomy (LS is becoming the procedure of choice in the treatment of children with hematological disorders. However, concerns remains regarding conversion rates, dissection and extraction of the spleen. The authors analyze their early experience at Boldrini's Children Cancer Center-Brazil in 40 LS performed in children and young adults. METHODS

  2. Non-resurfacing techniques in the management of the patella at total knee arthroplasty: A systematic review and meta-analysis.

    Science.gov (United States)

    Findlay, I; Wong, F; Smith, C; Back, D; Davies, A; Ajuied, A

    2016-03-01

    Recent meta-analyses support not resurfacing the patella at the time of TKA. Several different modes of intervention are reported for non-resurfacing management of the patella at TKA. We have conducted a systematic review and meta-analysis of non-resurfacing interventions in TKA. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study methodology and reporting system was adopted, utilising the PRISMA checklist and statement. Classes of patella interventions were defined as: 0. No intervention. 1. Osteophyte excision only. 2. Osteophyte excision, denervation, with soft tissue debridement. 3. Osteophyte excision, denervation, soft tissue debridement, and drilling or micro-fracture of eburnated bone. 4. Patellar resurfacing. A meta-analysis was conducted upon the pre- and post-operative KSS for each technique. Four hundred and twenty-three studies were identified, 12 studies met the inclusion criteria for the systematic review and eight for the meta-analysis. Two studies compared different non-resurfacing patellar techniques, the other studies used the non-resurfacing cohort as controls for their prospective RCTs comparing patellar resurfacing with non-resurfacing. The meta-analysis revealed no significant difference between the techniques. We conclude that there is no significant difference in KSS for differing non-resurfacing patellar techniques, but further trials using patellofemoral specific scores may better demonstrate superior efficacy of specific classes of patella intervention, by virtue of greater sensitivity for patellofemoral pain and dysfunction. I. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

  3. Modélisation et conception d'outils robotises et de techniques de fraisage pour l'arthroplastie total du genou

    OpenAIRE

    Plaskos, Christopher

    2005-01-01

    Computer-assisted surgery (CAS) has brought enormous added value to medical interventions by providing precise measurement tools that permit surgeons to quantify and control their gestures. In total knee arthroplasty (TKA), CAS has significantly reduced implant alignment and positioning variability, which has been correlated to early failures requiring revision surgery. There remains however a clinical demand for enhanced precision and capabilities that perhaps only robotics or ‘intelligent i...

  4. 睡莲花总黄酮超声提取工艺研究%A Study on Ultrasonic Extraction Techniques for Total Flavonoids from Nymphaea candida Presl

    Institute of Scientific and Technical Information of China (English)

    金晓红; 耿伟; 桂红武

    2011-01-01

    目的 以黄酮含量为评价指标,优选睡莲花超声提取最佳工艺.方法 单因素实验考察乙醇浓度、料液比、超声提取时间、超声提取次数、超声功率对药材黄酮提取效果的影响,并通过正交实验确定最佳提取工艺.结果 乙醇浓度、料液比、提取次数和提取时间对黄酮的提取率有显著影响.超声提取维药睡莲花中黄酮类化合物的最佳工艺条件为:乙醇浓度80%,料液比1:16,超声提取5次,提取时间30 min.结论 所优选的提取工艺稳定,重复性良好.%Objective To optimize the ultrasonic extraction for total flavonoids from Nymphaea Candida Presl. Methods The optimum process was determined with the single factor experiment and orthogonal test by evaluating effect of ethanol concentration,ratio of materia/extraction solution, extraction course, times and amount of total flavonoids extracted. Results The remarkable factors affecting total flavonoids extraction from Nymphaea Candida Presl. Included ethanol concentration,ratio of materia/extraction solution, extraction times and extraction duration. The optimum extraction for total flavonoids from Nymphaea Candida Presl. Was using 80% ethanol, keeping the ratio of materia/extraction solution as 1 : 16, making extraction for 5 times and 30 minutes in each time. Conclusion The optimum process is stable and reproducible.

  5. Mineral composition, nutritional properties, total phenolics and flavonoids compounds of the atemoya fruit (Annona squamosa L. x Annona cherimola Mill. and evaluation using multivariate analysis techniques

    Directory of Open Access Journals (Sweden)

    WALTER N.L. DOS SANTOS

    2016-01-01

    Full Text Available ABSTRACT The atemoya is a hybrid fruit obtained by crossing of cherimoya (Annona cherimola Mill. with sweet sop (Annona squamosa L.. The information about chemical composition of atemoya is scarce. The mineral composition was evaluated employing Inductively Coupled Plasma Optical Emission Spectrometry (ICP OES and the centesimal composition and the physico-chemical parameters were assessed employing procedures described in the AOAC methods. The total phenolic compounds (TPC and total flavonoids (TF were determined using spectroanalytical methods. Considering the Reference Daily Intake (RDI, the concentrations of K, Cu and Vitamin C found in atemoya were the highest, representing about 32, 23 and 37% of the RDI, respectively. The total carbohydrates were 32 g 100g-1 and the soluble solids was equivalent to (32.50 ± 0.03 °Brix. The result for TPC was 540.47 ± 2.32 mgGAE 100 g-1 and the TF was 11.56 ± 1.36 mgQE 100 g-1. The exploratory evaluation of 42 atemoya samples was performed through Principal Component Analysis (PCA, which discriminated green and ripe fruits according to their mineral composition. The elements that contributed most for the variability between green and ripe fruits were: Ba, Ca, Cu, K, Mg and P.

  6. 脾切除治疗35例血液病的临床分析%Splenectomy for hematological disease: an analysis of 35 cases

    Institute of Scientific and Technical Information of China (English)

    张勇学; 刘为军; 钟鸣

    2010-01-01

    目的 探讨脾切除对血液病的治疗效果、适应证以及术后并发症.方法 回顾分析2000年1至2010年1月云南省第一人民医院普外科治疗35例血液病患者的临床资料,探讨脾切除对血液病的治疗效果、术后并发症及预防措施.结果 脾切除对原发性血小板减少性紫癜、遗传性球形红细胞增多症、自身性免疫性溶血性贫血治疗效果确切,有效率分别为87.5%、100%和83.3%.结论 脾切除对内科治疗无效的良性血液病行之有效.%Objective To investigate the therapeutic efficacy, indications and postoperative complications of splenectomy in patients with hematological diseases. Methods The clinical data of 35 patients suffering from hematological diseases admitted between January 2000 and January 2010 at the general surgery department of the first people's hospital of yunnan province were analyzed retrospectively. The therapeutic efficacy, the postoperative complications and some preventive measures were discussed. Results Splenectomy could exert significant therapeutic effects on the diseases of idiopathic thrombocytopenic purpura(ITP), hereditary spherocytosis ( HS), autoimmune and hemolytic anemia ( AHA ). The effective rates were 87.5%, 100% and 83.3% respectively. Conclusion Splenectomy is effective on the benign hematological diseases whenever non-surgical management is invalid.

  7. Residual tissue post splenectomy detected by splenic scintillography with erythrocytes damaged by heat; Tejido residual postesplenectomia detectado por centellografia esplenica con eritrocitos danados por calor

    Energy Technology Data Exchange (ETDEWEB)

    Rivera B, B.; Garcia C, E.S.; Garcia O, J.R. [Centro Medico ABC, Departamento de Medicina Nuclear, Mexico, D.F. (Mexico)

    2005-07-01

    Feminine of 26 years old with diagnostic of purple thrombocytopenic idiopathic to those 4 years of age, tried with steroids and splenectomy at 11 years old. Pathway practically asymptomatic until 4 months ago she had presented asthenia, adynamia and general uneasiness, with platelet figures of 40,000 plat/microliter. It was carried out scintillographic study with damaged erythrocytes for post surgical remainder search. Its were took two-dimensional images and tomography by single photon emission (SPECT), being knitted splenic residual in area of anatomical projection of the spleen. (Author)

  8. Total algorithms

    NARCIS (Netherlands)

    Tel, G.

    1993-01-01

    We define the notion of total algorithms for networks of processes. A total algorithm enforces that a "decision" is taken by a subset of the processes, and that participation of all processes is required to reach this decision. Total algorithms are an important building block in the design of distri

  9. The Use of a Modular Titanium Baseplate with a Press-Fit Keel Implanted with a Surface Cementing Technique for Primary Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Christopher E. Pelt

    2014-01-01

    Full Text Available Little data exists regarding outcomes following TKA performed with surface-cementation for the fixation of modular tibial baseplates with press-fit keels. Thus, we retrospectively reviewed the clinical and radiographic outcomes of 439 consecutive primary TKAs performed with surface cemented tibial components. There were 290 female patients and 149 male patients with average age of 62 years (range 30–84. Two tibial components were revised for aseptic loosening (0.5% and four tibial components (0.9% were removed to improve instability (n=2 or malalignment (n=2. Complications included 13 deep infections treated with 2-stage revision (12 and fusion (1. These results support the surface cement technique with a modular grit-blasted titanium surface and cruciform stem during primary TKA.

  10. Trabecular metal patella--is it really doomed to fail in the totally patellar-deficient knee? A case report of patellar reconstruction with a novel technique.

    Science.gov (United States)

    Kumar Nanjayan, Shashi; Wilton, Timothy

    2014-06-01

    Reconstruction of the patella poses real problems for the revision TKR surgeon, particularly when the patella is absent, fractured or profoundly deficient. The trabecular metal patella was introduced in an attempt to address these issues. However the largest series of such cases published to date cast serious doubts on the validity of using Trabecular Metal (TM) in cases where there is no residual patellar bone stock at all. We present a case where the TM Patellar implant has survived satisfactorily for 8 years post reconstruction in a knee with no residual patella bone, resulting in greatly improved symptoms and function. We believe that this success might be related to specific technical details in the reconstruction and we present the technique. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Total skin electron beam therapy in mycosis fungoides. Evaluation of a technique for deceleration of electron beam energy and clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Terashima, Hiromi; Yamashita, Shigeru; Ishino, Yohichi; Suenaga, Yoshinori

    1988-08-01

    The studies using phantoms confirmed that the reduction of electron beam energy and minimization of X-ray contamination could be achieved when electron beam was interposed by an acrylic plate placed 20 cm anterior to a patient. Four patients of mycosis fungoides were treated with 8 MeV electron beam of a linear accelerator at UOEH Hospital from October 1981 to December 1986. Two of them were treated with this technique by placing 2 cm thick acrylic plate anterior to the patients and satisfactory results were obtained. Cutaneous lesions subsided remarkably with the dosage of 2000 cGy given in 2 months. Leucopenia due to bone marrow suppression was mild and the patients tolerated the treatment well.

  12. Total coliforms, arsenic and cadmium exposure through drinking water in the Western Region of Ghana: application of multivariate statistical technique to groundwater quality.

