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Sample records for tractor base bleeding

  1. Investigation of Tractor Base Bleeding for Heavy Vehicle Aerodynamic Drag Reduction

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, J; Salari, K; Storms, B

    2007-10-25

    One of the main contributors to the aerodynamic drag of a heavy vehicle is tractor-trailer gap drag, which arises when the vehicle operates within a crosswind. Under this operating condition, freestream flow is entrained into the tractor-trailer gap, imparting a momentum exchange to the vehicle and subsequently increasing the aerodynamic drag. While a number of add-on devices, including side extenders, splitter plates, vortex stabilizers, and gap sealers, have been previously tested to alleviate this source of drag, side extenders remain the primary add-on device of choice for reducing tractor-trailer gap drag. However, side extenders are not without maintenance and operational issues. When a heavy vehicle pivots sharply with respect to the trailer, as can occur during loading or unloading operations, the side extenders can become crushed against the trailer. Consequently, fleet operators are forced to incur additional costs to cover the repair or replacement of the damaged side extenders. This issue can be overcome by either shortening the side extenders or by devising an alternative drag reduction concept that can perform just as effectively as side extenders. To explore such a concept, we investigate tractor base bleeding as a means of reducing gap drag. Wind tunnel measurements are made on a 1:20 scale heavy vehicle model at a vehicle width-based Reynolds number of 420,000. The tractor bleeding flow, which is delivered through a porous material embedded within the tractor base, is introduced into the tractor-trailer gap at bleeding coefficients ranging from 0.0-0.018. To determine the performance of tractor base bleeding under more realistic operating conditions, computational fluid dynamics simulations are performed on a full-scale heavy vehicle within a crosswind for bleeding coefficients ranging from 0.0-0.13.

  2. Mechanical Design of Downhole Tractor Based on Two-Way Self-locking Mechanism

    Science.gov (United States)

    Fang, Delei; Shang, Jianzhong; Luo, Zirong; Wu, Guoheng; Liu, Yiying

    2018-03-01

    Based on the technology of horizontal well tractor, a kind of downhole tractor was developed which can realize Two-Way self-locking function. Aiming at the needs of horizontal well logging to realize the target of small size, high traction and high reliability, the tractor selects unique heart-shaped CAM as the locking mechanism. The motion principle of telescopic downhole tractor, the design of mechanical structure and locking principle of the locking mechanism are all analyzed. The mathematical expressions of traction are obtained by mechanical analysis of parallel support rod in the locking mechanism. The force analysis and contour design of the heart-shaped CAM are performed, which can lay the foundation for the development of tractor prototype.

  3. Fuzzy Logic Based Control of the Lateral Stability of Tractor Semitrailer Vehicle

    Directory of Open Access Journals (Sweden)

    Xiujian Yang

    2015-01-01

    Full Text Available A novel control scheme is proposed to improve the yaw stability of a tractor semitrailer vehicle in critical situations. The control scheme is a two-layer structure consisting of an upper yaw moment controller and a lower brake force distributor. The tractor and the trailer are, respectively, stabilized by two independent fuzzy logic based yaw moment controllers. The controllers for the tractor and the trailer are, respectively, designed to track the reference yaw rate of the tractor and the hitch angle between the tractor and the trailer while considering the variation of the hitch angular rate at the same time. The corrective yaw moments determined by the corresponding upper fuzzy yaw moment controllers are realized by active wheel braking. The performance of the proposed control scheme is evaluated by simulations on a nonlinear vehicle model. The results demonstrate that the proposed control scheme is robust and effective in stabilizing the severe instabilities such as jackknife and trailer oscillation in the chosen simulation scenarios. It is believed that this control scheme is robust to the variation of road adhesion conditions.

  4. Design of a Novel Electro-hydraulic Drive Downhole Tractor

    Science.gov (United States)

    Fang, Delei; Shang, Jianzhong; Yang, Junhong; Wang, Zhuo; Wu, Wei

    2018-02-01

    In order to improve the traction ability and the work efficiency of downhole tractor in oil field, a novel electro-hydraulic drive downhole tractor was designed. The tractor’s supporting mechanism and moving mechanism were analyzed based on the tractor mechanical structure. Through the introduction of hydraulic system, the hydraulic drive mechanism and the implementation process were researched. Based on software, analysis of tractor hydraulic drive characteristic and movement performance were simulated, which provide theoretical basis for the development of tractor prototype.

  5. Investigation of UK Farmer Go/No-Go Decisions in Response to Tractor-Based Risk Scenarios.

    Science.gov (United States)

    Irwin, Amy; Poots, Jill

    2018-01-01

    Tractors are a source of injury and fatality in agriculture. Despite this farmers continue to engage in risk-taking behaviors, including operating tractors without appropriate equipment. In order to change behaviors and attitudes toward safety, it is important to understand how farmers approach different types of risk relevant to tractor use. The current study used a qualitative approach to investigate farmer perception of four types of tractor-based risk related to self, equipment, lack of safety features, and environment. A sample of 148 farmers from the United Kingdom and Ireland was recruited from farming forums to take part in an online scenario-based qualitative study. Participants were presented with 12 tractor-based scenarios, three from each category of risk, and asked to indicate if they would proceed to use the tractor (go) or not (no-go), then report their reasoning. Thematic analysis was used to identify data patterns. Farmers appeared to assess the consequences of risk in broader terms than the risk of injury to themselves; they also evaluated risk in terms of potential costs (e.g., repair bill) and losses (e.g., delay). Analysis indicated that financial risk was considered with more caution than personal risk in many cases. Farmers also considered usability, such as the functionality of tractor seat belts, indicating the importance of ensuring all safety equipment is fit for purpose. The management of agricultural risk should consider farmer priorities (such as financial costs) in order to develop effective messaging that focuses on those priorities, with the aim of reducing risk-taking behaviors.

  6. Tractor performance monitor based on a single-chip microcomputer

    Energy Technology Data Exchange (ETDEWEB)

    Bedri, A.R.; Marley, S.J.; Buchelle, W.F.; Smay, T.A.

    1981-01-01

    A tractor performance monitor based on a single-chip microcomputer was developed to measure ground speed, slip, fuel consumption (rate and total), total area, theoretical time, and total time. Transducers used are presented in detail. 5 refs.

  7. ROBUST CONTROL OF OSCILLATIONS IN AGRICULTURAL TRACTORS

    DEFF Research Database (Denmark)

    Andersen, T. O.; Hansen, M. R.; Conrad, Finn

    2003-01-01

    for agricultural tractors equiped with hicth and implements. A control strategy is developed to make the implement counteract the movement of the tractor and thereby reducing the pitching oscillation. The control strategy is based on a linear plant model with constant or slowly varying parameters. Using...

  8. PROBLEMS OF FORMATION OF RUSSIAN INNOVATIVE AGRICULTURAL TRACTORS FLEET

    Directory of Open Access Journals (Sweden)

    V. M. Kryazhkov

    2015-01-01

    Full Text Available Formation of tractors park and its perspective development are carried out on the basis of realization and improvement of the scientifically based types range constructed on a traction classification sign which conforms to requirements of agricultural production when performing two main conditions: full meeting the requirements for various standard sizes of tractors applicable to conditions of the corresponding zones of Russia and continuous reproduction and development of tractor fleet, both by quantity of efficient machinery and its structure. The developed types range practically runs the gamut of organizational and economic and climatic conditions, and also all range of forms of the organizations using machinery, beginning from individual consumers, small and large rent and contract collectives and finishing large-scale enterprises and their associations. Federal Service of State Statistics (Rosstat information about a steady tendency of fleet reduction was used for studying of regularities of development of tractor fleet. This information was added by analytical synthesis of data about the annual brand purchases in the Russian market of agricultural tractors. The developed database shows a share of the tractors in fleets of agricultural organizations, which are used over depreciation term, and also minimum necessary number of new machines introduction for formation of volume of tractors with limit age and the total quantity of tractors necessary for minimization of set of expenses. It was established that it is possible to estimate visually the developed quantitative and age structure of tractors fleet and to predict its development on prospect by worked out database representing set of annual tractors brand lines purchasing.

  9. Tractor accelerated test on test rig

    Directory of Open Access Journals (Sweden)

    M. Mattetti

    2013-09-01

    Full Text Available The experimental tests performed to validate a tractor prototype before its production, need a substantial financial and time commitment. The tests could be reduced using accelerated tests able to reproduce on the structural part of the tractor, the same damage produced on the tractor during real life in a reduced time. These tests were usually performed reproducing a particular harsh condition a defined number of times, as for example using a bumpy road on track to carry out the test in any weather condition. Using these procedures the loads applied on the tractor structure are different with respect to those obtained during the real use, with the risk to apply loads hard to find in reality. Recently it has been demonstrated how, using the methodologies designed for cars, it is possible to also expedite the structural tests for tractors. In particular, automotive proving grounds were recently successfully used with tractors to perform accelerated structural tests able to reproduce the real use of the machine with an acceleration factor higher than that obtained with the traditional methods. However, the acceleration factor obtained with a tractor on proving grounds is in any case reduced due to the reduced speed of the tractors with respect to cars. In this context, the goal of the paper is to show the development of a methodology to perform an accelerated structural test on a medium power tractor using a 4 post test rig. In particular, several proving ground testing conditions have been performed to measure the loads on the tractor. The loads obtained were then edited to remove the not damaging portion of signals, and finally the loads obtained were reproduced in a 4 post test rig. The methodology proposed could be a valid alternative to the use of a proving ground to reproduce accelerated structural tests on tractors.

  10. Matter-Wave Tractor Beams

    DEFF Research Database (Denmark)

    Gorlach, Alexey A.; Gorlach, Maxim A.; Lavrinenko, Andrei

    2017-01-01

    Optical and acoustic tractor beams are currently the focus of intense research due to their counterintuitive property of exerting a pulling force on small scattering objects. In this Letter we propose a matter-wave tractor beam and utilize the de Broglie waves of nonrelativistic matter particles...... are compared, and the matter-wave pulling force is found to have exclusive properties of dragging slow particles in short-range potentials. We envisage that the use of tractor beams could lead to the unprecedented precision in manipulation with atomic-scale quantum objects....

  11. Realization of compact tractor beams using acoustic delay-lines

    Science.gov (United States)

    Marzo, A.; Ghobrial, A.; Cox, L.; Caleap, M.; Croxford, A.; Drinkwater, B. W.

    2017-01-01

    A method for generating stable ultrasonic levitation of physical matter in air using single beams (also known as tractor beams) is demonstrated. The method encodes the required phase modulation in passive unit cells into which the ultrasonic sources are mounted. These unit cells use waveguides such as straight and coiled tubes to act as delay-lines. It is shown that a static tractor beam can be generated using a single electrical driving signal, and a tractor beam with one-dimensional movement along the propagation direction can be created with two signals. Acoustic tractor beams capable of holding millimeter-sized polymer particles of density 1.25 g/cm3 and fruit-flies (Drosophila) are demonstrated. Based on these design concepts, we show that portable tractor beams can be constructed with simple components that are readily available and easily assembled, enabling applications in industrial contactless manipulation and biophysics.

  12. Ergonomic assessment of some commonly used tractors in Iran

    Directory of Open Access Journals (Sweden)

    M. A Rostami

    2015-09-01

    were measured, whiles the tractors were positioned on a level ground for measurements after the tires had been ganged. These specifications were tractor height, steering wheel height, footrest height, foot set height; tractor seat geometry as seat pan width, seat pan depth and seat pan support height; steering geometry as distance of steering wheel from seat reference point, steering wheel radius, steering wheel thickness, steering wheel inclination to the horizontal and seat reach adjustment; levers and pedals distance from seat reference point as gear lever, parking brake lever, hydraulic control lever, clutch pedal, accelerator pedal, brake pedal, front panel, workspace width and workspace length. Results and Discussion: The experiment that was conducted with operators attempting to get on the tractors indicated that tractor steps heights were higher than the desirable limit. Therefore, based on the ideas of the researcher and tractors drivers, getting on all tractors is difficult. With an increase in the number of steps or a decrease in their heights, the desirable condition can be created. Seat depth of new Holland and Valtra tractors were great for drivers in the 5th percentile value. A variable thickness pad can solve this problem. Results of studies indicated that Seat depth of Massey Ferguson 285 and 399 was shorter than driver’s leg length of 95th percentile value. To solve the problem an increase of 10 centimeters to pad height of these tractors was suggested. Seat pad of tractors were short for drivers in the 95th percentile value. Distance of steering wheel from seat reference point (SRP in Massey Ferguson 285 and Valtra was further than drivers hand length in the 5th percentile value. Therefore, the drivers hand is short for driver’s good operation. Surveys indicated that drivers had problems for gear lever access in Massey Ferguson 399. Therefore, for good access on gear lever we must increase seat stroke range by 5-10 centimeters. The record

  13. Research and Implementation of Tractor Power Shift Clutch Control System

    OpenAIRE

    Li Chengjun; Ke Meicong; Wu Youyu

    2018-01-01

    Applying power shift control technology on tractor can improve the power, economy and driving comfort of tractor. The separation and engagement control of clutch in tractor power shift transmission system is the key factor to optimize the quality of shift. Through many experiments and tests, an electronic control unit based on MC9S12 was developed, and an effective clutch control strategy was put forward, which improved the jerk of power shift and shortened the gear shift time.

  14. Piezoelectric-based actuators for improved tractor-trailer performance (Conference Presentation)

    Science.gov (United States)

    Menicovich, David; Amitay, Michael; Gallardo, Daniele

    2017-04-01

    The application of piezo-electrically-driven synthetic-jet-based active flow control to reduce drag on tractor-trailers and to improve thermal mixing in refrigerated trailers was explored on full-scale tests. The active flow control technique that is being used relies on a modular system comprised of distributed, small, highly efficient actuators. These actuators, called synthetic jets, are jets that are synthesized at the edge of an orifice by a periodic motion of a piezoelectric diaphragm(s) mounted on one (or more) walls of a sealed cavity. The synthetic jet is zero net mass flux (ZNMF), but it allows momentum transfer to flow. It is typically driven near diaphragm and/or cavity resonance, and therefore, small electric input [O(10W)] is required. Another advantage of this actuator is that no plumbing is required. The system doesn't require changes to the body of the truck, can be easily reconfigured to various types of vehicles, and consumes small amounts of electrical power from the existing electrical system of the truck. The actuators are operated in a closed feedback loop based on inputs received from the tractor's electronic control unit, various system components and environmental sensors. The data are collected and processed on-board and transmitted to a cloud-based data management platform for further big data analytics and diagnostics. The system functions as a smart connected product through the interchange of data between the physical truck-mounted system and its cloud platform.

  15. Agricultural Tractor Selection: A Hybrid and Multi-Attribute Approach

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    Jorge L. García-Alcaraz

    2016-02-01

    Full Text Available Usually, agricultural tractor investments are assessed using traditional economic techniques that only involve financial attributes, resulting in reductionist evaluations. However, tractors have qualitative and quantitative attributes that must be simultaneously integrated into the evaluation process. This article reports a hybrid and multi-attribute approach to assessing a set of agricultural tractors based on AHP-TOPSIS. To identify the attributes in the model, a survey including eighteen attributes was given to agricultural machinery salesmen and farmers for determining their importance. The list of attributes was presented to a decision group for a case of study, and their importance was estimated using AHP and integrated into the TOPSIS technique. In this case, one tractor was selected from a set of six alternatives, integrating six attributes in the model: initial cost, annual maintenance cost, liters of diesel per hour, safety of the operator, maintainability and after-sale customer service offered by the supplier. Based on the results obtained, the model can be considered easy to apply and to have good acceptance among farmers and salesmen, as there are no special software requirements for the application.

  16. Social and Individual Influences on Tractor Operating Practices of Young Adult Agricultural Workers.

    Science.gov (United States)

    Rudolphi, Josie M; Campo, Shelly; Gerr, Fred; Rohlman, Diane S

    2018-05-01

    Tractor-related incidents are the leading cause of agricultural-related fatalities in the United States. Injuries from rollovers can be prevented by equipping tractors with rollover protective structures (ROPS, an engineering approach) and by using seatbelts (a behavior-based approach). While adult farmers report low seatbelt use and frequent use of tractors without ROPS, it is unknown whether the young adult population has adopted similar tractor driving practices. This study was designed to identify tractor operating practices among young adult agricultural workers and the influence of supervisors, peers, and parents on their safety behaviors. An online survey was conducted among college students enrolled in agricultural science classes in four Midwestern colleges and universities. Participants answered questions about their tractor operating practices, the influence of supervisors, peers, parents, and individual risk taking tendencies on their workplace practices. A tractor operation safety score was estimated from participants' responses. Linear regression was used to examine the association of these influences and the tractor operation safety score. Of the 193 respondents, most (78.8%) reported that they never or rarely wear a seatbelt when operating a tractor with a ROPS. Supervisory influences, such as being negatively evaluated by a supervisor, were found to be more strongly associated with tractor operating behaviors than peer or parent influence. Young adult agricultural workers frequently reported unsafe tractor operating behaviors. Supervisors were found to have the most influence over reported behaviors of young adult agricultural workers. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Monitoring of the tractor working parameters from the CAN-Bus

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    Giovannni Molari

    2013-09-01

    Full Text Available The analysis of the tractor mission profile is one of the main objectives for tractor manufacturers. The mission profile has usually been estimated through the use of questionnaires submitted to consumers. This procedure is time-consuming and not totally reliable due to the trustworthiness in the questionnaire compilation. In all the high power tractors numerous transducers are fitted to monitor some parameters to optimise the operation of the machines. All of these transducers are connected to an electronic central unit or with the tractor CAN-Bus. In this context, a system able to monitor the working parameters of the machines capitalising the existing transducers could represent the optimal solution for monitoring tractors distributed in different regions. The high number of signals are in any case difficult to memorise without a high quantity of memory. The goal of the paper is to define a methodology to memorise the operation parameters useful to define the mission profile of a tractor using a small memory. A tractor of a nominal power of 230 kW was selected and a system able to measure the signals acquired by the transducers fitted on the tractor was connected to the CAN Bus of the tractor. After a detailed analysis of the parameters measured on the tractor, the useful parameters were defined and acquired in different working conditions. The analysis of the parameters stored in the memory has allowed a detailed analysis of the operational parameters of the tractor in different applications. These parameters could be used by engineers to design tractors with a higher quality and reliability and also to define predictive maintenance criteria and reduce unexpected tractor failures.

  18. Field Tests of a Tractor Rollover Detection and Emergency Notification System.

    Science.gov (United States)

    Liu, B; Koc, A B

    2015-04-01

    The objective of this research was to assess the feasibility of a rollover detection and emergency notification system for farm tractors using field tests. The emergency notification system was developed based on a tractor stability model and implemented on a mobile electronic device with the iOS operating system. A complementary filter was implemented to combine the data from the accelerometer and gyroscope sensors to improve their accuracies in calculating the roll and pitch angles and the roll and pitch rates. The system estimates a stability index value during tractor operation, displays feedback messages when the stability index is lower than a preset threshold value, and transmits emergency notification messages when an overturn happens. Ten tractor rollover tests were conducted on a field track. The developed system successfully monitored the stability of the tractor during all of the tests. The iOS application was able to detect rollover accidents and transmit emergency notifications in the form of a phone call and email when an accident was detected. The system can be a useful tool for training and education in safe tractor operation. The system also has potential for stability monitoring and emergency notification of other on-road and off-road motorized vehicles.

  19. Tractor Safety. Unit A-9.

    Science.gov (United States)

    Luft, Vernon D.; Backlund, Paul

    This document is a teacher's guide for a unit in tractor and machinery safety for college freshmen. It is intended to be used for 10 hours of instruction for freshmen who are intending to work on or around machinery. Safety hazards directly and indirectly related to many types of machinery are covered in addition to tractors. The objectives of the…

  20. The Influence of Tractor-Seat Height above the Ground on Lateral Vibrations

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    Jaime Gomez-Gil

    2014-10-01

    Full Text Available Farmers experience whole-body vibrations when they drive tractors. Among the various factors that influence the vibrations to which the driver is exposed are terrain roughness, tractor speed, tire type and pressure, rear axle width, and tractor seat height above the ground. In this paper the influence of tractor seat height above the ground on the lateral vibrations to which the tractor driver is exposed is studied by means of a geometrical and an experimental analysis. Both analyses show that: (i lateral vibrations experienced by a tractor driver increase linearly with tractor-seat height above the ground; (ii lateral vibrations to which the tractor driver is exposed can equal or exceed vertical vibrations; (iii in medium-size tractors, a feasible 30 cm reduction in the height of the tractor seat, which represents only 15% of its current height, will reduce the lateral vibrations by around 20%; and (iv vertical vibrations are scarcely influenced by tractor-seat height above the ground. The results suggest that manufacturers could increase the comfort of tractors by lowering tractor-seat height above the ground, which will reduce lateral vibrations.

  1. IMPROVEMENT OF ROAD-HOLDING ABILITY FOR “BELARUS” TRACTORS

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    V. P. Boikov

    2016-01-01

    Full Text Available Introduction of new efficient braking systems for energy-packed tractors is of great importance for agricultural production. Foreign tractor manufacturing companies are implementing brake systems and in addition to their main function they fulfil function for holding of the given driving direction. The paper considers achievements in the field of electronic systems for tractor road-holding ability. A diagram on proportion of high-power tractors in total export volume of tractors and machinery manufactured in Belarus in the period of 2007–2010 has been drawn in the paper. The paper also proposes a comparative diagram on tractor speeds of international manufacturers which can serve as indicators of speed and road-holding ability of tractors with special electronic systems and without them. The paper contains an analysis of various braking mechanisms of planetary gears and detailed description of their design. A scheme of a laboratory facility for investigation of planetary gear usage as a breaking mechanism while changing conditions of jamming has been presented in the paper. The paper provides description on graph dependencies of current strength and voltage on as a function of the braking torque which is applied to a planetary gear. Nowadays energy-packed “Belarus”-tractors of Class 5 do not have a separate braking for each of four wheels. Therefore, it is proposed to use planetary gearbox of the rear-axle drive being available in every wheel as the basis of a service brake with the purpose to implement the described design. Using such scheme it is possible to execute an introduction of electronic systems for road-holding ability. A generalized scheme of an electronic system for tractor road-holding ability which can ensure separate breaking of all tractor wheels has been drawn out on the basis of the existing automotive electronic systems.

  2. Filtration Systems Design for Universal Oils in Agricultural Tractors

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    R. Majdan

    2017-12-01

    Full Text Available Three filtration systems using the tractor hydraulic circuit were proposed and verified during the tractors operation. Using the tractor-implement hydraulic system and filter body with accessories the universally useful filtration systems were designed. The designed filtration systems are the second stage of universal oil filtration whereas the first stage is the standard tractor filter. The decrease in the content of iron reached the values 25.53 %, 32.95 % and 41.55 % and the average decrease in oil contamination characterized by average value of decrease in content of iron, copper and silicium reached values 24.3 %, 24.7 % and 35.53 % in dependence on the filtration system and an oil contamination level. The decrease in contamination level verified the ability of designed filtration systems for agricultural tractors.

  3. Involving fathers in teaching youth about farm tractor seatbelt safety--a randomized control study.

    Science.gov (United States)

    Jinnah, Hamida Amirali; Stoneman, Zolinda; Rains, Glen

    2014-03-01

    Farm youth continue to experience high rates of injury and deaths as a result of agricultural activities. Farm machinery, especially tractors, is the most common cause of casualties to youth. A Roll-Over Protection Structure (ROPS) along with a fastened seatbelt can prevent almost all injuries and fatalities from tractor overturns. Despite this knowledge, the use of seatbelts by farmers on ROPS tractors remains low. This study treats farm safety as a family issue and builds on the central role of parents as teachers and role models of farm safety for youth. This research study used a longitudinal, repeated-measures, randomized-control design in which youth 10-19 years of age were randomly assigned to either of two intervention groups (parent-led group and staff-led group) or the control group. Fathers in the parent-led group were less likely to operate ROPS tractors without a seatbelt compared with other groups. They were more likely to have communicated with youth about the importance of wearing seatbelts on ROPS tractors. Consequently, youth in the parent-led group were less likely to operate a ROPS tractor without a seatbelt than the control group at post-test. This randomized control trial supports the effectiveness of a home-based, father-led farm safety intervention as a promising strategy for reducing youth as well as father-unsafe behaviors (related to tractor seatbelts) on the farm. This intervention appealed to fathers' strong motivation to practice tractor safety for the sake of their youth. Involving fathers helped change both father as well as youth unsafe tractor-seatbelt behaviors. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. Optical tractor Bessel polarized beams

    International Nuclear Information System (INIS)

    Mitri, F.G.; Li, R.X.; Guo, L.X.; Ding, C.Y.