    Science.gov (United States)

    Affum, Andrews Obeng; Osae, Shiloh Dede; Nyarko, Benjamin Jabez Botwe; Afful, Samuel; Fianko, Joseph Richmond; Akiti, Tetteh Thomas; Adomako, Dickson; Acquaah, Samuel Osafo; Dorleku, Micheal; Antoh, Emmanuel; Barnes, Felix; Affum, Enoch Acheampong

    2015-02-01

    In recent times, surface water resource in the Western Region of Ghana has been found to be inadequate in supply and polluted by various anthropogenic activities. As a result of these problems, the demand for groundwater by the human populations in the peri-urban communities for domestic, municipal and irrigation purposes has increased without prior knowledge of its water quality. Water samples were collected from 14 public hand-dug wells during the rainy season in 2013 and investigated for total coliforms, Escherichia coli, mercury (Hg), arsenic (As), cadmium (Cd) and physicochemical parameters. Multivariate statistical analysis of the dataset and a linear stoichiometric plot of major ions were applied to group the water samples and to identify the main factors and sources of contamination. Hierarchal cluster analysis revealed four clusters from the hydrochemical variables (R-mode) and three clusters in the case of water samples (Q-mode) after z score standardization. Principal component analysis after a varimax rotation of the dataset indicated that the four factors extracted explained 93.3 % of the total variance, which highlighted salinity, toxic elements and hardness pollution as the dominant factors affecting groundwater quality. Cation exchange, mineral dissolution and silicate weathering influenced groundwater quality. The ranking order of major ions was Na(+) > Ca(2+) > K(+) > Mg(2+) and Cl(-) > SO4 (2-) > HCO3 (-). Based on piper plot and the hydrogeology of the study area, sodium chloride (86 %), sodium hydrogen carbonate and sodium carbonate (14 %) water types were identified. Although E. coli were absent in the water samples, 36 % of the wells contained total coliforms (Enterobacter species) which exceeded the WHO guidelines limit of zero colony-forming unit (CFU)/100 mL of drinking water. With the exception of Hg, the concentration of As and Cd in 79 and 43 % of the water samples exceeded the WHO guideline limits of 10 and 3

  13. Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    Science.gov (United States)

    Malik, M. H. A.; Gambhir, A. K.; Bale, L.; Pradhan, N.; Porter, M. L.

    2004-01-01

    BACKGROUND: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice. METHODS: A total of 86 surgeons from 26 hospitals were included in a questionnaire study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%. CONCLUSIONS: This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices

  14. Fourier transform infrared-attenuated total reflectance (FTIR-ATR spectroscopy and chemometric techniques for the determination of adulteration in petrodiesel/biodiesel blends

    Directory of Open Access Journals (Sweden)

    Armando Guerrero Peña

    2014-06-01

    Full Text Available We propose an analytical method based on fourier transform infrared-attenuated total reflectance (FTIR-ATR spectroscopy to detect the adulteration of petrodiesel and petrodiesel/palm biodiesel blends with African crude palm oil. The infrared spectral fingerprints from the sample analysis were used to perform principal components analysis (PCA and to construct a prediction model using partial least squares (PLS regression. The PCA results separated the samples into three groups, allowing identification of those subjected to adulteration with palm oil. The obtained model shows a good predictive capacity for determining the concentration of palm oil in petrodiesel/biodiesel blends. Advantages of the proposed method include cost-effectiveness and speed; it is also environmentally friendly.

  15. Total oxidant-scavenging capacities of plasma from glycogen storage disease type Ia patients as measured by cyclic voltammetry, FRAP and luminescence techniques.

    Science.gov (United States)

    Koren, E; Lipkin, J; Klar, A; Hershkovitz, E; Ginsburg, I; Kohen, R

    2009-10-01

    It has been suggested that the very low incidence of atherosclerosis in glycogen storage disease type Ia (GSD Ia) subjects might be attributed to elevated levels of uric acid, one of the potent low molecular- weight antioxidants found in plasma. The present communication describes a use of two analytical methods-cyclic voltammetry and ferric reducing ability of plasma-and also two chemiluminescence methods to evaluate the total oxidant-scavenging capacities (TOSC) of plasma from GSD Ia patients. Our results verified the elevation of TOSC in GSD Ia patients and we propose the inclusion of luminescence and cyclic voltammetry assays as reliable methods for estimating TOSC in a variety of clinical disorders. Our findings with the cyclic voltammetry method add support to the assumption that the elevated uric acid levels might be the main contributor to plasma antioxidant capacity and possible protection against atherosclerosis.

  16. Total laparoscopic technique for congenital choledochal cyst%完全腹腔镜在先天性胆总管囊肿手术中的应用

    Institute of Scientific and Technical Information of China (English)

    段小辉; 蒋波; 毛先海; 田秉璋; 沈贤波; 吴金术

    2013-01-01

    Objective:To explore the application and technical points of total laparoscopic surgery for congenital choledochal cyst.Methods:The clinical data of 7 patients undergoing laparoscopic surgery for choledochal cyst from August 2011 to December 2012 were retrospectively analyzed.Results:Cyst excision and Roux-en-Y hepato-enteric anastomosis were successfully performed by laparoscopic procedures in 5 patients,and the operative time was 310-400 min,intraoperative blood loss was 50-100 mL and length of postoperative hospital stay was 5-7 d.Follow-up ranged from 3 to 19 months,and no postoperative complications or death occurred.Two patients were converted to open surgery due to severe inflammation of the choledochal cyst or bleeding.Conclusion:Total laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy is a safe and feasible procedure with the advantages of minimal invasiveness and fast recovery for most cases of choledochal cyst.Excellent laparoscopic skills and teamwork is crucial for surgical success.%目的:探讨腹腔镜在先天性胆总管囊肿手术中的应用经验.方法:回顾性分析201 1年8月-2012年12月7例腹腔镜胆总管囊肿手术患者的临床资料.结果:5例患者在完全腹腔镜下完成胆总管囊肿切除和肝肠Roux-en-Y引流,手术时间为310~400 min,术中出血50~100 mL,术后住院时间5~7 d,术后随访3~19个月,未出现术后并发症,无死亡病例.2例因胆总管囊肿炎症重,渗血较多中转开腹完成手术.结论:完全腹腔镜胆总管囊肿切除和肝肠Roux-en-Y引流治疗先天性胆总囊肿是安全可行的,具有微创、术后恢复快等优点;熟练的腹腔镜技术,良好的团队配合是手术成功的关键.

  17. Primary total knee replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    Science.gov (United States)

    Malik, M. H. A.; Chougle, A.; Pradhan, N.; Gambhir, A. K.; Porter, M. L.

    2005-01-01

    INTRODUCTION: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Association for Surgery of the Knee (BASK) to provide a basis for regional and national auditable standards: we have compared practice in the North West of England to this document to ascertain adherence to this guide to best practice. MATERIALS AND METHODS: A direct comparison of data held on the North West Hip Arthroplasty Register for 2001/2002 and BASK/BOA guidelines was performed. 86 surgeons from 26 hospitals were included in the study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. 42.2% of respondents routinely used exhaust suits and 68.1% of respondents routinely used impermeable disposable gowns. All surgeons use some form of anti-thromboembolic prophylaxis; 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin. 93.7% of surgeons routinely use antibiotic-loaded cement. The PFC and Kinemax prostheses were the most commonly used prostheses. Interestingly, 97.7% of all first-choice implants were cemented. Only 2 surgeons used uncemented total knee replacement. 69.8% of surgeons used a posterior cruciate retaining design. A midline longitudinal skin incision is used by 87.2% of surgeons, a medial longitudinal skin incision by 7.0% and a lateral longitudinal skin incision by 5.8% of surgeons. A medial parapatellar capsular incision is preferred by 91.9% with the remainder using mid vastus or trivector retaining capsulotomy. Closure of capsulotomies is performed in flexion by 65.1% and in extension by 34.9%. In patients with osteoarthritis, 38.4% routinely resurfaced the patella, 34.9% never resurfaced the patella and 26.7% selectively resurfaced. This was in direct contrast to

  18. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report.

    Science.gov (United States)

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-03-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition.

  19. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report

    Science.gov (United States)

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko

    2015-01-01

    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition. PMID:25785319

  20. Heart and kidney transplantation using total lymphoid irradiation and donor bone marrow in mongrel dogs

    Energy Technology Data Exchange (ETDEWEB)

    Kahn, D.R.; Dufek, J.H.; Hong, R.; Caldwell, W.L.; Thomas, F.J.; Kolenda, D.R.; Swanson, D.K.; Struble, R.A.

    1980-07-01

    Heart and kidney allografts showed markedly prolonged survival in unrelated mongrel dogs following total lymphoid irradiation (TLI) and donor bone marrow without any other immunosuppression. In every animal the heart survived longer than the kidney. Placing the kidney allograft in the abdomen with the bone marrow given intraperitoneally doubled kidney survival over placement in the neck, but heart survival was equally prolonged in the abdomen or neck. Splenectomy before TLI or after TLI, but just before transplantation, almost completely eliminated the prolonged survival of both heart and kidney allografts. Thus there is suggestive evidence that TLI plus bone marrow from the donor may be valuable for transplantation in man, particularly heart transplantation.

  1. Rehabilitation of gait in patients after total hip arthroplasty: Comparison of the minimal invasive Yale 2-incision technique and the conventional lateral approach.

    Science.gov (United States)

    Böhm, Harald; Hagemeyer, Daniel; Thummerer, Yvonne; Kipping, Robert; Stöckle, Ulrich; Scheuerer, Konrad

    2016-02-01

    The minimal invasive anterolateral Yale 2-incision approach for total hip arthroplasty aims minimizing damage to the muscles for faster recovery of function. Therefore the hypothesis was investigated, that during the rehabilitation process the Yale approach shows a faster return to natural gait than a conventional lateral approach. Nineteen patients had the Yale, 16 the conventional Bauer approach. Instrumented gait analysis was performed 3 days, 3 and 12 month post operatively. Velocity, cadence, step length, weight bearing, thorax lean, Trendelenburg limp, hip abduction moments, and hip muscle activation times were evaluated. Three days post-surgery a significantly greater loading of the treated limb and increased hip abduction moment were observed in the Yale group. In addition, the Yale group showed its greatest improvement in walking speed and step length between at 3 days and 3 months, whereas the conventional group showed an additional significant gain between 3 and 12 month to reach a similar walking speed as the Yale group. For all hip muscles investigated, only muscle tensor fasciae latae in the conventional group showed a significant increase in activation time between 3 days and 3 months. This study showed significantly faster return to natural gait in the Yale compared to the conventional approach, which could be biomechanically related to less impairment of abductor muscles in the Yale approach.

  2. The use of kinesio taping as a complementary therapy to conventional techniques in the rehabilitation of patients with rheumatoid arthritis following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Agnieszka Prusinowska

    2014-07-01

    Full Text Available In line with the expectations of early and repaid rehabilitation – to achieve good rehabilitation results in the shortest possible time – good postoperative therapy programmes include various treatment methods to allow patients to quickly return to normal activities of daily living. Kinesiology taping is a supportive rehabilitative method, widely adopted by physical therapists, which demonstrates a number of therapeutic effects and is well tolerated by patients. This article contains detailed descriptions of the applications of kinesiology tapes in orthopaedic rheumatology in patients after total knee replacement surgery. The use of kinesio tapes has significantly contributed to the improved ability of patients with advanced destructive changes in other joints to perform activities of daily living. The descriptions were classified based on the required action and the time after which kinesio tapes may be used following surgery. The text describes how kinesio tapes can be used to reduce oedema and correct dysfunctional joint mechanics and surgical scars aiming to support the rehabilitation process from the first 24 hours after surgery.