    2017-01-01

    Axial and transverse radiation force cross-sections of optical tractor Bessel polarized beams are theoretically investigated for a dielectric sphere with particular emphasis on the beam topological charge (or order), half-cone angle and polarization. The angular spectrum decomposition method (ASDM) is used to derive the non-paraxial electromagnetic (EM) field components of the Bessel beams. The multipole expansion method using vector spherical harmonics is utilized and appropriate beam-shape coefficients are derived in order to compute the radiation force cross-sections. The analysis has no limitation to a particular range of frequencies such that the Rayleigh, Mie or geometrical optics regimes can all be considered effectively using the present rigorous formalism. The focus of this investigation is to identify some of the tractor beam conditions so as to achieve retrograde motion of a dielectric sphere located arbitrarily in space. Numerical computations for the axial and transverse radiation force cross-sections are presented for linear, right-circular, radial, azimuthal and mixed polarizations of the individual plane waves forming the Bessel beams of zeroth- and first-order (with positive or negative helicity), respectively. As the sphere shifts off the beam's axis, the axial pulling (tractor) force is weakened. Moreover, the transverse radiation force cross-section field changes with the sphere's size factor ka (where k is the wavenumber and a is the sphere radius). Both stable and unstable equilibrium regions around the beam's axis are found, depending on the choice of ka and the half-cone angle α_0. These results are particularly important in the development of emergent technologies for the photophoretic assembly of optically-engineered (meta)materials with designed properties using optical tractor (vortex) beams, particle manipulation, levitation and positioning, and other applications. - Highlights: • Optical tractor Bessel polarized beams are

  5. 49 CFR 399.207 - Truck and truck-tractor access requirements.

    Science.gov (United States)

    2010-10-01

    .... Exception. If air and electrical connections necessary to couple or uncouple a truck-tractor from a trailer... 49 Transportation 5 2010-10-01 2010-10-01 false Truck and truck-tractor access requirements. 399... Vehicles § 399.207 Truck and truck-tractor access requirements. (a) General rule. Any person entering or...

  6. Steering a Tractor by Means of an EMG-Based Human-Machine Interface

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    Sergio Alonso-Garcia

    2011-07-01

    Full Text Available An electromiographic (EMG-based human-machine interface (HMI is a communication pathway between a human and a machine that operates by means of the acquisition and processing of EMG signals. This article explores the use of EMG-based HMIs in the steering of farm tractors. An EPOC, a low-cost human-computer interface (HCI from the Emotiv Company, was employed. This device, by means of 14 saline sensors, measures and processes EMG and electroencephalographic (EEG signals from the scalp of the driver. In our tests, the HMI took into account only the detection of four trained muscular events on the driver’s scalp: eyes looking to the right and jaw opened, eyes looking to the right and jaw closed, eyes looking to the left and jaw opened, and eyes looking to the left and jaw closed. The EMG-based HMI guidance was compared with manual guidance and with autonomous GPS guidance. A driver tested these three guidance systems along three different trajectories: a straight line, a step, and a circumference. The accuracy of the EMG-based HMI guidance was lower than the accuracy obtained by manual guidance, which was lower in turn than the accuracy obtained by the autonomous GPS guidance; the computed standard deviations of error to the desired trajectory in the straight line were 16 cm, 9 cm, and 4 cm, respectively. Since the standard deviation between the manual guidance and the EMG-based HMI guidance differed only 7 cm, and this difference is not relevant in agricultural steering, it can be concluded that it is possible to steer a tractor by an EMG-based HMI with almost the same accuracy as with manual steering.

  7. The evaluations regarding tractor usage in farms in Eskişehir province

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    Neşe ALTINTAŞ

    2014-12-01

    Full Text Available Farmers’ demand of tractor, buying attitudes and satisfaction of tractor use are very important determinant for the decision makers in the sector. It is necessary that to be research of conditions of tractor use in farms and to be achieved certain data for efficient use of tractor in agricultural production. The survey forms which were prepared for this purpose have been filled in 2013 with 122 farmers which tractor owner and have been evaluated.

  8. Bifurcation of Lane Change and Control on Highway for Tractor-Semitrailer under Rainy Weather

    Directory of Open Access Journals (Sweden)

    Tao Peng

    2017-01-01

    Full Text Available A new method is proposed for analyzing the nonlinear dynamics and stability in lane changes on highways for tractor-semitrailer under rainy weather. Unlike most of the literature associated with a simulated linear dynamic model for tractor-semitrailers steady steering on dry road, a verified 5DOF mechanical model with nonlinear tire based on vehicle test was used in the lane change simulation on low adhesion coefficient road. According to Jacobian matrix eigenvalues of the vehicle model, bifurcations of steady steering and sinusoidal steering on highways under rainy weather were investigated using a numerical method. Furthermore, based on feedback linearization theory, taking the tractor yaw rate and joint angle as control objects, a feedback linearization controller combined with AFS and DYC was established. The numerical simulation results reveal that Hopf bifurcations are identified in steady and sinusoidal steering conditions, which translate into an oscillatory behavior leading to instability. And simulations of urgent step and single-lane change in high velocity show that the designed controller has good effects on eliminating bifurcations and improving lateral stability of tractor-semitrailer, during lane changing on highway under rainy weather. It is a valuable reference for safety design of tractor-semitrailers to improve the traffic safety with driver-vehicle-road closed-loop system.

  9. An experimental investigation of exhaust emission from agricultural tractors

    Energy Technology Data Exchange (ETDEWEB)

    Gholami, Rashid; Rabbani, Hekmat; Lorestani, Ali Nejat; Javadikia, Payam; Jaliliantabar, Farzad [Mechanics of Agricultural Machinery Department, Razi University of Kermanshah (Iran, Islamic Republic of)

    2013-07-01

    Agricultural machinery is an important source of emission of air pollutant in rural locations. Emissions of a specific tractor engine mainly depend on engine speed. Various driving methods and use of implements with different work capacities can affect the engine load. This study deals with the effects of types of tractors and operation conditions on engine emission. In this study two types of agricultural tractors (MF285 and U650) and some tillage implements such as centrifugal type spreader, boom type sprayer and rotary tiller were employed. Some of the exhausted gases from both tractors in each condition were measured such as, hydrocarbon (HC), carbon monoxide (CO), carbon dioxide (CO2), oxygen (O2) and nitrogen oxide (NO). Engine oil temperature was measured at every step for both types of tractors. Difference between steady-state condition and operation conditions was evaluated. The results showed all exhaust gases that measured and engine oil temperature at every operation conditions are higher than steady-state condition. A general conclusion of the work was that, using various implements and employing different types of tractors effect on engine emissions. The results of variance analysis showed all exhausted gases had a significant relationship with types of implements used at 1%. Also, all exhausted gases except CO had a significant relationship with types of tractors. A further conclusion was that NO emission increased as engine oil temperature increased. The final conclusion was about the difference between MF285 and U650; using U650 at operation conditions is better than MF285 in terms of pollution.

  10. A spatial cluster analysis of tractor overturns in Kentucky from 1960 to 2002.

    Directory of Open Access Journals (Sweden)

    Daniel M Saman

    Full Text Available Agricultural tractor overturns without rollover protective structures are the leading cause of farm fatalities in the United States. To our knowledge, no studies have incorporated the spatial scan statistic in identifying high-risk areas for tractor overturns. The aim of this study was to determine whether tractor overturns cluster in certain parts of Kentucky and identify factors associated with tractor overturns.A spatial statistical analysis using Kulldorff's spatial scan statistic was performed to identify county clusters at greatest risk for tractor overturns. A regression analysis was then performed to identify factors associated with tractor overturns.The spatial analysis revealed a cluster of higher than expected tractor overturns in four counties in northern Kentucky (RR = 2.55 and 10 counties in eastern Kentucky (RR = 1.97. Higher rates of tractor overturns were associated with steeper average percent slope of pasture land by county (p = 0.0002 and a greater percent of total tractors with less than 40 horsepower by county (p<0.0001.This study reveals that geographic hotspots of tractor overturns exist in Kentucky and identifies factors associated with overturns. This study provides policymakers a guide to targeted county-level interventions (e.g., roll-over protective structures promotion interventions with the intention of reducing tractor overturns in the highest risk counties in Kentucky.

  11. Costs of Tractor Ownership under Different Management Systems in ...

    African Journals Online (AJOL)

    Costs of Tractor Ownership under Different Management Systems in Nigeria. ... It requires high initial capital investment. ... making management plans and decisions especially in comparing different tractor types and models thereby assisting ...

  12. 30 CFR 77.409 - Shovels, draglines, and tractors.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Shovels, draglines, and tractors. 77.409... COAL MINES Safeguards for Mechanical Equipment § 77.409 Shovels, draglines, and tractors. (a) Shovels... the operator prior to starting operation. (b) Shovels and draglines shall be equipped with handrails...

  13. Evaluation of a Commercial Tractor Safety Monitoring System Using a Reverse Engineering Procedure.

    Science.gov (United States)

    Casazza, Camilla; Martelli, Roberta; Rondelli, Valda

    2016-10-17

    There is a high rate of work-related deaths in agriculture. In Italy, despite the obligato-ry installation of ROPS, fatal accidents involving tractors represent more than 40% of work-related deaths in agriculture. As death is often due to an overturn that the driver is incapable of predicting, driver assistance devices that can signal critical stability conditions have been studied and marketed to prevent accidents. These devices measure the working parameters of the tractor through sensors and elaborate the values using an algorithm that, taking into account the geometric characteristics of the tractor, pro-vides a risk index based on models elaborated on a theoretical basis. This research aimed to verify one of these stability indexes in the field, using a commercial driver as-sistance device to monitor five tractors on the University of Bologna experimental farm. The setup of the device involved determining the coordinates of the center of gravity of the tractor and the implement mounted on the tractor. The analysis of the stability in-dex, limited to events with a significant risk level, revealed a clear separation into two groups: events with high values of roll or pitch and low speeds, typical of a tractor when working, and events with low values of roll and pitch and high steering angle and forward speed, typical of travel on the road. The equation for calculating the critical speed when turning provided a significant contribution only for events that were typi-cal of travel rather than field work, suggesting a diversified calculation approach ac-cording to the work phase. Copyright© by the American Society of Agricultural Engineers.

  14. Agricultural Tractor Safety on Public Roads and Farms.

    Science.gov (United States)

    Department of Transportation, Washington, DC.

    This study investigated the extent, causes, and means of preventing agricultural tractor accidents. The report includes an estimate of annual tractor-related deaths, an identification of the primary causes of such accidents with consideration of the major hazards causing death or injury, and recommendations or means for preventing the occurrence…

  15. Pulling cylindrical particles using a soft-nonparaxial tractor beam

    DEFF Research Database (Denmark)

    Novitsky, Andrey; Ding, Weiqiang; Wang, Maoyan

    2017-01-01

    In order to pull objects towards the light source a single tractor beam inevitably needs to be strongly nonparaxial. This stringent requirement makes such a tractor beam somewhat hypothetical. Here we reveal that the cylindrical shape of dielectric particles can effectively mitigate the nonparaxi......In order to pull objects towards the light source a single tractor beam inevitably needs to be strongly nonparaxial. This stringent requirement makes such a tractor beam somewhat hypothetical. Here we reveal that the cylindrical shape of dielectric particles can effectively mitigate...... the nonparaxiality requirements, reducing the incidence angle of the partial plane waves of the light beam down to 45 degrees and even to 30 degrees for respectively dipole and dipole-quadrupole objects. The optical pulling force attributed to the interaction of magnetic dipole and magnetic quadrupole moments...... and sorting of targeted particles....

  16. Optical tractor Bessel polarized beams

    Science.gov (United States)

    Mitri, F. G.; Li, R. X.; Guo, L. X.; Ding, C. Y.

    2017-01-01

    Axial and transverse radiation force cross-sections of optical tractor Bessel polarized beams are theoretically investigated for a dielectric sphere with particular emphasis on the beam topological charge (or order), half-cone angle and polarization. The angular spectrum decomposition method (ASDM) is used to derive the non-paraxial electromagnetic (EM) field components of the Bessel beams. The multipole expansion method using vector spherical harmonics is utilized and appropriate beam-shape coefficients are derived in order to compute the radiation force cross-sections. The analysis has no limitation to a particular range of frequencies such that the Rayleigh, Mie or geometrical optics regimes can all be considered effectively using the present rigorous formalism. The focus of this investigation is to identify some of the tractor beam conditions so as to achieve retrograde motion of a dielectric sphere located arbitrarily in space. Numerical computations for the axial and transverse radiation force cross-sections are presented for linear, right-circular, radial, azimuthal and mixed polarizations of the individual plane waves forming the Bessel beams of zeroth- and first-order (with positive or negative helicity), respectively. As the sphere shifts off the beam's axis, the axial pulling (tractor) force is weakened. Moreover, the transverse radiation force cross-section field changes with the sphere's size factor ka (where k is the wavenumber and a is the sphere radius). Both stable and unstable equilibrium regions around the beam's axis are found, depending on the choice of ka and the half-cone angle α0. These results are particularly important in the development of emergent technologies for the photophoretic assembly of optically-engineered (meta)materials with designed properties using optical tractor (vortex) beams, particle manipulation, levitation and positioning, and other applications.

  17. Improvements of the base bleed effect using reactive particles

    Energy Technology Data Exchange (ETDEWEB)

    Bournot, Herve; Daniel, Eric [Polytech' Marseille, IUSTI UMR CNRS 6595, 5, rue E. Fermi, Technopole de Chateau Gombert, 13453 Marseille cedex 13 (France); Cayzac, Roxan [Giat Industries, 7, Route de Guerry, F-18023 Bourges cedex (France)

    2006-11-15

    A numerical study of the base drag reduction of axisymmetric body projectiles in supersonic flight using a base bleed injection is presented in this paper. Unsteady computations of compressible viscous flow have been achieved in order to investigate the coupled effect of the bleed temperature and the bleed mass flow rate on the base pressure. The idea developed in the study, consists in the addition of metallic particles in the propellant composition used to provide the additional mass injected in order to obtain the lowest base drag. Indeed, for a low mass addition, a significant increase of the mixture energy is expected due to the particles combustion. Base flow with reactive two-phase injection is then simulated. Results show the ability of the method to describe such flows and the efficiency of the particles combustion to increase the base bleed reducing drag effect. (author)

  18. EFFICIENCY ANALYSIS OF ENERGY ACCUMULATING MECHANISM FOR TRACTOR WITH ELECTROMECHANICAL TRANSMISSION

    Directory of Open Access Journals (Sweden)

    Ch. I. Zhdanovich

    2017-01-01

    Full Text Available Dependence of tractor wheel torque on theoretical tractor motion speed has been used for comparison of tractor operation with electromechanical transmission with installation of energy accumulating mechanism and without its installation. In this case a traction asynchronous electric motor is operating under nominal and limit conditions. The paper also considers dependence diagrams of actual input power for the traction asynchronous electric motor and its losses due to theoretical tractor motion speed. Tractor wheel torque is limited during the operation of the traction asynchronous electric motor with energy accumulating mechanisms by the following factors: maximum electric motor torque at the given frequency of supply voltage; maximum value of internal combustion motor output which can be transferred to the traction asynchronous electric motor; grip of the wheels. During the operation of the traction asynchronous electric motor with energy accumulating mechanisms there is a possibility for short power consumption without regard to the second limitation because it is possible to use power not only of internal combustion motor but also the power which is stored in the energy accumulating mechanisms. Comparison of characteristics has been made when a tractor is operating at high gear and when it is operating at all gears (that is two gears. Operation of the 5th class tractors has been analyzed for all possible cases (operation with energy accumulating mechanisms and without the mechanisms while being operated at all gears and various types of work: tilling, sowing, cultivation, bulldozing work, transport mode. In this case equipment has been used which is aggregated with the 5th class tractor

  19. Parameters for assay in engines of agricultural tractor for biofuel use

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, Reny Adilmar Prestes; Meyer, Wagner [Universidade Estadual de Maringa (DEA/CCA/UEM), Cidade Gaucha, PR (Brazil). Centro de Ciencias Agrarias. Dept. de Engenharia Agricola], E-mail: raplopes@uem.br; Pinheiro Neto, Raimundo; Pinheiro, Andreia Cristina [Universidade Estadual de Maringa (DAG/CCA/UEM), PR (Brazil). Centro de Ciencias Agrarias. Dept. de Agronomia; Laurindo, Jose Carlos [Instituto de Tecnologia do Parana (CERBIO/TECPAR), Curitiba, PR (Brazil). Centro Brasileiro de Referencia em Biocombustiveis; Biazzono, Sergio Luis [Instituto de Tecnologia do Parana (TECPAR), Maringa, PR (Brazil). Inspecao Veicular

    2008-07-01

    The use of biofuel in tractors of diesel engines and agricultural harvester, in the operations of preparation of soil and harvest, is a good option of economy for the agriculturist. For a good performance of the machine, regulation and maintenance is necessary. This paper has the objective to prepare the agricultural tractors engine for the use of biofuel. The experiment was carried through State University of Maringa. One used for the assays three Massey Ferguson tractors engines. The smoke assays and opacity had shown that both the tractors had presented problems of regulations. The assays demonstrate the necessity of periodically to carry through the correct maintenance of the machines, as well as the training of the operators. The regulations allow adjusting the engines of the tractors to operate in situations recommended for the manufacturers. The regulations allow the correct functioning and better accompaniment of the useful life of the engine using biofuel in operations of soil preparation, sowing and harvest. (author)

  20. Quantum coherent tractor beam effect for atoms trapped near a nanowaveguide

    Science.gov (United States)

    Sadgrove, Mark; Wimberger, Sandro; Nic Chormaic, Síle

    2016-01-01

    We propose several schemes to realize a tractor beam effect for ultracold atoms in the vicinity of a few-mode nanowaveguide. Atoms trapped near the waveguide are transported in a direction opposite to the guided mode propagation direction. We analyse three specific examples for ultracold 23Na atoms trapped near a specific nanowaveguide (i.e. an optical nanofibre): (i) a conveyor belt-type tractor beam effect, (ii) an accelerator tractor beam effect, and (iii) a quantum coherent tractor beam effect, all of which can effectively pull atoms along the nanofibre toward the light source. This technique provides a new tool for controlling the motion of particles near nanowaveguides with potential applications in the study of particle transport and binding as well as atom interferometry. PMID:27440516

  1. Action Learning: A New Method to Increase Tractor Rollover Protective Structure (ROPS) Adoption

    Science.gov (United States)

    Biddle, Elyce Anne; Keane, Paul R.

    2016-01-01

    Action Learning is a problem-solving process that is used in various industries to address difficult problems. This project applied Action Learning to a leading problem in agricultural safety. Tractor overturns are the leading cause of fatal injury to farmworkers. This cause of injury is preventable using rollover protective structures (ROPS), protective equipment that functions as a roll bar structure to protect the operator in the event of an overturn. For agricultural tractors manufactured after 1976 and employee operated, Occupational Safety and Health Administration (OSHA) regulation requires employers to equip them with ROPS and seat belts. By the mid-1980s, US tractor manufacturers began adding ROPS on all farm tractors over 20 horsepower sold in the United States (http://www.nasdonline.org/document/113/d001656/rollover-protection-for-farm-tractor-operators.html). However, many older tractors remain in use without ROPS, putting tractor operators at continued risk for traumatic injury and fatality. For many older tractor models ROPS are available for retrofit, but for a variety of reasons, tractor owners have not chosen to retrofit those ROPS. The National Institute for Occupational Safety and Health (NIOSH) attempted various means to ameliorate this occupational safety risk, including the manufacture of a low-cost ROPS for self-assembly. Other approaches address barriers to adoption. An Action Learning approach to increasing adoption of ROPS was followed in Virginia and New York, with mixed results. Virginia took action to increase the manufacturing and adoption of ROPS, but New York saw problems that would be insurmountable. Increased focus on team composition might be needed to establish effective Action Learning teams to address this problem. PMID:22994641

  2. A Wide Span Tractor concept developed for efficient and environmental friendly farming

    DEFF Research Database (Denmark)

    Pedersen, Hans Henrik; Grøn Sørensen, Claus; Oudshoorn, Frank W

    2013-01-01

    agricultural machines a new Wide Span (WS) tractor concept has been designed and a prototype tractor with a span of 9.6 m (wheel centre to wheel centre) has been built. It is designed to optimise the Controlled Traffic Farming (CTF) system that is already in place on the vegetable farm where it is being tested....... The tractor is designed to carry out all operations during vegetable production including harvest. Using the tractor means that less than 10% of the field area is affected by compaction due to field traffic. The economical and environmental effects of such a wide span CTF growing system will be assessed....

  3. Wireline tractor production logging experience in Australian horizontal wells

    Energy Technology Data Exchange (ETDEWEB)

    Local, E.; Searight, T. L.

    1998-12-31

    Australian experiences with the development of new wireline tractor technology and its successful application to deploy production logging tools in horizontal wells was discussed. Dynamics of the tractor operations have been modelled and the model was validated with field data. The field data was also used to quantify borehole friction coefficients. Successful application in the field indicates that the tough tubing capability of the tractor, combined with its capacity to drive in large casing sizes, makes wireline deployment possible in a wide range of well completions. Work on a number of new applications such as the capability to negotiate complex downhole hardware, and to intervene in completions with widely differing tubing diameters, is in progress. 5 refs., 1 tab., 10 figs.

  4. Vibration analysis on driver’s seat of agricultural tractors during tillage tests

    International Nuclear Information System (INIS)

    Gialamas, T.; Gravalos, I.; Kateris, D.; Xyradakis, P.; Dimitriadis, C.

    2016-01-01

    The vibration of the driver’s seat of agricultural tractors was investigated during three alternative tillage operations. Three tractors including a range of specifications were considered, at a range of forward speeds. The interactions between the tractors, implements and speeds were examined using the SPSS program and the GLM-ANOVA method. The results analysis indicated that the tractors played the first major role in vibration development in the lateral axis and was followed by the implements. In contrast, the implements played the first major role in the development of vibration in the horizontal axis and are followed by factor tractors. The statistically significant effect in vertical and horizontal axes shows the factor implements. In addition, the statistically significant effect in the vertical and lateral axes shows again the implements to be the most significant factor. Of the implements, the plough shows the highest vibration and displays statistically significant difference in comparison with the other implements.

  5. Vibration analysis on driver’s seat of agricultural tractors during tillage tests

    Energy Technology Data Exchange (ETDEWEB)

    Gialamas, T.; Gravalos, I.; Kateris, D.; Xyradakis, P.; Dimitriadis, C.

    2016-07-01

    The vibration of the driver’s seat of agricultural tractors was investigated during three alternative tillage operations. Three tractors including a range of specifications were considered, at a range of forward speeds. The interactions between the tractors, implements and speeds were examined using the SPSS program and the GLM-ANOVA method. The results analysis indicated that the tractors played the first major role in vibration development in the lateral axis and was followed by the implements. In contrast, the implements played the first major role in the development of vibration in the horizontal axis and are followed by factor tractors. The statistically significant effect in vertical and horizontal axes shows the factor implements. In addition, the statistically significant effect in the vertical and lateral axes shows again the implements to be the most significant factor. Of the implements, the plough shows the highest vibration and displays statistically significant difference in comparison with the other implements.

  6. Assay in engine of agricultural tractor with biofuel

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, Reny Adilmar Prestes; Meyer, Wagner [Universidade Estadual de Maringa (DEA/CCA/UEM), Cidade Gaucha, PR (Brazil). Centro de Ciencias Agrarias. Dept. de Engenharia Agricola], E-mail: raplopes@uem.br; Pinheiro Neto, Raimundo; Pinheiro, Andreia Cristina [Universidade Estadual de Maringa (DAG/CCA/UEM), PR (Brazil). Centro de Ciencias Agrarias. Dept. de Agronomia; Laurindo, Jose Carlos [Instituto de Tecnologia do Parana (CERBIO/TECPAR), Curitiba, PR (Brazil). Centro Brasileiro de Referencia em Biocombustiveis; Biazzono, Sergio Luis [Instituto de Tecnologia do Parana (TECPAR), Maringa, PR (Brazil). Inspecao Veicular

    2008-07-01

    The use of biofuel in tractors of diesel engines and agricultural harvester, in the operations of soil preparation and harvest, is a good option of fuel economy for the agriculturist. For a good performance of the machine a good regulation is necessary. The experiment was carried through in the Experimental Farm Iguatemi of the State University of Maringa, Maringa - PR. A tractor Massey Ferguson MF275 was used for the assay connected to be even grating. It carried through if the assays of consumption of diesel (100%) and biofuel (diesel 80% + vegetable oil 20%). To carry through the assay tractor + grating with three openings and without load was used to be even set. The rotation without load and of work was of 1900 rpm and mean speed of 6 km h{sup -1}. The hourly consumption was verified by a test tube and a fluxgate OVAL Flow mate M III - LSF 45L0-M2 connected to data logger CR23X. The hourly consumption was express in L h{sup -1}. The engine of the tractor presented similar behavior of fuel consumption for diesel and biofuel. The mean values of consumption had been inside of the specified one for the manufacturer. Mixture 80% diesel + 20% vegetable oil can be used as biofuel in the engine in study. (author)

  7. Conformal superalgebras via tractor calculus

    Science.gov (United States)

    Lischewski, Andree

    2015-01-01

    We use the manifestly conformally invariant description of a Lorentzian conformal structure in terms of a parabolic Cartan geometry in order to introduce a superalgebra structure on the space of twistor spinors and normal conformal vector fields formulated in purely algebraic terms on parallel sections in tractor bundles. Via a fixed metric in the conformal class, one reproduces a conformal superalgebra structure that has been considered in the literature before. The tractor approach, however, makes clear that the failure of this object to be a Lie superalgebra in certain cases is due to purely algebraic identities on the spinor module and to special properties of the conformal holonomy representation. Moreover, it naturally generalizes to higher signatures. This yields new formulas for constructing new twistor spinors and higher order normal conformal Killing forms out of existing ones, generalizing the well-known spinorial Lie derivative. Moreover, we derive restrictions on the possible dimension of the space of twistor spinors in any metric signature.