  3. Recent advances of anastomosis techniques of esophagojejunostomy after laparoscopic totally gastrectomy in gastric tumor%腹腔镜全胃切除食管空肠吻合技术研究进展

    Institute of Scientific and Technical Information of China (English)

    李溪; 柯重伟

    2015-01-01

    The esophageal jejunum anastomosis of the digestive tract reconstruction techniques in laparoscopic total gastrectomy includes two categories: circular stapler anastomosis techniques and linear stapler anastomosis techniques. Circular stapler anastomosis techniques include manual anastomosis method, purse string instrument method, Hiki improved special anvil anastomosis technique , the transorally inserted anvil(OrVilTM) and reverse puncture device technique. Linear stapler anastomosis techniques include side to side anastomosis technique and Overlap side to side anastomosis technique. Esophageal jejunum anastomosis technique has a wide selection of different technologies with different strengths and the corresponding limitations. This article will introduce research progress of laparoscopic total gastrectomy esophagus jejunum anastomosis from both sides of the development of anastomosis technology and the selection of anastomosis technology.%腹腔镜全胃切除食管空肠吻合的消化道重建技术主要包括应用圆形吻合器的吻合技术和应用直线切割吻合器的吻合技术两大类。圆形吻合器吻合技术主要包括手工吻合法、荷包钳法、Hiki改良特殊抵钉座吻合技术、经口钉砧头系统(OrVilTM)和反穿刺器技术。直线切割吻合器吻合技术主要包括侧侧吻合技术和Overlap侧侧吻合技术。食管空肠吻合技术存在多种选择,不同技术存在不同优势及相应的限制,本文从吻合技术的发展及吻合技术的选择两方面介绍腹腔镜全胃切除食管空肠吻合技术研究进展。

  4. Gradient-echo magnetic resonance imaging study of pancreatic iron overload in young Egyptian beta-thalassemia major patients and effect of splenectomy

    Directory of Open Access Journals (Sweden)

    Matter Randa M

    2010-04-01

    Full Text Available Abstract Background Thalassemic patients suffer from diabetes mellitus secondary to hemosiderosis. Aims The study aimed to evaluate pancreatic iron overload by T2*-weighted Gradient-echo magnetic resonance imaging (MRI in young beta-thalassemia major patients and to correlate it with glucose disturbances, hepatic hemosiderosis, serum ferritin and splenectomy. Methods Forty thalassemic patients (20 non diabetic, 10 diabetic, and 10 with impaired glucose tolerance were recruited from Pediatric Hematology Clinic, in addition to 20 healthy controls. All patients underwent clinical assessment and laboratory investigations included complete blood count, liver function tests, serum ferritin and oral glucose tolerance test (OGTT. A T2*-weighted gradient-echo sequence MRI was performed with 1.5 T scanner and signal intensity ratio (SIR of the liver and the pancreas to noise were calculated. Results Significant reduction in signal intensity ratio (SIR of the liver and the pancreas was shown in thalassemic patients compared to controls (P Conclusions pancreatic siderosis can be detected by T2* gradient-echo MRI since childhood in thalassemic patients, and is more evident in patients with abnormal glucose tolerance. After splenectomy, iron deposition may be accelerated in the pancreas. Follow up of thalassemic patients using pancreatic MRI together with intensive chelation therapy may help to prevent the development of overt diabetes.

  5. Retention and marginal adaptation of a compomer placed in non-stress-bearing areas used with the total-etch technique: a 3-year retrospective study.

    Science.gov (United States)

    Prati, C; Chersoni, S; Cretti, L; Montanari, G

    1998-12-01

    The aim of this clinical study was to evaluate class V and class III cavities restored with a polyacid-modified resin composite (compomer) restorative material in association with two different dentin-enamel bonding systems: Dyract-PSA (Primer Sealer Adhesive-DentSply, Germany) and Prime & Bond 2.0 (DentSply, Germany). The control group was a hybrid composite used with ProBond bonding system (DentSply, Germany). A total of 116 restorations (79 class V, 37 class III) were made and reevaluated after 1, 2 and 3 years in 55 patients in two private practices and in a university department. Class V nonretentive cavities were located at the CEJ level and class III at interproximal level close to CEJ. Each cavity was prepared using a water-cooled, high-speed handpiece with a fine diamond burr. A small bevel was prepared along enamel margin. Cavity dimensions were no more than 3.5 x 3.5 mm (using burr as reference point). Each restoration was finished immediately with fine diamond burrs and Sof-Lex disks (3 M, USA). The criteria that were evaluated by the USPHS method included: retention, color match, marginal integrity, marginal discoloration, and secondary caries. Results indicated that all compomer restorations were fully retained at 3 years, and that no secondary caries detected. Seven composite restorations were lost during the 3-year study. No statistical differences were observed between class III and class V or among other conditions (e.g., upper-lower arc, sex, age). This study demonstrates that compomers are suitable restorative materials for class III-V restorations. They may represent a clinical alternative to composites in class V and III restorations.

  6. Determination of total arsenic using a novel Zn-ferrite binding gel for DGT techniques: Application to the redox speciation of arsenic in river sediments.

    Science.gov (United States)

    Gorny, Josselin; Lesven, Ludovic; Billon, Gabriel; Dumoulin, David; Noiriel, Catherine; Pirovano, Caroline; Madé, Benoît

    2015-11-01

    A new laboratory-made Zn-ferrite (ZnFe2O4) binding gel is fully tested using Diffusive Gradient in Thin films (DGT) probes to measure total As [including inorganic As(III) and As(V), as well as MonoMethyl Arsenic Acid (MMAA(V)) and DiMethyl Arsenic Acid (DMAA(V))] in river waters and sediment pore waters. The synthesis of the binding gel is easy, cheap and its insertion into the acrylamide gel is not problematic. An important series of triplicate tests have been carried out to validate the use of the Zn-ferrite binding gel in routine for several environmental matrixes studies, in order to test: (i) the effect of pH on the accumulation efficiency of inorganic As species; (ii) the reproducibility of the results; (iii) the accumulation efficiency of As species; (iv) the effects of the ionic strength and possible competitive anions; and (v) the uptake and the elution efficiency of As species after accumulation in the binding gel. All experimental conditions have been reproduced using two other existing binding gels for comparison: ferrihydrite and Metsorb® HMRP 50. We clearly demonstrate that the Zn-ferrite binding gel is at least as good as the two other binding gels, especially for pH values higher than 8. In addition, by taking into consideration the diffusion rates of As(III) and As(V) in the gel, combining the 3-mercaptopropyl [accumulating only As(III)] with the Zn-ferrite binding gels allows for performing speciation studies. An environmental study along the Marque River finally illustrates the ability of the new binding gel to be used for field studies.

  7. Total milk fat extraction and quantification of polar and neutral lipids of cow, goat, and ewe milk by using a pressurized liquid system and chromatographic techniques.

    Science.gov (United States)

    Castro-Gómez, M P; Rodriguez-Alcalá, L M; Calvo, M V; Romero, J; Mendiola, J A; Ibañez, E; Fontecha, J

    2014-11-01

    Although milk polar lipids such as phospholipids and sphingolipids located in the milk fat globule membrane constitute 0.1 to 1% of the total milk fat, those lipid fractions are gaining increasing interest because of their potential beneficial effects on human health and technological properties. In this context, the accurate quantification of the milk polar lipids is crucial for comparison of different milk species, products, or dairy treatments. Although the official International Organization for Standardization-International Dairy Federation method for milk lipid extraction gives satisfactory results for neutral lipids, it has important disadvantages in terms of polar lipid losses. Other methods using mixtures of solvents such as chloroform:methanol are highly efficient for extracting polar lipids but are also associated with low sample throughput, long time, and large solvent consumption. As an alternative, we have optimized the milk fat extraction yield by using a pressurized liquid extraction (PLE) method at different temperatures and times in comparison with those traditional lipid extraction procedures using 2:1 chloroform:methanol as a mixture of solvents. Comparison of classical extraction methods with the developed PLE procedure were carried out using raw whole milk from different species (cows, ewes, and goats) and considering fat yield, fatty acid methyl ester composition, triacylglyceride species, cholesterol content, and lipid class compositions, with special attention to polar lipids such as phospholipids and sphingolipids. The developed PLE procedure was validated for milk fat extraction and the results show that this method performs a complete or close to complete extraction of all lipid classes and in less time than the official and Folch methods. In conclusion, the PLE method optimized in this study could be an alternative to carry out milk fat extraction as a routine method.

  8. Initial experience of transumbilical single incision laparoscopic splenectomy%经脐单切口腹腔镜脾切除术

    Institute of Scientific and Technical Information of China (English)

    于增文; 牛忠; 李索林; 孙驰; 许书清; 李英超; 马亚贞

    2011-01-01

    目的 总结儿童经脐单切口腹腔镜脾切除术的初步经验,并探讨其可行性和安全性.方法 回顾分析2010年4月至2011年1月期间5例脾相关疾病儿童经脐单切口入路腹腔镜脾切除术的临床资料,男3例,女2例,年龄4~12岁,包括遗传性球形红细胞增多症3例和特发性血小板减少性紫癜2例.我们使用自行改进的三通道套管和弯曲器械,超声刀切断脾周围韧带,切割钉合器或生物夹处理脾蒂,脾脏从单切口取出.结果 5例腹腔镜脾切除术均经脐单切口入路获得成功,没有中转常规腹腔镜手术.手术时间125~220 min,估计术中出血量10~30 ml,无围手术期并发症,术后5~8 d痊愈出院.随访3~12个月,5例患儿均生长发育良好,贫血得到纠正,血小板计数正常.结论 经脐单切口腹腔镜脾切除术较常规腹腔镜脾切除术对腹壁创伤更小、美容效果更好,可在儿童安全实施;但需要更多数量和进一步前瞻性研究来评价其真正益处.%Objective To review our initial experience of transumbilical single incision laparoscopic splenectomy in children and to assess the feasibility and safety of this laparoscopic procedures.Methods Clinical data of 5 children who underwent laparoscopic splenectomy via a single umbilical incision between April 2010 and January 2011 were reviewed. There were 3 boys and 2 girls. The age ranged from 4 to 12 years. Of them,3 cases suffered from hereditary spherocytosis and 2 cases from idiopathic thrombocytopenic purpura. We used the Tri-port and self-modified curved instruments. The splenic attachments were taken down using the harmonic scalpel,and the hilum was clipped with Hemo-lok or transected with Endo-GIA. The spleen was removed from the abdomen via the single incision.Results All of the laparoscopic splenectomies were completed successfully with transumbilical single incision approach without conversion to conventional laparoscopic surgery. The operation

  9. The Influence of Splenectomy Performed Simultaneously with Gastrectomy on Postoperative Complications in Patients with Gastric Cancer Undergoing Surgery with the Intention to Treat

    Directory of Open Access Journals (Sweden)

    Głuszek Stanisław

    2014-07-01

    Full Text Available Despite the growing understanding of the pathophysiological processes in the perioperative period and significant advancements in surgical techniques, operative treatment for gastric cancer remains a challenge for surgeons, especially because the primary procedure of total or nearly total gastrectomy must at times be extended by the resection of other organs.

  10. Comparison of an automated most-probable-number technique with traditional plating methods for estimating populations of total aerobes, coliforms, and Escherichia coli associated with freshly processed broiler chickens.

    Science.gov (United States)

    Line, J E; Stern, N J; Oakley, B B; Seal, B S

    2011-09-01

    An instrument (TEMPO) has been developed to automate the most-probable-number (MPN) technique and reduce the effort required to estimate some bacterial populations. We compared the automated MPN technique with traditional microbiological plating methods and Petrifilm methods for estimating the total viable count of aerobic microorganisms (TVC), total coliforms (CC), and Escherichia coli populations (EC) on freshly processed broiler chicken carcasses (postchill whole carcass rinse [WCR] samples) and cumulative drip-line samples from a commercial broiler processing facility. Overall, 120 broiler carcasses, 36 prechill drip-line samples, and 40 postchill drip-line samples were collected over 5 days (representing five individual flocks) and analyzed by the automated MPN and direct agar plating and Petrifilm methods. The TVC correlation coefficient between the automated MPN and traditional methods was very high (0.972) for the prechill drip samples, which had mean log-transformed values of 3.09 and 3.02, respectively. The TVC correlation coefficient was lower (0.710) for the postchill WCR samples, which had lower mean log values of 1.53 and 1.31, respectively. Correlations between the methods for the prechill CC and EC samples were 0.812 and 0.880, respectively. The estimated number of total aerobes was generally greater than the total number of coliforms or E. coli recovered for all sample types (P methods and the automated MPN method.