  8. Tractor-mounted, GPS-based spot fumigation system manages Prunus replant disease

    Directory of Open Access Journals (Sweden)

    V. Udompetaikul

    2013-10-01

    Full Text Available Our research goal was to use recent advances in global positioning system (GPS and computer technology to apply just the right amount of fumigant where it is most needed (i.e., in a small target treatment zone in and around each tree replanting site to control Prunus replant disease (PRD. We developed and confirmed the function of (1 GPS-based software that can be used on cleared orchard land to flexibly plan and map all of an orchard's future tree sites and associated spot fumigation treatment zones and 2 a tractor-based GPS-controlled spot fumigation system to quickly and safely treat the targeted tree site treatment zones. In trials in two almond orchards and one peach orchard, our evaluations of the composite mapping and application system, which examined spatial accuracy of the spot treatments, delivery rate accuracy of the spot treatments, and tree growth responses to the spot treatments, all indicated that GPS spot fumigation has excellent potential to greatly reduce fumigant usage while adequately managing the PRD complex.

  9. The Tractor and Semitrailer Routing Considering Carbon Dioxide Emissions

    Directory of Open Access Journals (Sweden)

    Hongqi Li

    2013-01-01

    Full Text Available The incorporation of the minimization of carbon dioxide (CO2 emissions in the VRP is important to logistics companies. The paper deals with the tractor and semitrailer routing problem with full truckload between any two depots of the network; an integer programming model with the objective of minimizing CO2 emissions per ton-kilometer is proposed. A two-stage approach with the same core steps of the simulated annealing (SA in both stages is designed. The number of tractors is provided in the first stage and the CO2 emissions per ton-kilometer are then optimized in the second stage. Computational experiments on small-scale randomly generated instances supported the feasibility and validity of the heuristic algorithm. To a practical-scale problem, the SA algorithm can provide advice on the number of tractors, the routes, and the location of the central depot to realize CO2 emissions decrease.

  10. Parental knowledge of child development and the assignment of tractor work to children.

    Science.gov (United States)

    Pickett, William; Marlenga, Barbara; Berg, Richard L

    2003-07-01

    Many childhood farm tractor injuries occur during the performance of work that was assigned by parents, and some tractor work is beyond the developmental capabilities of children. This has been highlighted recently by a policy statement authored by the American Academy of Pediatrics. The objective of this study was 1) to assess child development knowledge of farm parents who received a new resource, the North American Guidelines for Children's Agricultural Tasks (NAGCAT), and 2) to determine whether this knowledge was associated with use of NAGCAT in the assignment of tractor jobs and with compliance with 2 aspects of the NAGCAT tractor guideline. Secondary analysis of data collected during a randomized controlled trial that involved 450 farms in the United States and Canada was conducted. Variables assessed included 1) parental knowledge of child development across several age groups and 3 domains of child development (physical, cognitive, and psychosocial), 2) documentation of the most common tractor jobs assigned to each child, and 3) a report of whether NAGCAT was used in assigning these tractor jobs. High parental knowledge of child development was associated with enhanced use of NAGCAT and fewer violations when assigning tractor work to children. However, even in the presence of high knowledge, some farm parents still assigned to their children work that was in violation of NAGCAT. Educational interventions by themselves are not sufficient to remove many farm children from known occupational hazards. These findings are discussed in light of the recent policy statement on agricultural injuries from the American Academy of Pediatrics.

  11. Ergonomic assessment of drivers in MF285 and MF399 tractors during clutching using algometer

    Directory of Open Access Journals (Sweden)

    Hossein Fallahi

    2016-03-01

    The results showed that the clutching forces for MF285 and MF399 tractors were 340 N and 290 N, respectively. The knee angle of the drivers of the two tractors was statistically different at the one percent level of significance. The reduction of pain threshold after 30 and 60 s clutching and also 60 s rest after clutching in MF285 tractor, for all three muscles, were more than those of MF399 tractor. The impact of clutching on the average decreases of pain threshold, for all drivers and all clutching periods, during and after clutching, in the Quadratus lumborum muscle was more than the other two muscles, in both tractors. In order to reduce the clutching force for MF285 tractor some modifications is suggested. In this regard the force transfer joint between the pedal and the clutch release linkage may be replaced with one made of cast iron.

  12. A fuel cell driven aircraft baggage tractor

    Energy Technology Data Exchange (ETDEWEB)

    Sterkenburg, Stefan van [HAN Univ. of Applied Sciences (Netherlands); Rijs, Aart van; Hupkens, Huib [Silent Motor Company, Arnhem (Netherlands)

    2010-07-01

    Silent Motor Company and the HAN University of Applied Science collaborate in the development of an aircraft baggage tractor. The baggage tractor is equipped with an 8kW fuel cell stack connected to a 26kWh battery-pack. The control system implemented minimizes the start-up time of the fuel cell system, protects the fuel cell against overload and underload and controls the State of Charge (SOC) of the battery to its optimum value. A practical SOC-determination method is implemented which does not need detailed knowledge about the batteries applied. This paper presents a description of the fuel cell system, its energy management system and SOC-determination method and the results of first test measurements. (orig.)

  13. The influence of the tire inflation on pull properties of agriculture tractors

    Directory of Open Access Journals (Sweden)

    Jakub Katrenčík

    2013-01-01

    Full Text Available Agricultural tractors are robust and versatile machines, which must comply with the basic requirements of users under various conditions. The main requirements include economical and reliable operation and high performance. Fuel economy could be improved using multiple methods, for example a well trained operator, adequate farming conditions and optimal tire inflation. Tractor tires transmit engine power to the surface and as such they are crucial to tractor operation. In the first part of the field measurement, all tires were inflated to 180kPa, while in the second part of the field measurements the tire pressure was set to 75kPa in front tires and to 65 kPa in rear tires. The results of the field measurement of the John Deere 6920S tractor with different tire inflation shows that pull performance increased by 9.9% and wheel slip decreased by 9.7%.

  14. Simulated stability tests of a small articulated tractor designed for extreme-sloped vineyards

    Directory of Open Access Journals (Sweden)

    F. Mazzetto

    2013-09-01

    Full Text Available A new reversible wheeled articulated tractor, designed to work in terraced vineyards trained with “pergola” system, common in mountain areas, is here described in its latest version and analysed through numerical simulations. This tractor has small dimensions, necessary to operate in that environment, and its central articulation has two rotational degrees-offreedom. The described features are surely strong design points but could be critical for vehicle’s stability, as affecting the supporting base’s dimensions and shape. Therefore, the tractor was equipped with a new automatic safety system: a self-locking articulation activated by contact sensors on the wheels. This device makes the vehicle partially-rigid in case of lateral unbalancing, so that rollover can happen only by overcoming the whole vehicle mass. A mathematical description of vehicle-ground interactions was implemented to deeply inquiry the tractor behaviour in different configurations (straight, angled at increasing values of ground slope; roll and pitch stability indexes were then computed and used for comparisons with conventional tractors. Thanks to the low centre-of-gravity, the resulting rollover angle with the vehicle in straight configuration is promising (43.8°→96%: it is greater than the maximum lateral (20°→36% and frontal (38°→78% slope angle ever recorded on terraced vineyards. The same rollover angle is lower when the tractor turns.

  15. Design and implementation of a GPS guidance system for agricultural tractors using augmented reality technology.

    Science.gov (United States)

    Santana-Fernández, Javier; Gómez-Gil, Jaime; del-Pozo-San-Cirilo, Laura

    2010-01-01

    Current commercial tractor guidance systems present to the driver information to perform agricultural tasks in the best way. This information generally includes a treated zones map referenced to the tractor's position. Unlike actual guidance systems where the tractor driver must mentally associate treated zone maps and the plot layout, this paper presents a guidance system that using Augmented Reality (AR) technology, allows the tractor driver to see the real plot though eye monitor glasses with the treated zones in a different color. The paper includes a description of the system hardware and software, a real test done with image captures seen by the tractor driver, and a discussion predicting that the historical evolution of guidance systems could involve the use of AR technology in the agricultural guidance and monitoring systems.

  16. Life-cycle assessment of a Solar Assist Plug-in Hybrid electric Tractor (SAPHT) in comparison with a conventional tractor

    International Nuclear Information System (INIS)

    Mousazadeh, Hossein; Keyhani, Alireza; Javadi, Arzhang; Mobli, Hossein; Abrinia, Karen; Sharifi, Ahmad

    2011-01-01

    The most well-known reason of global warming is equivalent carbon dioxide (CO 2equ ) emitted from fossil fuels combustion in on-road and off-road vehicles. An appreciable portion of off-road pollution is allocated to farm implements. All cited studies have shown that renewable based electric vehicles (EVs) decrease petroleum consumption and consequently reduce criteria emissions under nearly all circumstances. Considering this, a Solar Assist Plug-in Hybrid electric Tractor (SAPHT) was designed, constructed and evaluated. This research evaluated the life cycle analysis of SAPHT project and compared the results with that of an internal combustion engine tractor (ICET). The life cycle was analyzed based on economical cost and environmental emissions. The externality of environmental pollutions was calculated to derive the life-cycle costs (LCC). The results showed that substituting each ICET by SAPHT can prevent 14 ton CO 2equ emission to atmosphere annually. Also it prevents a high volume of other emissions such as CO, NO x and PM 10 entering the atmosphere. LCC assessment emphasizes on economical effectiveness of SAPHT rather than ICET at any diesel fuel price, therefore, increasing fuel unit prices leads to more effectiveness. It is concluded that levelized cost of energy (LCE) in Euro /kW h for ICET is almost twice as that of SAPHT. Some of these advantages for SAPHT are offset in part by high purchase costs, heavy and massive batteries and low operating range.

  17. PARAMETER MATCHING OF INTERNAL COMBUSTION ENGINE AND ELECTROMECHANICAL POWER TRAIN OF WHEEL TRACTOR

    Directory of Open Access Journals (Sweden)

    A. V. Kliuchnikov

    2012-01-01

    Full Text Available The paper considers stepless electromechanical power train of a wheel tractor. Methodology for parameter matching of electromechanical transmission and internal combustion engine for their optimum performance as part of a power wheel tractor unit. 

  18. A novel design procedure for tractor clutch fingers by using optimization and response surface methods

    Energy Technology Data Exchange (ETDEWEB)

    Dogan, Oguz; Karpat, Fatih; Yuce, Celalettin; Kaya, Necmettin; Yavuz, Nurettin [Uludag University, Gorukle (Turkmenistan); Sen, Hasan [Valeo A. S., Bursa (Turkmenistan)

    2016-06-15

    This paper presents a methodology for re-designing a failed tractor transmission component subjected to cyclic loading. Unlike other vehicles, tractors cope with tough working conditions. Thus, it is necessary to re-design components by using modern optimization techniques. To extend their service life, we present a design methodology for a failed tractor clutch power take-off finger. The finger was completely re-designed using topology and shape optimization approach. Stress-life based fatigue analyses were performed. Shape optimization and response surface methodology were conducted to obtain optimum dimensions of the finger. Two design parameters were selected for the design of experiment method and 15 cases were analyzed. By using design of the experiment method, three responses were obtained: Maximum stresses, mass, and displacement depending on the selected the design parameters. After solving the optimization problem, we achieved a maximum stress and mass reduction of 14% and 6%, respectively. The stiffness was improved up to 31.6% compared to the initial design.

  19. High voltage electrification of tractor and agricultural machinery – A review

    International Nuclear Information System (INIS)

    Moreda, G.P.; Muñoz-García, M.A.; Barreiro, P.

    2016-01-01

    Highlights: • CO_2 emission reduction calls for energy-efficient mobile work machines. • Energy recovery could be possible in some agricultural machinery operations. • Owning and operating costs of electrified tractor-implement pairs should be analyzed. • Plug-in hybrid electric tractors running along tramlines make sense. • Electrification allows for precise speed control, noise reduction and flexible design. - Abstract: Reduction of both pollutant emissions and fossil fuel dependency is an objective of energy policies worldwide. In many countries, governments promote the use of efficient vehicles like the hybrid electric vehicle. Incorporation of electric drives in tractor and agricultural machinery presents advantages in terms of increased energy efficiency and expanded functionalities. Higher efficiency means reduction in fuel consumption and subsequent decrease in CO_2 emission. New functionalities improve work quality and increase operator comfort. Tractor electrification takes advantage of decoupling loads and drives from the engine, which allows operating the latter at its highest efficiency point. Major advantages of machinery electrification are torque and speed control, noise reduction, and a more flexible design. In this paper, a review of the state-of-the-art of agricultural machinery high voltage electrification is presented.

  20. Artificial neural network applying for justification of tractors undercarriages parameters

    Directory of Open Access Journals (Sweden)

    V. A. Kuz’Min

    2017-01-01

    Full Text Available One of the most important properties that determine undercarriage layout on design stage is the soil compaction effect. Existing domestic standards of undercarriages impact to soil do not meet modern agricultural requirements completely. The authors justify the need for analysis of traction and transportation machines travel systems and recommendations for these parameters applied to machines that are on design or modernization stage. The database of crawler agricultural tractors particularly in such parameters as traction class and basic operational weight, engine power rating, average ground pressure, square of track basic branch surface area was modeled. Meanwhile the considered machines were divided into two groups by producing countries: Europe/North America and Russian Federation/CIS. The main graphical dependences for every group of machines are plotted, and the conforming analytical dependences within the ranges with greatest concentration of machines are generated. To make the procedure of obtaining parameters of the soil panning by tractors easier it is expedient to use the program tool - artificial neural network (or perceptron. It is necessary to apply to the solution of this task multilayered perceptron - neutron network of direct distribution of signals (without feedback. To carry out the analysis of parameters of running systems taking into account parameters of the soil panning by them and to recommend the choice of these parameters for newly created machines. The program code of artificial neural network is developed. On the basis of the created base of tractors the artificial neural network was created and tested. Accumulated error was not more than 5 percent. These data indicate the results accuracy and tool reliability. It is possible by operating initial design-data base and using the designed artificial neural network to define missing parameters.

  1. SmartWay Mark Signature Page: Tractors & Trailers

    Science.gov (United States)

    This SmartWay agreement is for companies and organizations who wish to comply with the SmartWay Graphic Standards and Usage Guide guidelines and requirements for using the SmartWay logos on SmartWay designated Tractors and Trailers.

  2. Ergonomic assessment of drivers in MF285 and MF399 tractors during clutching using algometer

    OpenAIRE

    Hossein Fallahi; Mohammad Hossein Abbaspour-Fard; Amin Azhari; Mehdi Khojastehpour; Amin Nikkhah

    2016-01-01

    Tractor as one of the most widely used agricultural machinery should be considered from different aspects. The frequent application of clutch and brake pedals and also the steering wheel within farms, along with the unfavorable working conditions, cause negative effects on the occupational health of the tractor drivers. Thus, in this research, the imposed forces on three engaged muscles including: Gastrocnemius, Trapezius and Quadrate’s lumborum of the tractor drivers during clutching have be...

  3. Accidents with tractors and agricultural machinery in public transport of Republic of Serbia without provinces

    OpenAIRE

    Gliogrevic, Kosta; Oljaca, Mico; Ruzicic, Lazar; Dimitrovski, Zoran

    2012-01-01

    Working processes in agriculture nowadays cannot be imagined without the use of modern agricultural mechanization, especially primary power unit, tractor. Along with the tractor unit development and the benefits induced by its application, according to the author’s research, these machines are one of the main causes of accidents with different types of violations of the participants, and the tragic consequences. The great number of those accidents with tractors and other agricultural machiner...

  4. Non-Diffractive Tractor Beams

    DEFF Research Database (Denmark)

    Novitsky, Andrey; Gao, Dongliang; Gorlach, Alexey A.

    2017-01-01

    Pulling optical force discovered recently in the theory and experiment has drawn great attention owing to its counterintuitive nature and promising applications. Pulling force originates from the enhanced forward light scattering that in accordance with the momentum conservation conveys light...... demonstrate how to ease the conditions required in experiment for realization of the optical tractor beams using the cylindrical objects. We pay a particular attention to the case of the pulling optical force due to the interaction of magnetic dipole and quadrupole moments....

  5. Risk exposure to vibration and noise in the use of agricultural track-laying tractors

    Directory of Open Access Journals (Sweden)

    Mariangela Vallone

    2016-09-01

    Full Text Available Human exposure to mechanical vibration may represent a significant risk factor for exposed workers in the agricultural sector. Also, noise in agriculture is one of the risk factors to be taken into account in the evaluation of workers’ health and safety. One of the major sources of discomfort for the workers operating a tractors is the noise to which they are exposed during work. The aim of this study was to evaluate the risk of exposure to whole-body vibration for the operator driving track-laying tractors in vineyard orchard and the noise level. The experimental tests were performed with six different track-laying tractors coupled with the same rototilling machine. The results showed that the vibration values of track-laying tractors coupled to rototilling machine, referred to the 8-hour working day, were always higher than 0.5 m s -2 , the daily exposure action value established by Directive 2002/44/EC of the European Parliament. The daily noise exposure levels always exceeded the exposure limit value of 87 dB(A established by Directive 2003/10/EC of the European Parliament. The ANOVA repeated measures model showed that the factor ‘site’, namely, the soil characteristics, did not influence the vibration level on the X and Y-axes of the tractors measured, regardless of their age. In the Z-axis, the vibration level was enhanced as the soil structure increased. As tractor age increased, the influence of soil characteristics was less important. In term of the age of the tractor and the number of hours worked, it was possible to identify three risk classes, which were up to 3,000 hours worked and offered a low risk; from 3,000 – 6,000 hours worked with a medium risk, and over 6,000 hours with a high risk level.

  6. Risk exposure to vibration and noise in the use of agricultural track-laying tractors.

    Science.gov (United States)

    Vallone, Mariangela; Bono, Filippa; Quendler, Elisabeth; Febo, Pierluigi; Catania, Pietro

    2016-12-23

    Human exposure to mechanical vibration may represent a significant risk factor for exposed workers in the agricultural sector. Also, noise in agriculture is one of the risk factors to be taken into account in the evaluation of workers' health and safety. One of the major sources of discomfort for the workers operating a tractors is the noise to which they are exposed during work. The aim of this study was to evaluate the risk of exposure to whole-body vibration for the operator driving track-laying tractors in vineyard orchard and the noise level. The experimental tests were performed with six different track-laying tractors coupled with the same rototilling machine. The results showed that the vibration values of track-laying tractors coupled to rototilling machine, referred to the 8-hour working day, were always higher than 0.5 m s -2 , the daily exposure action value established by Directive 2002/44/EC of the European Parliament. The daily noise exposure levels always exceeded the exposure limit value of 87 dB(A) established by Directive 2003/10/EC of the European Parliament. The ANOVA repeated measures model showed that the factor 'site', namely, the soil characteristics, did not influence the vibration level on the X and Y-axes of the tractors measured, regardless of their age. In the Z-axis, the vibration level was enhanced as the soil structure increased. As tractor age increased, the influence of soil characteristics was less important. In term of the age of the tractor and the number of hours worked, it was possible to identify three risk classes, which were up to 3,000 hours worked and offered a low risk; from 3,000 - 6,000 hours worked with a medium risk, and over 6,000 hours with a high risk level.

  7. IMPACT OF THE REPEATED TRACTOR PASSES ON SOME PHYSICAL PROPERTIES OF SILTY LOAM SOIL

    Directory of Open Access Journals (Sweden)

    Dubravko Filipović

    2011-12-01

    Full Text Available The aim of this paper was to quantify soil compaction induced by tractor traffic on untilled wet silty loam soil (Mollic Fluvisol. Changes in penetration resistance, bulk density and total porosity were measured for detecting the soil compaction. Treatments include ten passes of a four-wheel drive tractor with the engine power of 54.0 kW and weight of 3560 kg (1580 kg on the front axle and 1980 kg on the rear axle, 2.41 m distance between axles. The tyres on the tractor were cross-ply, front 11.2-24 and rear 16.9-30, with the inflation pressure of 160 kPa and 100 kPa, respectively. The speed of tractor during passes over experimental plots was 5.0 km h-1. In comparison to control, each tractor pass induced an increase in soil penetration resistance at all depths, and the average increment ratios, determined as the average of all layers, were 9.8, 18.5 and 26.1% after one, five and ten passes, respectively. The bulk density also increased with number of tractor passes, but with less percentage increasing. The increment ratios comparison to the control were 3.6, 9.5 and 12.9% after one, five and ten passes, respectively. The total porosity decreased with the number of passes, and the decrement ratios were 4.5, 16.5 and 20.8% after one, five and ten passes, respectively.

  8. Organizational and technological compatibility of the technological processes of second and third line maintenance of KhTZ-3522 tractors

    Directory of Open Access Journals (Sweden)

    Kyzminskyj Roman

    2018-01-01

    Full Text Available The work is devoted to systematic substantiation of productivity, production structure and specialization of service stations of KhTZ-3522 tractors. Based on the technical and economic comparative analysis of the results of the technological processes modeling of the second and third line maintenance of KhTZ-3522 tractors, the parametrical series of production structures of service stations both mono- and polytechnological specialization, which can work effectively in a wide range of the general annual program of orders, and in the conditions of seasonal fluctuations of orders for the maintenance of these tractors, are found. The results of calculations of the indicators system for organizational and technological compatibility of technological processes of the second and third line maintenance of KhTZ-3522 tractors in the joint technological flow are presented. The dependencies of these indicators on the total annual program of orders for service stations of different productivity are analyzed. According to the results of the analysis, the polytechnological specialization of such service stations is substantiated.

  9. Ergonomic assessment of brake and accelerator mechanisms of MF285 and MF399 tractors using electromyography method

    Directory of Open Access Journals (Sweden)

    A Nikkhah

    2016-04-01

    Full Text Available Introduction: Too many people are working in the agricultural sector and therefore, pay more attention to the safety and health at work in the agricultural sector is important. This issue is more important in developing industrial countries where the level of the ergonomic working condition is less than that of developed countries. Attention to ergonomic condition of agricultural machinery drivers is one of the goals of agricultural mechanization. Therefore, in this study the ergonomic conditions of brake and accelerator mechanisms for MF285 and MF399 tractor's drivers were investigated using a new method. Materials and Methods: 25 people were selected for experiment. The electrical activity of Medialis gastrocnemius, Lateralis gastrocnemius, Vastus medialis, Vastus lateralis, Quadratus Lumborum and Trapezius muscles of drivers before and during pressing the pedal and after rest time were recorded using Biovision device. Measurements were performed for each person on each muscle 30 seconds before pressing the pedal, 60 seconds after pressing the pedal and after 60 seconds of rest. For all drivers, the muscles on the right side (brake and accelerator side have been selected and tested. The measurements were performed in compliance with appropriate time intervals between the measurements. Results and Discussion: Ergonomic assessment of brake pedal: The results showed that the RMS electrical activity of muscles of Vastus medialis and Medial gastrocnemius, during 60 seconds braking were 2.47 and 1.97. So, Vastus medialis and Medial gastrocnemius had the highest stress during pressing the MF399 tractor's brake pedal. Moreover, the Medial gastrocnemius and Lateral gastrocnemius with RMS electrical activity ratio of 2.47 and 1.74 had the highest RMS electrical activity ratio respectively, during 60 seconds braking compared to before braking of MF285 tractor. The comparison of results showed that the Vastus medialis and Trapezius had the higher stress

  10. A Tractor or an Automobile? A 1920s Farm Family Faces a Decision.

    Science.gov (United States)

    Kunze, Joel P.

    1991-01-01

    Outlines a lesson plan in which students role play a 1920s farm family deciding whether to buy an automobile or a tractor. Other students act as automobile and tractor sales groups. Explains how the lesson illuminates relationships between technological advance and social history. Includes handouts identifying benefits of purchasing cars or…

  11. Enhanced Gravity Tractor Technique for Planetary Defense

    Science.gov (United States)

    Mazanek, Daniel D.; Reeves, David M.; Hopkins, Joshua B.; Wade, Darren W.; Tantardini, Marco; Shen, Haijun

    2015-01-01

    Given sufficient warning time, Earth-impacting asteroids and comets can be deflected with a variety of different "slow push/pull" techniques. The gravity tractor is one technique that uses the gravitational attraction of a rendezvous spacecraft to the impactor and a low-thrust, high-efficiency propulsion system to provide a gradual velocity change and alter its trajectory. An innovation to this technique, known as the Enhanced Gravity Tractor (EGT), uses mass collected in-situ to augment the mass of the spacecraft, thereby greatly increasing the gravitational force between the objects. The collected material can be a single boulder, multiple boulders, regolith or a combination of different sources. The collected mass would likely range from tens to hundreds of metric tons depending on the size of the impactor and warning time available. Depending on the propulsion system's capability and the mass collected, the EGT approach can reduce the deflection times by a factor of 10 to 50 or more, thus reducing the deflection times of several decades to years or less and overcoming the main criticism of the traditional gravity tractor approach. Additionally, multiple spacecraft can orbit the target in formation to provide the necessary velocity change and further reduce the time needed by the EGT technique to divert hazardous asteroids and comets. The robotic segment of NASA's Asteroid Redirect Mission (ARM) will collect a multi-ton boulder from the surface of a large Near-Earth Asteroid (NEA) and will provide the first ever demonstration of the EGT technique and validate one method of collecting in-situ mass on an asteroid of hazardous size.