  11. 小儿脾切除84例的病因及随访%Causes and Follow up of the Splenectomy in Children: A Report of 84 Cases

    Institute of Scientific and Technical Information of China (English)

    赵玉元; 高明太; 姚南

    1995-01-01

    对小儿脾切除84例中67例进行了随访,其中遗传性球形红细胞增多症(HS)、Banti综合征患儿术后生长发育、营养、血液生化检查及免疫学检查正常或接近正常.脾破裂患儿术后半年IgA、IgG、及IgM有代偿性增高.全组患儿淋巴细胞转化率均略低于正常对照组,普通感冒发生率较对照组高9.7%,术后均未出现暴发性感染者.%Eighty-four children with various diseases were treated by splenectomy, 67 of them were followed up and analysized. General development, nutrition, and laboratory and immunology examination were all normal or nearly normal after splenectomy for hereditary spherocytosis, Banti's syndrome and others, At the 6th postoperative month, the IgA, IgG and IgM in the blood of children after splenectomy were higher than that of control group. The lymphocyte transformation rate in all children after splenecyomy was slightly lower than that of control group. The morbidity of common cold in children after splenectomy was 9.7% higher than that of control group. None of them had OPSI.

  12. Laparoscopic Spleen Removal (Splenectomy)

    Science.gov (United States)

    ... Laparoscopic Appendectomy Surgery Patient Information from SAGES Laparoscopic Colon Resection Surgery Patient Information from ... and Endoscopic Surgeons 11300 W. OIympic Blvd Suite 600 Los Angeles, CA 90064 USA webmaster@sages.org Tel: (310) 437- ...

  13. The clinical experience of laparoscopic splenectomy: with a report of 51 cases%腹腔镜脾切除术的临床体会(附51例报告)

    Institute of Scientific and Technical Information of China (English)

    马陈; 陈晓岗; 王东杰; 朱挺

    2013-01-01

    目的:总结腹腔镜脾切除术(laparoscopic splenectomy,LS)的手术经验与临床体会.方法:回顾分析2005年7月至2011年7月为51例患者行LS的临床资料,其中原发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP) 38例,先天性溶血性贫血4例,遗传性球形红细胞增多症3例,门静脉高压症伴脾亢2例,外伤性脾破裂4例.结果:46例成功完成手术,5例中转手助腹腔镜手术.手术时间120 ~ 180 min,平均(150±12.1) min;术中出血量50~ 500 ml,平均(150±11.3) ml.术后住院3~7d,平均(5±0.6)d,术后无并发症发生.38例ITP患者中37例血小板恢复正常,1例术后升高后又降低.结论:LS安全可行,术前准备工作、术中体位、术者与助手的配合及脾蒂处理是手术成功的关键.%Objective:To explore and summarize the surgical and clinical experiences of laparoscopic splenectomy (LS).Methods:The clinical data of 51 patients who underwent LS between Jul.2005 and Jul.2011 were retrospectively analyzed.There were 38 cases of idiopathic thrombocytopenic purpura (ITP),4 cases of congenital hemolytic anemia,3 cases of hereditary spherocytosis,2 cases of portal hypertension with hypersplenism,and 4 cases of traumatic spleen rupture.Results:Forty-six operations were successfully done,5 cases were converted to hand-assisted laparoscopic surgery.The operating time was 120-180 min,mean (150 ± 12.1) min;the intraoperative blood loss was 50-500 ml,mean (150 ± 11.3) ml;the average postoperative hospital stay was 3-7 d,mean (5 ±0.6) d.There was no postoperative complication.Among the 38 ITP cases,the platelets in 37 cases recovered,while they increased and then decreased in 1 case after surgery.Conclusions:LS is a safe and feasible technique.The key points of the successful surgery are associated with preoperative preparation,intraoperative position,the cooperation between the surgeon and his assistants,and splenic pedicle handling.

  14. Development techniques of total product maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S. D.; Oh, Y. W.; Soong, W. S.; Oh, W. H

    2000-06-01

    Facilities should be maintained in solid operational condition and the time required for correcting the malfunctions should be minimized since the operational pause due to malfunctions would be one of the most influencing factors on the accomplishments of research goals. It is well-known that we are able to obtain about a 30% reduction of the disbursement through the scheduled pre-repairing processes and to minimize the duration of the malfunctions provided that the relevant factors were administered under systematic coordination. Hence, the development of the facility integrity management system is necessary in order to minimize the duration of the operational pause due to malfunctions with the least disbursement and to minimize the repair time, and also to maximize the efficiency of the budget execution, manpower organization and maintenance management.

  15. Rotational total skin and total nodal radiotherapy in mycosis fungoides

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, M.; Molls, M.; Langrock, J.; Muskalla, K.; Quast, U.

    1987-04-01

    The following report describes our technique of rotational total skin radiotherapy with electrons (TSER). We present stage related treatment results. Furthermore our first experiences with the combination of TSER and total nodal irradiation (TNI) are communicated.

  16. Laparoscopic splenectomy: a single-center clinical study on 55 patients%腹腔镜脾切除术55例临床分析

    Institute of Scientific and Technical Information of China (English)

    盛卫忠; 刘寒; 吴海福

    2012-01-01

    目的 探讨腹腔镜脾切除术在各类脾脏疾病中的安全性及疗效.方法 回顾分析2007年5月至2009年12月完成的55例腹腔镜脾切除术资料.其中特发性血小板减少性紫癜(ITP)11例,自身免疫性溶血性贫血6例,球形红细胞增生症1例,脾淋巴瘤1例,脾囊肿10例,脾血管瘤5例,脾脉管瘤2例,肝硬化门脉高压脾功能亢进(脾亢)患者9例,肝硬化脾亢患者9例,不明原因脾肿大脾亢1例.结果 55例患者均顺利完成腹腔镜脾切除术,无中转手助或中转开腹,平均手术时间(119.7±33.0)min.术中出血量平均(83.8±65.2)ml.术后平均住院时间(5.7±1.1)d.术后腹水1例,腹腔引流液淀粉酶升高7例,无手术死亡.结论 腹腔镜脾切除术能安全有效地适用于多种脾脏疾病的手术治疗.%Objective To study the safety and efficacy of laparoscopic splenectomy for splenic diseases.Method We retrospectively studied the outcomes of 55 patients who underwent laparoscopic splenectomy from May 2007 to December 2009.Splenic diseases included idiopathic thrombocytopenia purpura (n=11),autoimmune hemolytic anemia (n=6),hereditary spherocytosis (n=1),splenic lymphoma (n =1),splenic cyst (n=10),splenic angioma (n=5),vascular tumor of spleen (n=2),cirrhosis,portal hypertension and hypersplenism (n=9),cirrhosis and hyperplenism (n=9),and idiopathic splenomegaly (n=1).Results All patients underwent laparoscopic splenectomy,and there was no conversion to open surgery.The operation time (mean±S.D.) was (119.7±33.0) min.The intraoperative blood loss (mean± S.D.) was (83.8± 65.2) ml,and the postoperative hospital stay (mean±S.D.) was (5.7±1.1) days.One patient developed postoperative ascites,and 7 patients had drain fluid rich in amylase.There was no perioperatively death.Conclusion Laparoscopic splenectomy was safe and efficacious for splenic diseases.

  17. Persistent thrombocytopaenia in a young man with splenomegaly, rebound thrombocytosis after splenectomy and subsequent pulmonary embolism: splenic littoral cell angioma and associated events.

    Science.gov (United States)

    de Ridder, Gustaaf Gregoire; Galeotti, Jonathan; Carney, John; Wang, Endi

    2015-11-24

    Littoral cell angioma (LCA) is a rare endothelial cell neoplasm in the spleen. Although many cases of LCA are asymptomatic, some present with signs and symptoms related to splenomegaly, whereas others manifest with haematological abnormalities, including anaemia and/or thrombocytopaenia (ie, hypersplenism). We report a case of LCA presenting with chronic thrombocytopaenia, probably due to splenic sequestration of platelets or phagocytosis of platelets by neoplastic cells. Following therapeutic splenectomy, the patient suffered from a marked rebound thrombocytosis and subsequently developed pulmonary embolisms. He was treated with anticoagulant therapy combined with antiplatelet therapy, and his symptoms were quickly resolved. This case emphasises an exclusion of primary splenic disorders in patients with chronic thrombocytopaenia, especially in those with splenomegaly and the contemplation of thromboembolism prophylaxis postsplenectomy. 2015 BMJ Publishing Group Ltd.

  18. One stage laparoscopic splenectomy plus portaazygous disconnection and hepatectomy%一期腹腔镜下脾切除断流联合肝癌切除术

    Institute of Scientific and Technical Information of China (English)

    蒋国庆; 石磊; 柏斗胜; 钱建军; 陈平; 金圣杰

    2015-01-01

    Objective To investigate the feasibility and safety of elective synchronous laparoscopic splenectomy plus portaazygous disconnection and hepatectomy for cirrhotic portal hypertension patients with hypersplenism, esophageal and gastric variceal bleeding and hepatocellular carcinoma.Methods Two hepatocellular carcinoma patients with a history of upper gastrointestinal hemorrhage and secondary hypersplenism underwent one stage, non-emergency laparoscopic splenectomy plus portaazygous disconnection and hepatectomy between April 2015 and May 2015 in our department.Autologous red cell salvage was used during the operation.Liver resection was performed after splenectomy, portaazygous disconnection and the use of cell saver.Results The two operations were performed successfully.The operative time was 190 min and 205 min respectively, Volume of intraoperative bleeding was 180 ml and 260 ml.There was no intraoperative homologous blood transfusion.The two patients recovered smoothly, without major complications and postoperative hospital stay was 8 d and 9 d.Conclusions The procedure of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy for cirrhotic patients with hepatocellular carcinoma, hypersplenism and esophageal and gastric variceal bleeding is safe and feasible.%目的 探讨同步的腹腔镜下脾切、断流联合腹腔镜下肝癌切除术同时治疗门静脉高压性脾功能亢进、胃底食管静脉曲张破裂出血及原发性肝细胞肝癌的可行性及安全性.方法 回顾性分析2015年4-5月扬州大学临床医学院肝胆外科收治的2例肝硬化性门脉高压患者同时并发继发性脾功能亢进、上消化道出血与原发性肝细胞肝癌的临床资料.2例患者均施行同步的腹腔镜下脾切、断流联合腹腔镜下肝癌切除术,并同时行术中的自体血回输.手术按照先行无菌手术的原则,先行脾切和断流,并同时进行自体血回输,之后再进行肝切除.结果 2

  19. Clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension%脾切除联合冠腔分流术治疗门静脉高压症的临床疗效

    Institute of Scientific and Technical Information of China (English)