  12. Design and Implementation of a GPS Guidance System for Agricultural Tractors Using Augmented Reality Technology

    Directory of Open Access Journals (Sweden)

    Laura del-Pozo-San-Cirilo

    2010-11-01

    Full Text Available Current commercial tractor guidance systems present to the driver information to perform agricultural tasks in the best way. This information generally includes a treated zones map referenced to the tractor’s position. Unlike actual guidance systems where the tractor driver must mentally associate treated zone maps and the plot layout, this paper presents a guidance system that using Augmented Reality (AR technology, allows the tractor driver to see the real plot though eye monitor glasses with the treated zones in a different color. The paper includes a description of the system hardware and software, a real test done with image captures seen by the tractor driver, and a discussion predicting that the historical evolution of guidance systems could involve the use of AR technology in the agricultural guidance and monitoring systems.

  13. A Kalman Filter Implementation for Precision Improvement in Low-Cost GPS Positioning of Tractors

    Science.gov (United States)

    Gomez-Gil, Jaime; Ruiz-Gonzalez, Ruben; Alonso-Garcia, Sergio; Gomez-Gil, Francisco Javier

    2013-01-01

    Low-cost GPS receivers provide geodetic positioning information using the NMEA protocol, usually with eight digits for latitude and nine digits for longitude. When these geodetic coordinates are converted into Cartesian coordinates, the positions fit in a quantization grid of some decimeters in size, the dimensions of which vary depending on the point of the terrestrial surface. The aim of this study is to reduce the quantization errors of some low-cost GPS receivers by using a Kalman filter. Kinematic tractor model equations were employed to particularize the filter, which was tuned by applying Monte Carlo techniques to eighteen straight trajectories, to select the covariance matrices that produced the lowest Root Mean Square Error in these trajectories. Filter performance was tested by using straight tractor paths, which were either simulated or real trajectories acquired by a GPS receiver. The results show that the filter can reduce the quantization error in distance by around 43%. Moreover, it reduces the standard deviation of the heading by 75%. Data suggest that the proposed filter can satisfactorily preprocess the low-cost GPS receiver data when used in an assistance guidance GPS system for tractors. It could also be useful to smooth tractor GPS trajectories that are sharpened when the tractor moves over rough terrain. PMID:24217355

  14. ENHANCEMENT OF DURABILITY OF TRACTOR SUSPENSION AXLES

    Directory of Open Access Journals (Sweden)

    I. Doshchechkina

    2017-12-01

    Full Text Available The ‘soft’ nitriding of the suspension axle surface of the T150K tractor at the depth of 0.08 mm enables us to enhance its constructive strength, to increase its service life by 25 % and have a considerable economic effect.

  15. Evaluation of Massey Ferguson Model 165 Tractor Drivers exposed to whole-body vibration

    Directory of Open Access Journals (Sweden)

    P. Nassiri

    2013-12-01

    Conclusion: This study shows that the need to provide intervention , controlling and managing measures to eliminate or reduce exposure to whole body vibration among tractor drivers its necessary. And, preventing main disorder Including musculoskeletal disorders, discomfort and early fatigue is of circular importance. More studies are also necessary to identify the sources of vibration among various of tractors.

  16. A mission planner for an autonomous tractor

    DEFF Research Database (Denmark)

    Bochtis, Dionysis; Vougioukas, S.G.; Griepentrog, Hans W.

    2009-01-01

    . Using the tree hierarchy of the mission file, several actions are determined, including the sequence of points the tractor has to follow, the type of motion between successive points (e.g.,straight motion or maneuvering), the type of predefined turning routine used in maneuvering, and the actions...

  17. Chores at Times of Fatal or Serious Injuries Associated with Tractor Overturns with and without Rollover Protection

    Directory of Open Access Journals (Sweden)

    Henry P. Cole

    2016-09-01

    Full Text Available This study describes chores when farmers were either fatally or seriously injured and required emergency medical treatment as a result of overturns of tractors with or without rollover protective structures (ROPS. Data from the 2002 Kentucky Farm Tractor Overturn Survey were used for this study. The data were collected by a telephone survey of a population-based random sample of 6063 (7.98% of Kentucky’s 76,017 farm operators as listed in the Kentucky Agricultural Statistics Service database. Of farm operators interviewed, 551 (9.1% reported 603 overturns and 5512 (90.9% reported no overturns in the history of their farm, covering a period from 1925 to February 2002. Only the latest overturn was considered to improve recall accuracy. In addition, since the 1925 to 1959 time period had only 49 (8.1% of the overturns reported, (14 farmers did not provide the year of most recent overturn; only data from the 1960 to 2002 period (approximately 41 years were used. After making these adjustments, incidents evaluated included 25 cases (one fatal and four serious nonfatal injuries that involved ROPS-equipped tractor overturns and 88 cases (24 fatal and 64 serious nonfatal injuries that involved non-ROPS tractor overturns. Chores at highest risk for tractor overturns were identified for which educational and ROPS retrofit interventions could be emphasized. The highest frequency of overturn-related fatalities and nonfatal injuries were associated with hay harvesting, rotary mowing, and on-farm travel chores. These three chores represented 68.2% of fatal events and 50.0% of permanent and 56.6% of temporary disability overturn incidents. Tragically, in countries such as India and China with emerging mechanization, a large majority of tractors are produced without ROPS that can be expected to result in the same overturn-related epidemic of deaths experienced in highly mechanized countries, despite evidence of the protection provided by ROPS.

  18. Identifying and prioritizing customer requirements from tractor production by QFD method

    Directory of Open Access Journals (Sweden)

    H Taghizadeh

    2017-05-01

    Full Text Available Introduction Discovering and understanding customer needs and expectations are considered as important factors on customer satisfaction and play vital role to maintain the current activity among its competitors, proceeding and obtaining customer satisfaction which are critical factors to design a successful production; thus the successful organizations must meet their needs containing the quality of the products or services to customers. Quality Function Deployment (QFD is a technique for studying demands and needs of customers which is going to give more emphasis to the customer's interests in this way. The QFD method in general implemented various tools and methods for reaching qualitative goals; but the most important and the main tool of this method is the house of quality diagrams. The Analytic Hierarchy Process (AHP is a famous and common MADM method based on pair wise comparisons used for determining the priority of understudied factors in various studies until now. With considering effectiveness of QFD method to explicating customer's demands and obtaining customer satisfaction, generally, the researchers followed this question's suite and scientific answer: how can QFD explicate real demands and requirements of customers from tractor final production and what is the prioritization of these demands and requirements in view of customers. Accordingly, the aim of this study was to identify and prioritize the customer requirements of Massey Ferguson (MF 285 tractor production in Iran tractor manufacturing company with t- student statistical test, AHP and QFD methods. Materials and Methods Research method was descriptive and statistical population included all of the tractor customers of Tractor Manufacturing Company in Iran from March 2011 to March 2015. The statistical sample size was 171 which are determined with Cochran index. Moreover, 20 experts' opinion has been considered for determining product's technical requirements. Literature

  19. INTEGRAL ASSESSMENT OF EFFICIENCY OF A FLEET OF AGRICULTURAL MACHINERY AND TRACTORS

    Directory of Open Access Journals (Sweden)

    V. M. Korotchenya

    2015-01-01

    Full Text Available An indicator for an integral assessment of efficiency of a fleet of agricultural machinery and tractors is proposed. Its calculating consists in multiplying partial efficiencies together: technical and price efficiency of agricultural production, and eco-efficiency of a fleet of agricultural machinery and tractors. Using an axiomatic method, the concept of efficiency of fleet was studied within broader category of productivity and in wider scales - within agriculture. The most general and obvious statements according to which efficiency of machine and tractor fleet is considered as indirectly settlement size counted proceeding from efficiency of agricultural production, were accepted as axioms. In general, efficiency is a ratio between productivity of an object in question and that of the theoretical ideal or an object with maximum productivity efficiency of which is accepted equal to unity or 100%. Technical efficiency of agricultural production characterizes the ability of an agricultural sector to produce the technically maximum output of agricultural produce obtained from the available resources (land, labor, machines, etc.. Price efficiency evaluates the ability of an agricultural sector to produce output of agricultural produce with regard to employing the optimal mix of resources given their prices. Because the theoretical ideal does not exist, efficiency of an agricultural sector, e.g. in Russia and of its fleet of agricultural machinery and tractors, is measured against agriculture of another country with maximum productivity efficiency of which is accepted as equal to unity or 100 percent. The calculation can be made on the basis of the Data Envelopment Analysis method. It is possible to calculate price and economic efficiency of Russian agriculture (fleet of agricultural machinery and tractors due to use its domestic prices.

  20. Whole-Body Vibration in Farming: Background Document for Creating a Simplified Procedure to Determine Agricultural Tractor Vibration Comfort

    Directory of Open Access Journals (Sweden)

    Maurizio Cutini

    2017-09-01

    Full Text Available Operator exposure to high levels of whole-body vibration (WBV presents risks to health and safety and it is reported to worsen or even cause back injuries. Work activities resulting in operator exposure to whole-body vibration have a common onset in off-road work such as farming. Despite the wide variability of agricultural surface profiles, studies have shown that with changing soil profile and tractor speed, the accelerations resulting from ground input present similar spectral trends. While on the one hand such studies confirmed that tractor WBV emission levels are very dependent upon the nature of the operation performed, on the other, irrespective of the wide range of conditions characterizing agricultural operations, they led researchers to set up a possible and realistic simplification and standardization of tractor driver comfort testing activities. The studies presented herewith indicate the usefulness, and the possibility, of developing simplified procedures to determine agricultural tractor vibration comfort. The results obtained could be used effectively to compare tractors of the same category or a given tractor when equipped with different seats, suspension, tyres, etc.

  1. Implementation of Virtual Reality in the Conceptual Design of a Tractor Trailer

    OpenAIRE

    Arunesh Chandra; Pankaj Chandna

    2014-01-01

    Virtual reality (VR) is a rapidly emerging computer interface that attempts to immerse the user completely within an experimental recreation; thereby, greatly enhancing the overall impact and providing a much more intuitive link between the computer and the human participants. The main objective of this study is to design tractor trailer capable of meeting the customers’ requirements and suitable for rough conditions to be used in combination with a farm tractor in India....

  2. Eficiência energética de tratores agrícolas fabricados no Brasil Energy efficiency of Brazilian agricultural tractors

    Directory of Open Access Journals (Sweden)

    Gastão M. da Silveira

    2010-04-01

    Full Text Available Atualmente, cresce o interesse global na economia de combustível fóssil e na redução das emissões de gases, por motivos econômicos e ecológicos. Neste trabalho se aplicou um método para classificação de tratores agrícolas, com base na sua eficiência energética, usando-se o consumo específico (em L kWh-1 como termo de comparação. O fator energético mais importante para essa máquina é o seu motor, seguido da transmissão. O trabalho se baseia no resultado dos ensaios de tratores realizados segundo normas brasileiras, tendo como modelo o código OECD, além de ser uma classificação de modelos de tratores fabricados no País. Os tratores movidos a álcool apresentaram consumo elevado de combustível. A metodologia permite a idéia de como os tratores se comportam, no que diz respeito à eficiência energética.Nowadays there is a growing global interest in saving fossil fuel and reducing gas emissions for economical and ecological reasons. This research applied a method of classification of agricultural tractors depending on their energy efficiency, using the specific fuel consumption (in L kWh-1 as a comparison. The most important energy factor in these machines is the engine, followed by the transmission. This research is based on results of the OECD tractor test and classifies tractor models, which have been principally sold in Brazil. The tractors fueled by ethanol presented a high level of fuel consumption. The methodology allows us to understand how tractors perform in terms of energy efficiency.

  3. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

    ... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...

  4. System automated for evaluation of the consuption of biodiesel in agricola tractor

    OpenAIRE

    Ivair Marchetti

    2006-01-01

    This work had as objective the assembly of a system automated for evaluation of the consumption of fuel in agricultural tractors, in the utilization of biodiesel in diverse mixtures diesel/biodiesel for the accomplishment of testing, without the utilization of the tank of the tractor. The system was projected and mounted on the UNIOESTE Cascavel - PR in partnership with the UTFPR Medianeira â PR. The system is composed for two auxiliary tanks confectioned in stainless steel ...