    曲凯; 刘昌

    2016-01-01

    Objective To investigate the clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension (PHT).Methods The retrospective descriptive study was conducted.The clinical data of 21 patients with PHT who underwent splenectomy combined with coronary-caval shunt at the First Affiliated Hospital of Xi'an Jiaotong University from January 2001 to December 2015 were collected.Observation indicators included (1) operation situations,changes of pre-and post-operative portal hemodynamics including operation time and volume of intraoperative blood loss,diameter and blood flow velocity of portal vein (PV),gastric coronary vein and superior mesenteric vein (SMV).(2) Clinical indexes in perioperative period (before operation,at postoperative 1 week and 1 month):① blood routine test:the counts of red blood cell (RBC),white blood cell (WBC) and platelet (PLT),② liver function:Child-Pugh score,alanine transaminase (ALT),total bilirubin (TBil),albumin (Alb),extended time of prothrombin time (PT) and international normalized ratio (INR).(3) Follow-up:postoperative 1-,3-,5-year complications [upper gastrointestinal re-bleeding,peritoneal effusion,hepatic encephalopathy,hepatic failure,portal vein thrombosis (PVT) and anastomotic stoma thrombosis].The follow-up using outpatient examination and telephone interview was regularly conducted once every 3 months within postoperative 1 year and once every 6 months after postoperative 1 year up to March 2016 or end of follow-up (death).Measurement data with normal distribution were presented as x ± s.The comparison of different time-point was analyzed by the repeated measures ANOVA and Student t test.Measurement data with sknewed distribution were presented as M (range).Results (1) Operation situations and changes of pre-and post-operative portal hemodynamics:21 patients underwent successful splenectomy combined with coronary-caval shunt,including 19 receiving splenic vein bypass combined with

  20. Avaliação intra-operatória da pressão portal e resultados imediatos do tratamento cirúrgico da hipertensão portal em pacientes esquistossomóticos submetidos a desconexão ázigo-portal e esplenectomia Intra-operative evaluation of portal pressure and immediate results of surgical treatment of portal hypertension in schistosomotic patients submitted to esophagogastric devascularization with splenectomy

    Directory of Open Access Journals (Sweden)

    Walter De Biase da Silva-Neto

    2004-09-01

    é-operatório. CONCLUSÃO: A desconexão ázigo-portal e esplenectomia promoveram queda imediata na pressão portal, com conseqüente diminuição do calibre das varizes esofágicas. Observou-se ainda que não é insignificante o risco de mortalidade e complicações graves relacionados a essa técnica.BACKGROUND: The main cause of portal hypertension in Brazil is the hepato-splenic form of mansonic schistosomiasis and the most employed technique for the surgical approach of this disease is the esophagogastric devascularization with splenectomy, generally associated to postoperative endoscopical esophageal varices sclerotherapy. The hemodynamic alterations after surgical treatment and its possible influence on the outcome are not well established. AIM: To evaluate the immediate impact of esophagogastric devascularization with splenectomy upon portal pressure as well as the results of the surgical treatment on digestive hemorrhage recurrence and on esophageal varices. METHODS: Nineteen patients with mean age of 37.9 years and portal hypertension and previous episodes of digestive hemorrhage caused by esophageal varices rupture due to hepato-splenic schistosomiasis were studied. None of the patients had received any treatment prior to the surgery and underwent to elective esophagogastric devascularization with splenectomy. Portal pressure was assessed at the beginning and at the end of esophagogastric devascularization with splenectomy through portal vein catheterization with a polyethylene catheter introduced through a jejunal branch vein. All patients were submitted to digestive endoscopy before and after the surgery, in order to classify the size of esophageal varices after esophagogastric devascularization with splenectomy according to Palmer’s classification. RESULTS: In all patients the portal pressure had diminished with a mean decrease of 31.3% after esophagogastric devascularization with splenectomy. In the postoperative endoscopic follow-up (1 month, the esophageal varices

  1. Fat absorption after total gastrectomy in rats submitted to Roux-en-Y or Rosanov-like double-transit technique Absorção de gordura após gastrectomia total em ratos com reconstrução em Y de Roux e em duplo trânsito tipo Rosanov modificado

    Directory of Open Access Journals (Sweden)

    Gustavo Sevá-Pereira

    2006-12-01

    Full Text Available PURPOSE: Steatorrhea is one of the most common complications in reconstruction after total gastrectomy. Many reconstruction techniques after total gastrectomy have been developed in order to avoid these undesirable effects, but each one of them has some inconvenience. In this experiment, a modified Rosanov technique that keeps duodenal transit, evaluation of fat absorption after gastrectomy was tested. METHODS: Three groups of rats with the same characteristics were used. Total gastrectomy was performed in two groups: one was operated on and transit was reestablished by the Roux-en-Y technique (group Y, while the other was submitted to the modified Rosanov technique (group R. Following surgery, a handmade hyper fatty diet (11% of fat was offered. A third group (control - group C was not operated but was submitted to the same conditions of the other groups, and used for reference steatocrit values. The animals underwent laparotomy 14 days after surgery and had their feces collected from cecum to determine their steatocrit by analysis of their values. RESULTS: Steatocrit values for groups R and C (mean 5.16% and 4.15% respectively were similar (p > 0.1, while group Y had significantly higher values (mean = 28.18%, p = 0.0001 - p OBJETIVO: Uma das principais complicações tardias da gastrectomia total com reconstrução de trânsito excluindo duodeno é a esteatorréia. Várias técnicas de reconstrução após gastrectomia total foram descritas para que se pudesse evitar esses efeitos indesejáveis, mas cada uma apresentou seus inconvenientes. Nesse estudo foi avaliada a técnica descrita por Rosanov com uma pequena modificação, que mantém o trânsito através do duodeno, para avaliar a absorção de gorduras. MÉTODOS: Foram utilizados três grupos de ratos Wistar machos, com peso e características semelhante. Dois grupos foram submetidos à gastrectomia total: o primeiro teve sua reconstrução com técnica de Y de Roux (grupo Y, e o

  2. Laparoscopic total pancreatectomy

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

  3. 酶法辅助提取补骨脂中总黄酮的工艺研究%Study on the Extraction Process of Total Flavonoids from Psoralea corylifolia by Enzyme-assisted Technique

    Institute of Scientific and Technical Information of China (English)

    严优芍; 廖华卫; 郭丽冰

    2012-01-01

    目的:研究纤维素酶辅助提取补骨脂中总黄酮的最佳工艺条件.方法:在单因素试验的基础上,采用响应面分析法研究了酶解pH值、酶解温度、酶解时间和酶用量对补骨脂中总黄酮得率的影响.结果:酶法辅助提取补骨脂中总黄酮的最佳条件为pH值4.9,酶解温度46℃,酶解时间150 min,酶用量7.2 mg/g;在该条件下,总黄酮得率验证值与预测值的相对误差为1.16%.结论:优化所得工艺条件简单可行,可用于补骨脂中总黄酮的提取.%Objective:To study the optimum extraction process of total flavonoids from Psoralea corylifolia by cellulose-assisted technique. Methods: Based on single-factor experiments, the effects of pH value, temperature of enzymatic hydrolysis, time of enzymatic hydrolysis and enzyme amount on the extraction yields of total flavonoids from Psoralea corylifolia were studied by response surface methodology. Results:The optimum enzyme-assisted extraction process was:pH value 4. 9, temperature 46 ℃ , time 150 min and enzyme amount 7. 2 mg/g,under this condition,the relative error of the observed and predicted values was 1. 16%. Conclusion:The optimum enzyme-assisted extraction process is simple and feasible,the extraction rate of total flavonoids increases by 28% compared with ultrasonic extraction, so it can be used to extract total flavonoids from Psoralea corylifolia.

  4. Hernioplastia laparoscópica totalmente extraperitoneal com tela 3-D sem fixação: técnica de Dulucq Laparoscopic totally extraperitoneal hernioplasty with nonfixation of three-dimensional mesh: Dulucq's technique

    Directory of Open Access Journals (Sweden)

    Alberto Meyer

    2013-03-01

    Full Text Available INTRODUÇÃO: A reparação da hérnia inguinal tem sido área controversa na prática cirúrgica, desde que desde que ela foi concebida. O fato de que inúmeros procedimentos diferentes estão em uso reflete a complexidade de hérnia inguinal e seu reparo. OBJETIVO: Descrever a técnica de Dulucq e as modificações do uso da tela 3-D na correção de hérnia inguinal laparoscópica totalmente extraperitoneal. MÉTODOS: A técnica da correção da hérnia laparoscópica totalmente extraperitoneal é detalhada no texto. CONCLUSÃO: Correção laparoscópica totalmente extraperitoneal é preferível à correção de hérnias transabdominais pré-peritoneais porque o peritônio não é violado. A dissecção deve ser sempre realizada nos mesmos passos, sem utilizar cautério monopolar e o paciente em leve posição de Trendelemburg. Com estas recomendações, a hernioplastia laparoscópica totalmente extraperitoneal é factível com poucas complicações intra-abdominais.INTRODUCTION: The inguinal hernia repair has been a controversial area in the surgical practice ever since it has been conceived. The fact that numerous different procedures are in use reflects the complexity of inguinal hernia and its repair. AIM: The purposes of this study were to describe Dulucq's technique and the modifications of using 3-D mesh in laparoscopic totally extraperitoneal inguinal hernia repair. METHODS: Surgical technique of laparoscopic totally extraperitoneal hernia repair is detailed on the text. CONCLUSION: Laparoscopic totally extraperitoneal is preferred over transabdominal preperitoneal hernia as the peritoneum is not violated. The dissection must always be done with the same stages, without monopolar diathermy and the patient in a slight Trendelenburg position. Following these recommendations, the laparoscopic totally extraperitoneal hernioplasty is feasible with fewer intra-abdominal complications.

  5. 军队医院实施特色技术全面质量管理的探索%Total Quality Management of Special Technique in Military Hospital

    Institute of Scientific and Technical Information of China (English)

    胡文魁; 田浩; 伍敏

    2012-01-01

    本文总结医院在特色技术实践中引入全面质量管理的经验与效果,提出建立有效地质量管理体系、强化质量标准化管理、加强质量监控管理、加大质量评估和奖惩力度等对策.%The article summarized the experiences and effects of implementing total quality management in special techniques of hospital. The author also put forward some countermeasures, which included the establishment of effective quality management system, reinforcement of quality standard management, quality monitoring management , quality evaluating, and the efforts of rewards and punishment.

  6. Application experience of developing individualized surgical treatment based on preoperative CTA in laparoscopic splenectomy%依据CT血管成像制定个体化手术方案在腹腔镜脾切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    李巍; 董晓彤; 崔志新; 刘亚利; 康建省; 张学军

    2011-01-01

    Objective To explore the application of developing individualized surgical treatment based on preoperative CTA in Laparoscopic Splenectomy. Methods To do the splenic artery CTA examination before operation and guide the development of individualized surgical treatment: using the technique of spleen subpedicle severance in distributed splenic artery and using the technique of spleen pedicle severance in centralized splenic artery;Splenic artery was located above the pancreatic tail,and to isolate it first and to do ligation of splenic artery;Splenic artery was located in the pancreas or behind pancreas tail,and to cut the surrounding ligaments first and to peel off the pancreas tail, and then to expose the splenic pedicle. Results 40 patients were successfully completed laparoscopic splenectomy, bleeding was reduced and the operation time was shorten. Conclusion CTA can identify splenic artery and its branches anatomy type and traveling before LS, therebyto guide the development of individualized surgical reatment,it can increase thesafety of LS.%目的 探讨术前依据CT血管成像(CTA)制定个体化手术方案在腹腔镜脾切除术中的应用.方法 对40例患者术前行脾动脉CTA检查,制定个体化手术方案.分散型脾动脉行脾蒂二级血管离断术,集中型脾动脉行脾蒂一级血管离断术;脾动脉位于胰腺上缘,先行分离并结扎脾动脉主干,脾动脉位于胰腺后方或胰尾内,先离断脾周围韧带和剥离胰尾,再显露脾蒂血管.结果 40例患者顺利完成腹腔镜脾切除术,术中出血减少,手术时间缩短.结论 术前CTA可明确脾动脉及其分支解剖类型及其走行,指导制定个性化手术方案,增强手术的安全性.

  7. 苯甲酸釜残液全部回收的工艺开发利用%Development on the Technique of Total Recovery of Benzoic Acid Residue

    Institute of Scientific and Technical Information of China (English)

    徐姣; 何杰; 张卫江; 杨焘; 焦书军; 胡雪东

    2009-01-01

    Benzoic acid residue is solid waste produced from the production of benzoic acid by oxidizing toluene. Because it contained important chemical raw materials such as benzoic acid, benzyl benzoate and fluorenone, it is necessary to recover them from the residue. In this work the technique featured with high efficiency evaporation and vacuum distillation was developed to obtain total recovery and utilization of the benzoic acid residue. By con-trolling the operation temperature at 260℃ and the pressure of 16 kPa in the rising and falling film evaporators, heavy components separated efficiently from the residue can be polymerized and the light components consisting of 63% of the residue entered into a benzoic acid vacuum distillation column. Keeping the temperature of polymeriza-tion at (280±10)℃, coumarone resin was produccd after adjusting the softening point according to the market re-quirements. Vacuum distillation was operated under the following conditions: top temperature at 186℃, top pres-sure of 16 kPa, bottom temperature at 240 250℃, reflux ratio being 3:1. Benzoic acid of 98% purity was distilled out from the column as a side stream and the bottom product was crude benzyl benzoate. By the developed tech-nique, the benzoic acid residue was splitted into three products, benzoic acid, crude benzyl benzoate and coumarone resin without any surplus waste.

  8. A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

    Directory of Open Access Journals (Sweden)

    Ryosuke Desaki

    2014-01-01

    Full Text Available For pancreatic ductal adenocarcinoma (PDAC of the head and/or body invading the splenic artery (SA, we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR. We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n=66 and PD-SAR (n=18. Most patients were treated by preoperative chemoradiotherapy (CRT. Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P=0.538, despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

  9. Study on effect of splenic vein formation prevention of venous thrombosis after splenectomy%脾静脉置管防治脾切除术后门静脉血栓形成疗效研究

    Institute of Scientific and Technical Information of China (English)

    甄萍; 许丙辉; 刘昭明; 齐双玉; 杜桂梅

    2014-01-01

    Objective to investigate the operative splenicvein catheter safety and effectiveness in preventing portal vein thrombosis after splenectomy. Methods from 2010March to 2013 January, were randomly divided 120 patients admitted to our hospital for splenectomy into 2 groups, 60 cases in the treatment group, 60 cases in the control group. the treatment group after splenectomy,splenic venous epidural catheterization, and retroperitonealthrough lateral abdominal wall leads, after the catheter pump into heparinized saline to prevent portal vein thrombosis. the control group used routine splenectomy,platelet chan ge monitoring after operation, platelet than normal, start taking aspirin, Pan shengding, and the infusion of low molecular dextran, prevention of portal vein thrombosis. Between the two groups in operation time,amount of bleeding, the incidence of portal vein thrombosis, hospitalization time. Results in the treatmentgroup and the control group, operation time and there is no significant difference (P >0.05), portal vein thrombosis occurred in the treatment group was lower than that in the control group, the differences were significant (P 0.05),治疗组门静脉血栓发生率低于对照组,差异均有显著性(P <0.05),治疗组手术死亡率较对照组降低,异有显著性(P <0.05)。结论术中脾静脉置管可以有效预防脾切除术后门静脉血栓形成,缩短住院时间,降低手术死亡率。

  10. Clinical Analysis of Portal Vein Thrombosis after Splenectomy%脾切除术后门静脉系统血栓形成的临床分析

    Institute of Scientific and Technical Information of China (English)

    陈国富; 范国华

    2012-01-01

    目的 探讨脾切除术后门静脉血栓形成(portal vein thrombosis,PVT)的原因、诊断和治疗.方法 对我院2002年8月至2008年8月期间收治的因肝硬变门静脉高压症及外伤脾破裂行脾切除术后发现PVT的29例患者的临床资料进行回顾性分析.结果 29例PVT患者中27例经抗凝溶栓治疗后血栓完全或部分溶解吸收、康复出院;1例因腹膜炎、感染性休克和多器官功能衰竭死亡;1例因呕血、肝昏迷及多器官功能衰竭死亡.24例患者获随访,3例失访,随访时间0.5~3年,平均2年,其中2例因大出血死亡、1例因肝性脑病死亡、1例因肝功能衰竭死亡,2例于出院1年后发生下肢深静脉血栓,其余患者未再发生静脉血栓.结论 PVT与脾切除术后血小板升高及血流动力学改变有关,手术操作规范化、早期诊断以及抗凝祛聚是防治PVT的有效方法.%To explore the cause, diagnosis, and treatment methods of portal vein thrombosis (PVT) after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweenty-seven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis, septic shock, and multiple organ failure. One case died of hematemesis, hepatic coma, and multiple organ failure. Tweenty-four patients were followed up, the follow-up time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy, and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of

  11. 间隙平衡技术在全膝关节置换术中应用的中期随访研究%Mid-term follow-up of gap balancing technique in total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    孙振辉; 刘军; 田峥巍; 张宇; 王磊; 孙云波

    2013-01-01

    [目的]分析间隙平衡技术在全膝关节置换(total knee arthroplasty,TKA)术中应用的临床效果及注意事项.[方法]回顾分析2004年3月~ 2006年3月应用间隙平衡(gap balancing,GB)技术的TKA患者45例(49膝),男16例,女29例,手术时年龄52 ~ 79岁,平均62.4岁.另取同期采用测量截骨(measured resection,MR)技术的TKA患者70例(76膝)设为对照组.比较分析两组患者的手术情况、影像学、膝关节功能恢复情况.[结果] 115例患者均获随访,时间6~8年,平均6.8年.GB组单膝手术时间、胫骨截骨量、股骨截骨量均明显低于MR组,术中股骨假体相对外上髁解剖轴内旋角度GB组大于MR组(P<0.05).TKA术后两组患者髌骨外倾角度存在显著性差异(P<0.05),GB组明显大于MR组.术后膝关节KSS、VAS评分及并发症发生率两组比较均无显著性差异(P>0.05).[结论] TKA术中应用GB技术手术时间短,截骨量少,股骨假体相对外上髁解剖轴内旋和髌骨倾斜角度较大,中期随访临床效果和MR技术无明显差异,GB技术应避免内侧软组织过度松解,预防术后屈曲失稳及髌股关节并发症.%[Objective] To evaluate the efficiency and surgical notes of gap balancing (GB) technique used in total knee arthroplasty (TKA).[Methods] Forty-five cases (49 knees) underwent TKA with GB technique from March 2004 to March 2006 were retrospectively analyzed,including 16 males and 29 females,average age 62.4.And another 70 patients (76 knees) were selected as control group,who underwent measured resection (MR) technology at the same period.The data of surgery,imaging and knee function were compared.[Results] All patients were followed up for 6-8 years,average 6.8 years.The one side knee surgery time,tibial and femoral bone resection in the GB group was significantly lower than in the MR group,the femoral component internal rotation relative to the anatomical epicondylar axis was greater in the GB group (P < 0.05).And

  12. The Experiences of Splenectomy in 35 Cases of Hereditary Spherocytosis in Children%脾切除治疗小儿遗传性球形细胞增多症(附35例临床分析)

    Institute of Scientific and Technical Information of China (English)

    李振东; 牟弦琴; 张道荣; 牛爱国

    1987-01-01

    35 cases of hereditary spherocytosis (HS) were treated by splenectomy in the author's hospital from July 1974 to December 1985. 18 males and 17 females. The age sranged from 18 months to 14 years. Sixteen of them were between 4~6 years. All of them had jaundice, anemia and splenomegaly of various degree. Splenectomy was performed on all of the 35 cases. Accessory spleens were found in ten (32%) of the patients and all were removed. Gallstone was found in a girl and was removed. Postoperative courses were uneventfull in all. Twenty-eight cases were followed-up for 76.3 months ( mean of 13-142 months ) . All of them were symptom free,The age of splenectomy, cautions during operation, and the treatment of gallstone were discussed.%作者就35例脾切除治疗小儿遗传性球形细胞增多症的经验,分析和讨论了有关脾切除的年龄,手术注意事项以及合并胆结石的处理问题.

  13. NURSING ON THE HEPATECTOMY AND SPLENECTOMY IN TREATMENT OF LIVER CANCER%肝癌切除合并脾切除手术护理

    Institute of Scientific and Technical Information of China (English)

    张静

    2011-01-01

    [目的]探讨肝癌切除合并脾切除手术治疗的临床观察和护理疗效.[方法]选择80例原发性肝细胞癌合并肝硬化及脾淤血性肿大患者.并给术前肝功能及凝血功能改善,营养支持及肠道准备,并建立足够的门静脉通道;术中观察患者的尿量,出血量等,并积极配合手术进程;术后加强心理护理以及并发症的预防.[结果]护理人员充分地术前准备、术中密切地观察和护理、积极有效地配合使得80例患者手术均获成功,术后血小板、白细胞恢复正常,肝功能2周后有改善. [结论]积极有效地护理配合是肝癌切除合并脾切除手术成功的重要保障.%[Objective] To explore the clinical efficacy and nursing on the hepateclomy and splenectomy in treatment of liver cancer. [Methods] We retrospectively collected 80 patients with primary hepatocellular carcinoma complicated with cirrhosis and congestive splenomegaly. Before operation, they received therapy for liver cancer improvement and coagulant function, nutrition support, bowl preparation, and portal vein channel establishment. In the operation, the urine volume and amount of bleeding of the patients were observed, and the nurses actively cooperated with doctors during the surgery. After operation, the related psychological nursing and prevention of complications were strengthened. [Results] Sufficient preparation before surgery, carefully observation and nursing as well as active cooperation during surgery were the essential factors for the successful of surgery. After surgery, the blood cells and leukocyte reached normal or higher, and the liver function was improved after two weeks of surgery. [Conclusion] Active and effective nursing is the guarantee for hepatectomy and splenectomy in treatment of liver cancer.

  14. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  15. Technique of dissection in the pre-rectal space during laparoscopic total mesorectal excision%腹腔镜TME术中直肠前间隙的解剖分离技巧

    Institute of Scientific and Technical Information of China (English)

    池畔; 陈致奋

    2015-01-01

    直肠前间隙的解剖是腹腔镜直肠全系膜切除术(total mesorectal excision,TME)的一个难点。术中若解剖层面不当,容易造成直肠前壁固有筋膜破损或损伤邻近的神经血管束。对于直肠前壁的肿瘤,直肠固有筋膜破裂可能造成环周切缘阳性及局部复发;神经血管束损伤则可能导致术后性功能障碍,特别是在男性患者。掌握直肠前间隙的解剖技巧有利于提高TME手术的手术质量及患者的术后生存质量。%It is a difficult procedure to dissect in the pre-rectal space during laparoscopic total mesorectal excision(TME). If the dissection was not in the right space, the fascia propria of the anterior rectal wall would be broken and damage the neurovascular bundles nearby. With regard to the tumor located in the anterior rectal wall, the broken fascia propria of the rectum may result in the involvement of the circumferential resection margin and local recurrence. And the damage of the neurovascular bundles would lead to post-operative sexual dysfunction, especially in the male. It is important for the surgeons to master the technique of dissection in the pre-rectal space, and it is helpful to improve the quality of TME and the quality of life of the patients after operations.

  16. 腹腔镜下原位脾切除治疗遗传性球形红细胞增多症临床观察%Orthotopic splenectomy by laparoscope in treatment of hereditary spherocytosis

    Institute of Scientific and Technical Information of China (English)

    曲义坤; 徐剑; 张英海; 夏伟滨

    2013-01-01

    目的 总结腹腔镜下原位脾切除治疗遗传性球形红细胞增多症的疗效.方法 回顾分析我院实施脾切除术治疗22例遗传性球形红细胞增多症患者,其中采用腹腔镜下原位脾切除治疗10例,常规开腹行脾切除12例患者的临床资料.结果 10例均成功完成腹腔镜下原位脾切除术,手术时间平均140 min,术中出血量平均150 mL,住院时间平均6d,出院时血红蛋白均高于120 g/L,术后均未出现胰瘘,贫血及黄疸消失.结论 腹腔镜下原位脾切除和常规开腹行脾切除相比具有创伤小、术中术后出血少、恢复快和并发症发生率低等优点,是治疗难治性遗传性球形红细胞增多症的有效方法.%Objective To summarize the efficacy of orthotopic splenectomy by laparoscope in the treatment of hereditary spherocytosis.Methods There were 22 patients with hereditary spherocytosis(HS),who received orthotopic splenectomy by laparoscope,10 cases of them underwent orthotopic splenectomy by laparoscope,12 cases treated with traditional splenectomy.Results Ten cases successfully completed surgery.The average operation time was 140 min,average blood loss during operation was 150 mL,and average length of hospitalization was 6 days.The level of hemoglobin was higher than 120 g/L,no pancreatic fistula occurred postoperatively,anemia and jaundice disappeared.Conclusion Orthotopic splenectomy by laparoscope is a effective treatment for HS,with less trauma,less bleeding,faster recovery after surgery and lower incidence of complications.

  17. Estudo histológico da regeneração esplênica de ratos submetidos a esplenectomia subtotal Histological study of splenic regeneration in rats underwent to subtotal splenectomy

    Directory of Open Access Journals (Sweden)

    Orlando Jorge Martins Torres

    2000-06-01

    Full Text Available Um aumento da susceptibilidade à infecção severa é uma complicação reconhecida da esplenectomia. Um grande número de alternativas tem sido propostas que poderiam impedir esta complicação do estado asplênico. O presente estudo analisa a regeneração histológica do tecido esplênico em ratos submetidos a esplenectomia subtotal. Foram utilizados trinta ratos machos da linhagem Wistar, adultos, pesando entre 160 e 210g. Os animais foram submetidos a esplenectomia subtotal e divididos em três grupos contendo dez ratos cada onde foram estudados após 15, 30 e 45 dias. Após este período de observação o tecido esplênico foi recuperado e submetido a exame histológico. A estrutura tecidual esplênica no 15º dia se apresentava irregular, porém sem necrose. Após 30 dias , a cápsula se apresentava histologicamente espessada e com maior desenvolvimento. Em 45 dias foi observado semelhança considerável entre o tecido esplênico remanescente e o baço normal. O presente estudo mostra que o baço submetido a esplenectomia subtotal se regenera completamente em um período de 45 dias.An increase susceptibility to overwhelming infection is now a well-recognized complication of splenectomy. A number of alternatives to splenectomy have been proposed that could possibly prevent this complication of the asplenic state. The present study analize the histological regeneration of the splenic tissue in rats underwent to subtotal splenectomy. Thirty adult male Wistar rats were used, weighing 160 to 210g. The rats were underwent to subtotal splenectomy, divided into three groups of ten rats each, and analized after 15, 30, and 45 days. After this period of time the splenic tissue were withdrawn and submitted to histological examination. The splenic tissue structure on the 15th day was irregular without necrosis. The histological examination on the 30th day, the splenic tissue in the capsule was now with a greater development. After 45th day, an

  18. The Effect of Early Enteral Nutrition Nursing on Postoperative Recovery in the Patients with Liver Cirrhosis After Simple Splenectomy%术后早期肠内营养护理方式对肝硬化行单纯脾切除术患者术后恢复的影响

    Institute of Scientific and Technical Information of China (English)

    孙青; 徐清玲

    2015-01-01

    Objective To explore the effects of early enteral nutrition nursing in patients with liver cirrhosis after simple splenectomy.Methods From January 2013 to June 2014 in our hospital fifty patients with liver cirrhosis after simple splenectomy were selected and randomly divided into 2 groups: the observation group and the control group, two groups' preoperative treatment methods were the same. The control group was given the conventional diet nursing, the observation group was given early post-operative enteral nutrition nursing. The postoperative nutrition situation, immune status, gastrointestinal function, rehabilitation conditions were compared between the two groups.ResultsTotal plasma protein, albumin, prealbumin and hemoglobin 5 days after the operation in the observation group were significantly higher than those in the control group with statistical significance (P<0.05). The postoperative recovery time of bowel sound, anal exhaust time, defecation time, wound healing time, ordinary diet time, hospital-stay time in the observation group were signifi cantly less than those in the control group with statistical signifi cance (P<0.05).Conclusion Early enteral nutrition nursing could improve nutrition situation and intestinal function of patients with liver cirrhosis after simple splenectomy and accelerate rehabilitation.%目的:探讨术后早期肠内营养护理在肝硬化行单纯脾切除患者术后的应用效果。方法选取2013年1月—2014年6月收治的50例肝硬化行单纯脾切除术的患者,随机分为观察组和对照组,两组术前处理方法相同。对照组术后采用常规护理、常规营养;观察组采用术后早期肠内营养护理。比较两组患者术后营养、免疫状态、胃肠功能及康复情况。结果观察组术后5 d的血浆总蛋白、白蛋白、前蛋白、血红蛋白计数均高于对照组,差异有统计学意义(P<0.05)。观察组术后的肠鸣音恢复时间、肛门排气时

  19. Splenectomy versus Partial Splenic Embolization for Massive Splenomegaly Secondary to Hepatitis B-Related Liver Cirrhosis: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Shoufei Jiao

    2016-01-01

    Full Text Available Background. Both splenectomy (SP and partial splenic embolization (PSE are used to treat massive splenomegaly (MSM secondary to hepatitis B-related liver cirrhosis (HB-LC. This retrospective case-control study was conducted to compare the effects of SP and PSE on these patients. Methods. From July 2004 to January 2012, patients with MSM secondary to HB-LC who underwent SP or PSE were 1 : 1 : 1 matched with similar nonsurgery patients, respectively. Intraoperative situation, hematological indices, liver function, HBV DNA level, HBeAg seroconversion rate, morbidity, and mortality at 6 months postoperatively were compared. Results. Operative time, estimated blood loss, blood transfusion rate, severe pain, postoperative stay, and portal vein thrombosis (PVT rate in the PSE group were significantly superior to the SP group, although SP and PSE were similar in liver function improvement, HBV suppression, morbidity, and mortality at 6 months postoperatively, and SP even improved WBC and PLT counts higher than PSE. Conclusion. Both SP and PSE are effective in improving liver function, increasing WBC and PLT counts, and suppressing replication of HBV for MSM secondary to HB-LC. Although postoperative improvement in WBC and PLT counts by SP can be higher than PSE, PSE is simple and minimally invasive and has a lower incidence of PVT.

  20. Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction.

    Science.gov (United States)

    Murata, S; Yamazaki, M; Kosugi, C; Hirano, A; Yoshimura, Y; Shiragami, R; Suzuki, M; Shuto, K; Koda, K

    2014-01-01

    Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.

  1. VOICE REHABILITATION FOLLOWING TOTAL LARYNGECTOMY

    Directory of Open Access Journals (Sweden)

    Balasubramanian Thiagarajan

    2015-03-01

    Full Text Available Despite continuing advances in surgical management of laryngeal malignancy, total laryngectomy is still the treatment of choice in advanced laryngeal malignancies. Considering the longevity of the patient following total laryngectomy, various measures have been adopted in order to provide voice function to the patient. Significant advancements have taken place in voice rehabilitation of post laryngectomy patients. Advancements in oncological surgical techniques and irradiation techniques have literally cured laryngeal malignancies. Among the various voice rehabilitation techniques available TEP (Tracheo oesophageal puncture is considered to be the gold standard. This article attempts to explore the various voice rehabilitation technique available with primary focus on TEP.

  2. Unraveling transition metal dissolution of Li1.04Ni1/3Co1/3Mn1/3O2 (NCM 111) in lithium ion full cells by using the total reflection X-ray fluorescence technique

    Science.gov (United States)

    Evertz, Marco; Horsthemke, Fabian; Kasnatscheew, Johannes; Börner, Markus; Winter, Martin; Nowak, Sascha

    2016-10-01

    In this work we investigated the transition metal dissolution of the layered cathode material Li1.04Ni1/3Co1/3Mn1/3O2 in dependence on the cycle number and cut-off cell voltage during charge by using the total reflection X-ray fluorescence technique for the elemental analysis of the specific lithium ion battery degradation products. We could show that with ongoing cycling transition metal dissolution from the cathode increased over time. However, it was less pronounced at 4.3 V compared to elevated charge cut-off voltages of 4.6 V. After a maximum of 100 cycles, we detected an overall transition metal loss of 0.2 wt‰ in relation to the whole cathode active material for cells cycled to 4.3 V. At an increased charge cut-off voltage of 4.6 V, 4.5 wt‰ transition metal loss in relation to the whole cathode active material could be detected. The corresponding transition metal dissolution induced capacity loss at the cathode could thus be attributed to 1.2 mAh g-1. Compared to the overall capacity loss of 80 mAh g-1 of the complete cell after 100 galvanostatic charge/discharge cycles the value is quite low. Hence, the overall full cell capacity fade cannot be assigned exclusively to the transition metal dissolution induced cathode fading.

  3. A new technique for the deposition of standard solutions in total reflection X-ray fluorescence spectrometry (TXRF) using pico-droplets generated by inkjet printers and its applicability for aerosol analysis with SR-TXRF

    Energy Technology Data Exchange (ETDEWEB)

    Fittschen, U.E.A. [University of Hamburg, Department of Chemistry, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg (Germany)]. E-mail: ursula.fittschen@chemie.uni-hamburg.de; Hauschild, S. [University of Hamburg, Department of Chemistry, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg (Germany); Amberger, M.A. [University of Hamburg, Department of Chemistry, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg (Germany); Lammel, G. [Max Planck Institute for Meteorology, Bundesstrasse 53, 20146 Hamburg (Germany); Streli, C. [Atominstitut, Vienna University of Technology, Stadionallee 2, 1020 Vienna (Austria); Foerster, S. [University of Hamburg, Department of Chemistry, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg (Germany); Wobrauschek, P. [Atominstitut, Vienna University of Technology, Stadionallee 2, 1020 Vienna (Austria); Jokubonis, C. [Atominstitut, Vienna University of Technology, Stadionallee 2, 1020 Vienna (Austria); Pepponi, G. [ITC-irst, Via Sommarive 18, 38050 Povo (Trento) (Italy); Falkenberg, G. [Hamburger Synchrotronstrahlungslabor at Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22603 Hamburg (Germany); Broekaert, J.A.C. [University of Hamburg, Department of Chemistry, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg (Germany)

    2006-11-15

    A new technique for the deposition of standard solutions on particulate aerosol samples using pico-droplets for elemental determinations with total reflection X-ray fluorescence spectrometry (TXRF) is described. It enables short analysis times without influencing the sample structure and avoids time consuming scanning of the sample with the exciting beam in SR-TXRF analysis. Droplets of picoliter volume ({approx} 5-130 pL) were generated with commercially available and slightly modified inkjet printers operated with popular image processing software. The size of the dried droplets on surfaces of different polarity namely silicone coated and untreated quartz reflectors, was determined for five different printer types and ten different cartridge types. The results show that droplets generated by inkjet printers are between 50 and 200 {mu}m in diameter (corresponding to volumes of 5 to 130 pL) depending on the cartridge type, which is smaller than the width of the synchrotron beam used in the experiments (< 1 mm at an energy of 17 keV at the beamline L at HASYLAB, Hamburg). The precision of the printing of a certain amount of a single element standard solution was found to be comparable to aliquoting with micropipettes in TXRF, where for 2.5 ng of cobalt relative standard deviations of 12% are found. However, it could be shown that the printing of simple patterns is possible, which is important when structured samples have to be analysed.

  4. Obtention of polymeric membrane fuel cells by low pressure plasma technique: Evaluation of total cell efficiency by function on the amount of platinum and the thickness of the deposited carbon support

    Science.gov (United States)

    Moreira, A. J.; Ordonez, N.; Mansano, R. D.

    2015-03-01

    This work aimed to obtain catalytic support over polymeric membrane building a fuel cell using low pressure plasma technique. For this, polymeric membranes were coated with carbon layer and platinum nanoparticles. The procedures were performed in separate steps in order to obtain firstly carbon layer and catalytic platinum nanoparticles. In the first step, the plasma processes were carried methane in order to obtain carbon layer over the polymeric membrane. At this stage, in order to obtain different thicknesses, were made several processes, reaching a thickness of 0.36μm to 1.4μm. The second step was to get the platinum nanoparticles on the carbon layer. For this, was used a platinum solid source and argon plasma. The study relied primarily on assessing the influence of the carbon layer on the performance of fuel cell. Compared with the commercial processes, it was observed that the results for fuel cells obtained by plasma have a better electric contact on three cell layers (catalyst - electrolyte - reagent). By electrochemical activity test was possible observe increase of reverse voltage of 0.8 volts to 1.24 volts according to increase the thickness of the carbon layer. The same behavior was also observed in the analysis of total efficiency, which was limited to 50% of maximum efficiency of commercial cell due the thickness of the carbon layer deposited during the preparation of this study, indicating a greater thickness with carbon it is possible to achieve the same efficiency of cells better than commercial.

  5. Total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2012-01-01

    Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

  6. Calibrações por meio da técnica da espectroscopia no infravermelho próximo para teor de extrativos totais, de lignina total e holocelulose usando espectros obtidos na madeira sólida / Calibrations using the technique of near infrared spectroscopy for content of extractives, lignin total and holocellulose using spectra obtained in solid wood

    Directory of Open Access Journals (Sweden)

    Carlos Rogério Andrade

    2011-04-01

    Full Text Available O objetivo desse trabalho foi obter curvas de calibrações por meio da técnica de espectroscopia no infravermelho próximo (NIRS para as propriedades teor de extrativos totais, lignina total e de holocelulose, usando espectros das faces radial, tangencial e transversal da madeira sólida. Foi utilizado um híbrido natural de Eucalyptus urophylla pertencente à empresa V&M Florestal, localizada no município de Paraopeba (MG. O híbrido tinha sete anos de idade e estava plantado em espaçamento de 3m x 3m. Os corpos-de-prova foram retirados ao longo de todo o fuste. O equipamento utilizado foi um espectrômetro da marca Bruker modelo MPA-R. Os espectros foram adquiridos na gama de 800 a 1.500 nm, em modo de reflexão difusa. Os modelos foram ajustados pelo método PLS-1. Foi utilizado o método da validação cruzada com pré-tratamentos de primeira e segunda derivada e remoção do espalhamento de luz. Pelos resultados conclui-se que: De maneira geral, os maiores valores de correlação foram obtidos a partir da média das faces tangencial, transversal e radial; as melhores calibrações foram obtidas quando aplicou-se o pré-tratamento de segunda derivada; melhores resultados: extrativos totais r = 0,66 e RPD = 1,3; teor de lignina total r = 0,70 e RPD = 1,5 e teor de holocelulose r = 0,66 e RPD = 1,4.AbstractThe purpose of this study was to obtain calibration curves using Near Infrared Spectroscopy Technique (NIRS for the determination of total extractive content, total lignin, and holocellulose, using the radial face, tangential, and transversal spectra of solid wood. We used a natural hybrid of Eucalyptus urophylla owned by V & M Florestal, located in Paraopeba city (MG. The hybrid was seven years old and was planted in 3m x 3m space. The soils-proof was taken throughout the shaft. The used equipment was a Bruker spectrometer brand model MPA-R. The spectra were acquired in the range from 800 to 1,500 nm in diffuse reflection mode. The

  7. Splenectomy exacerbates atrial inflammatory fibrosis and vulnerability to atrial fibrillation induced by pressure overload in rats: Possible role of spleen-derived interleukin-10.

    Science.gov (United States)

    Kondo, Hidekazu; Takahashi, Naohiko; Gotoh, Koro; Fukui, Akira; Saito, Shotaro; Aoki, Kohei; Kume, Osamu; Shinohara, Tetsuji; Teshima, Yasushi; Saikawa, Tetsunori

    2016-01-01

    The spleen is important for cardiac remodeling induced by myocardial infarction. However, the role of the spleen in inflammatory atrial fibrosis induced by pressure overload is unknown. The purpose of this study was to investigate whether splenectomy (SPX) attenuates or exacerbates pressure overload-induced atrial inflammatory fibrosis and vulnerability to atrial fibrillation (AF) in rats. Male Sprague-Dawley rats (6 weeks old) were divided into Sham+Sham, Sham+SPX, abdominal aortic constriction (AAC)+Sham, and AAC+SPX groups, and were evaluated for inflammation, fibrosis, and AF on days 2, 4, 14, and 28. On day 4, an AAC-induced rise in interleukin-10 (IL-10) level was observed in the spleen, serum, and left atrium (LA), with SPX showing inhibitory effects in the latter 2 instances. In addition, AAC-induced M2 macrophage recruitment into the LA was decreased by SPX, as determined by immunofluorescence labeling (P <.05). On day 28, AAC-induced heterogeneous interstitial fibrosis of the LA was enhanced by SPX (P <.05). Electrophysiologic recordings revealed that the duration of AF and prolongation of interatrial conduction time induced by AAC were increased by SPX (P < .01 and P <.05, respectively). Furthermore, in the AAC+SPX group, the number of macrophages infiltrating into the LA on day 2 was marginal, but increased on day 28 relative to the AAC+Sham group. IL-10 administration attenuated the AAC-induced atrial remodeling that was aggravated by SPX. The study results suggest that SPX exacerbates AAC-induced inflammatory atrial fibrosis and increases vulnerability to AF after 4 weeks, likely because of depletion of spleen-derived IL-10. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  8. Application of the total etching technique or self-etching primers on primary teeth after air abrasion Aplicação da técnica de condicionamento total ou de "primers" autocondicionantes em dentes decíduos após abrasão a ar

    Directory of Open Access Journals (Sweden)

    Fábio Renato Manzolli Leite

    2005-09-01

    Full Text Available Since the use of air abrasion has grown in pediatric dentistry, the aim of this study was to evaluate, by means of shear bond strength testing, the need to use the total etching technique or self-etching primers on dentin of primary teeth after air abrasion. Twenty-five exfoliated primary molars had their occlusal dentin exposed by trimming and polishing. Specimens were treated by: Air abrasion + Scotchbond MultiPurpose adhesive (G1; 37% phosphoric acid + Scotchbond MP adhesive (G2; Clearfil SE (G3; Air abrasion + 37% phosphoric acid + Scotchbond MP adhesive (G4; Air abrasion + Clearfil SE (G5. On the treated surface, a cylinder of 2 mm by 6 mm was made using a composite resin (Z100. Duncan's test showed that: (G2 = G3 = G5 > (G1 = G4. The use of a self-etching primer on air abraded dentin is recommended to obtain higher bond strengths.Como o uso da abrasão a ar tem aumentado em odontopediatria, o objetivo deste trabalho foi avaliar a resistência ao cisalhamento da resina composta Z100 sobre a superfície dentinária de dentes decíduos após abrasionamento a ar associado ou não a técnica de condicionamento total (ácido fosfórico + Scotchbond Multi Purpose ou "primer" autocondicionante (Clearfil SE Bond. A superfície oclusal de 25 molares decíduos foi removida para exposição completa da superfície dentinária. Após polimento com lixas abrasivas, foram divididos em 5 grupos (5 espécimes em cada tratados por abrasão + adesivo Scotchbond (G1; condicionamento ácido + adesivo Scotchbond (G2; adesivo Clearfil (G3; abrasão a ar + condicionamento ácido + adesivo Scotchbond (G4; abrasão a ar + adesivo Clearfil (G5. Uma matriz bipartida foi adaptada à superfície dentinária e preenchida com resina composta. Após polimerização, corpos-de-prova de 2 mm x 6 mm foram obtidos. O teste de Duncan mostrou a desigualdade (G1 = G4 < (G2 = G3 = G5. Desse modo, conclui-se que, após o abrasionamento dentinário, deve ser utilizado o sistema de

  9. Aplicación de Gestión Total Eficiente de Energía en el Centro Internacional de Salud “La Pradera”; Application of Total Management Techniques of Energy Efficiency at the International Health Centre "La Pradera”

    Directory of Open Access Journals (Sweden)

    Leyat Fernández Velázquez

    2015-04-01

    Full Text Available En este artículo se presentan los primeros resultados obtenidos de la aplicación de la Metodología de las Técnicas de Gestión Total Eficiente de la Energía en el Centro Internacional de Salud “La Pradera”. Se realizó una caracterización energética del Centro, determinándose la estructura de consumo de los portadores energéticos. Se efectuó una investigación estadística de los datos del Centro durante los años 2010 y 2011, obteniéndose que el portador energético más influyente en el consumo de la instalación es la energía eléctrica. Se analizó la relación entre el índice de consumo kilowatt hora vs habitación-día-ocupada (kWh/HDO para evaluar correctamente la eficiencia energética del centro, determinándose que la temperatura ambiente es un factor significativo en los consumos de electricidad, lo cual conllevó a la obtención de un nuevo índice de consumo que refleja acertadamente el comportamiento del consumo de energía eléctrica en función de los servicios prestados por esta entidad.  This article presents the first results of the application of the Methodology for Total Management Techniques of Energy Efficiency at the International Health Centre "La Pradera". It was realized an energetic characterization of the Centre, determining the structure of energy carriers consumption. It was conducted a statistical investigation of the data Centre during the years 2010 and 2011, giving the electricity as the more influential energy consumption of the facility. It was analyzed the relationship between kilowatt hour consumption rate vs day-occupied-room (kWh / HDO to assess correctly the energy efficiency of the Centre concluding that the room temperature is a significant factor in the consumption of electricity, which led to the award of a new index that accurately reflects the consumption behaviour of electric energy consumption based on the services provided by this entity.

  10. Aplicación de Gestión Total Eficiente de Energía en el Centro Internacional de Salud “La Pradera” ; Application of Total Management Techniques of Energy Efficiency at the International Health Centre "La Pradera”

    Directory of Open Access Journals (Sweden)

    Leyat Fernández Velázquez

    2014-06-01

    Full Text Available En este artículo se presentan los primeros resultados obtenidos de la aplicación de la Metodología de las Técnicas de Gestión Total Eficiente de la Energía en el Centro Internacional de Salud “La Pradera”. Se realizó una caracterización energética del Centro, determinándose la estructura de consumo de los portadores energéticos. Se efectuó una investigación estadística de los datos del Centro durante los años 2010 y 2011, obteniéndose que el portador energético más influyente en el consumo de la instalación es la energía eléctrica. Se analizó la relación entre el índice de consumo kilowatt hora vs habitación-día-ocupada (kWh/HDO para evaluar correctamente la eficiencia energética del centro, determinándose que la temperatura ambiente es un factor significativo en los consumos de electricidad, lo cual conllevó a la obtención de un nuevo índice de consumo que refleja acertadamente el comportamiento del consumo de energía eléctrica en función de los servicios prestados por esta entidad. This article presents the first results of the application of the Methodology for Total Management Techniques of Ener