  5. DETERMINATION OF TRANSMISSION GEAR RATIO IN MECHANICAL PART OF TRACTOR ELECTRO-MECHANICAL TRANSMISSION

    Directory of Open Access Journals (Sweden)

    Ch. I. Zhdanovich

    2016-01-01

    Full Text Available A methodology has been developed for selection of gear number and transmission gear ratios in mechanical part of a wheel-type tractor with electro-mechanical transmission containing a propulsion asynchronous electric motor with variablefrequency control. The paper proposes to determine a transmission gear ratio on the basis of the following: provision of wheel torque dependence on tractor speed which is the best one for a traction process and during transfer from one gear to the other; provision of nominal operational mode of the electric motor for all tractor operations where it is working for a long period of time; provision of minimum possible number of gears; complete realization of internal combustion engine power on the tractor wheels at limit operational mode of the electric motor. As a characteristic of the asynchronous electric motor with variable-frequency control contains various portions which can be used either completely or partially due to operating conditions, the gear number is determined in the process of transmission gear ration finding but not prior to this. A wheel torque of the tractor with electro-mechanical transmission can be limited according to the following factors: grip of wheel with supporting surface; maximum power of an internal combustion engine which can be transferred to the wheels and a torque which is developed by a propulsion electric motor. It is not proposed to exceed nominal operational mode of the propulsion electric motor for all the operations of the tractor if it is working for a long period of time because in the case of significant excess of the nominal operational mode of the asynchronous electric motor its rather long operation leads to low efficiency and high losses in power, large heat liberation and consequently requires to develop more complicated system for electric motor cooling. An excess of nominal electric motor torque can be justified for short-term operational modes because in this case

  6. Process Approach for Modeling of Machine and Tractor Fleet Structure

    Science.gov (United States)

    Dokin, B. D.; Aletdinova, A. A.; Kravchenko, M. S.; Tsybina, Y. S.

    2018-05-01

    The existing software complexes on modelling of the machine and tractor fleet structure are mostly aimed at solving the task of optimization. However, the creators, choosing only one optimization criterion and incorporating it in their software, provide grounds on why it is the best without giving a decision maker the opportunity to choose it for their enterprise. To analyze “bottlenecks” of machine and tractor fleet modelling, the authors of this article created a process model, in which they included adjustment to the plan of using machinery based on searching through alternative technologies. As a result, the following recommendations for software complex development have been worked out: the introduction of a database of alternative technologies; the possibility for a user to change the timing of the operations even beyond the allowable limits and in that case the calculation of the incurred loss; the possibility to rule out the solution of an optimization task, and if there is a necessity in it - the possibility to choose an optimization criterion; introducing graphical display of an annual complex of works, which could be enough for the development and adjustment of a business strategy.

  7. Generating a stationary infinite range tractor force via a multimode optical fibre

    Science.gov (United States)

    Ebongue, C. A.; Holzmann, D.; Ostermann, S.; Ritsch, H.

    2017-06-01

    Optical fibres confine and guide light almost unattenuated and thus convey light forces to polarizable nano-particles over very long distances. Radiation pressure forces arise from scattering of guided photons into free space while gradient forces are based on coherent scattering between different fibre modes or propagation directions. Interestingly, even scattering between co-propagating modes induces longitudinal forces as the transverse confinement of the light modes creates mode dependent longitudinal wave-vectors and photon momenta. We generalize a proven scattering matrix based approach to calculate single as well as inter-particle forces to include several forward and backward propagating modes. We show that an injection of the higher order mode only in a two mode fibre will induce a stationary tractor force against the injection direction, when the mode coupling to the lower order mode dominates against backscattering and free space losses. Generically this arises for non-absorbing particles at the centre of a waveguide. The model also gives improved predictions for inter-particle forces in evanescent nanofibre fields as experimentally observed recently. Surprisingly strong tractor forces can also act on whole optically bound arrays.

  8. Comparison between ISO 5008 and field whole body vibration tractor values

    Directory of Open Access Journals (Sweden)

    Roberto Deboli

    2012-09-01

    Full Text Available The exposure to whole body vibration (WBV of tractor drivers during field operations is a problem that has never been solved. WBV values are quite difficult to predict because of the high number of variables, such as mass and geometry of the vehicle, forward speed, tire pressure, type of ground, operation cycle, and environmental factors. The use of an artificial track is useful to limit the variability of some field parameters, such as the path followed, fluctuations in speed, weather, temperature, and soil conditions. For comparative purposes, these variables need to be maintained as constant as possible in order to obtain the most useful data. An analysis of the literature provoked the question: Is there a lower forward speed on artificial track that can generate the same vibration response on tractors working in the same field? In this paper, we analyze the available literature and provide some WBV values and frequency analysis of acceleration measured on agricultural tractors traveling on an artificial test track and on different types of ground.

  9. Operational comparison of two types of tractor sprayers (microner and boom-type against wheat crop weeds

    Directory of Open Access Journals (Sweden)

    M Hamid

    2015-09-01

    % levels (Table 5. The most percent of crop loss belonged to sprayer boom tractor with flowage nozzle (27.03% and the least belonged to microner boom sprayer tractor (6%. The most percent of drift belonged to microner boom sprayer tractor with medium speed of rotation disk (76.19% and the least belonged to sprayer boom tractor with flowage nozzle (23.81%. The best spraying quality (1.17 was for microner with medium rotation disk treat (Table 6. Conclusions: Performance of a sprayers mostly depends upon the working of its nozzle. In this research, two different sprayers with three typical nozzles were used to control wheat crop weeds. In general, the tractor sprayer of microner (40 million Rials is more expensive than the typical boom sprayer, and because most farmers owntractor mounted boom sprayers the most convenient and least expensive method is to use Italian fan nozzle (standard due to lower cost and higher performance. However, there are many effectiveness parameters to select a suitable sprayer for the field. But on the bases of the sprayer's technological specifications, weed control parameters, economical parameters and etc., technical methods such as Analytical Hierarchy Process (AHP or other ones are proposed to choose the better sprayer for pesticide applications.

  10. Pulsed Nonlinear Automatic Control System for Guidance of a Caterpillar Tractor Unit in Vineyards

    Directory of Open Access Journals (Sweden)

    Sit M.L.

    2018-04-01

    Full Text Available The automatic guidance systems of tractors for soil cultivation in vineyards have attracted the attention of researchers since the second half of the twentieth century. The purpose of this paper is to investigate the driving quality of an automatic guidance system (AGS for a caterpillar tractor unit (CTU consisting of a crawler tractor and a vineyard plow and having the orientation system by grapes stamps. Compared with the known works (in which GPS, LIDAR, and video cameras are used for orientation, the proposed system is the least expensive. For this, the existence of stability of the AGS as a whole in the range of operating speeds of the unit was proved. The dynamic model of the vineyard plow was verified on a three-point hitching system of the tractor, field tests of the AGS were carried out, which confirmed the results of theoretical studies, and suggested directions for further research. The shape and parameters of the modulation characteristic (MC of the pulse-width modulator (PWM of the AGS control system, the rational values of the hydraulic drive speeds of the sequential control mechanism of the clutch of the turn and the crawler tractor belt brake, were established, depending on the slope angle and the speed of the unit, ensuring agrotechnical requirements for driving. New solutions, in comparison with the known ones, are the ways of forming the MC of PWM using a new design probe and the associated driver MC of PWM.

  11. Design and Development of A Three-Point Auto Hitch Dynamometer for An Agricultural Tractor

    Directory of Open Access Journals (Sweden)

    A. F. Kheiralla

    2017-12-01

    Full Text Available This paper describes the design, development and calibration of a three-point auto hitch dynamometer for measuring the horizontal and vertical forces that existed at the three-point hitch of an agricultural tractor.  The design concept of the dynamometer was based on an instrumented inverted U frame assembly that was mounted between tractor links and implement. The design incorporates for both lower point hitch spread and mast height adjustments, and quick hitch capability in accordance with category 1 and II three-point hitch system.  The force sensing elements were comprised of three steel extended octagonal ring transducers that were located between the inverted U frame and hook brackets.  Electrical resistance strain gauges were mounted on the extended octagonal ring transducer at strain angle nodes to independently monitor strains that were proportional to the horizontal and vertical forces at the ring center. Each transducer was designed for maximum horizontal and vertical forces of 25 kN and 10 kN at measurement mean sensitivities of 25.19 µStrain/kN and 25.60 µStrain/kN, respectively. However, the complete dynamometer has been designed to measure the maximum resultant horizontal and vertical forces of 50 kN and 20 kN, respectively.  Field demonstration tests on the dynamometer and data acquisition system showed that they were able to function effectively as intended.  The data acquisition system was able to successfully scan and record the dynamometer signals as programmed.  This dynamometer was part of the complete instrumentation system to be developed onboard a Massey Ferguson 3060 tractor for the generation of a comprehensive database on the power and energy requirements of the tractor and its working implement in the field.

  12. A SURVEY OF FARM TRACTOR MANAGEMENT IN ZAMFARA STATE

    African Journals Online (AJOL)

    2013-03-01

    Mar 1, 2013 ... farm tractor, maintenance, management, mechanization, survey study. 1. Introduction ... demand for agricultural operations, there is an ever .... 3rd Ed., AVI Publishing. Company, Inc., Westport, Connecticut, 1978. 8. Apollos ...

  13. Towing Asteroids with Gravity Tractors Enhanced by Tethers and Solar Sails

    Science.gov (United States)

    Shen, Haijun; Roithmayr, Carlos M.

    2015-01-01

    Material collected from an asteroid's surface can be used to increase gravitational attraction between the asteroid and a Gravity Tractor (GT); the spacecraft therefore operates more effectively and is referred to as an Enhanced Gravity Tractor (EGT). The use of tethers and solar sails to further improve effectiveness and simplify operations is investigated. By employing a tether, the asteroidal material can be placed close to the asteroid while the spacecraft is stationed farther away, resulting in a better safety margin and improved thruster efficiency. A solar sail on a spacecraft can naturally provide radial offset and inter-spacecraft separation required for multiple EGTs.

  14. Effect of using GPS autosteer guidance systems on the eye-glance behavior and posture of tractor operators.

    Science.gov (United States)

    Karimi, D; Henry, J; Mann, D D

    2012-10-01

    Tractor operators are prone to neck and back discomfort and disorders. It is well known that awkward posture is a major contributor to this problem. Previous studies have investigated the prevalence of awkward posture and the resulting discomfort and disorders among tractor operators. They have also suggested various ways to mitigate this problem. With the introduction of new autosteer guidance systems, the tractor operator is relieved from the task of steering the tractor for most of the time during field work. Therefore, it is expected that the operator's posture will change. The goal of this study was to investigate the changes in the eye-glance behavior and posture of tractor operators as a result of using autosteer guidance systems. An eye-tracking system and a camcorder were used to record the eye-glance behavior and posture of 13 tractor operators as they performed seeding operations. The experiment with each operator consisted of two sessions. In one session, the operator used an autosteer system, while in the other session the operator steered the tractor manually. Analysis of the data showed that the eye-glance behavior and posture of the operators were significantly different between the autosteer and manual steering sessions. With the autosteer system, the operators spent less time in an awkward posture, and they changed their posture less frequently. However, even with the autosteer system, the operators spent 1/3 of their time in an awkward posture. Subjective feedback from the operators indicated that more than half of them experienced back or neck/shoulder discomfort during or after seeding. It is essential that the recommendations of the previous studies, such as using large rear-view mirrors or a rotating tractor seat, be evaluated when the operator is using an autosteer system. Other tools, such as video cameras that show the attached equipment, should also be tested to evaluate their effectiveness in reducing the operator's exposure to awkward

  15. performance (assessment) of two- wheel tractors for small holder

    African Journals Online (AJOL)

    CHIKA

    and easy operation and maintenance; reasonably rugged ... whole the professional two- wheel tractor is expected to have ... in order to achieve reasonable productivity in developing .... producers of both food and cash crops in. Nigeria, power ...

  16. Emission and operating performance of a biomethane tractor with dual fuel engine

    International Nuclear Information System (INIS)

    Mautner, Sebastian; Emberger, Peter; Thuneke, Klaus; Remmele, Edgar

    2016-01-01

    The use of biomethane as fuel for agricultural machinery with dual fuel technology is contributing to climate protection and ensures safe fuel supply. So far, hardly any documented operational experiences are known. The aim of the project, funded by the Bavarian Ministry of Economic Affairs and Media, Energy and Technology, was to investigate practicability for daily use and the emission behaviour of a Valtra N101 prototype tractor (exhaust stage IIIA). The retrofitted dual-fuel technology of the former conventional diesel tractor simultaneously uses biomethane or natural gas and diesel as ignition fuel. During the field test over 590 working hours, the tractor showed overall high reliability. On average the operating range in dual-fuel mode with one complete filling of the gas tanks was about 11.5 hours. On the tractor test bench a significant improvement of the exhaust emissions could be observed, since the gas ECU had been optimized and changed by the manufacturer. For dual-fuel operation, nitrogen oxides (NO x ) are lower, whereas carbon monoxide (CO), hydrocarbons (HC) and particulate matter emissions (PM) are higher compared to solely diesel operation. In particular, HC emissions exceed the proposed limiting value, submitted by the European Commission. This is due to incomplete gas combustion and insufficient conversion by the exhaust after-treatment-system (methane slip). A big potential for optimization is expected by adjusting the operating point-specific gasdiesel ratio and improving the exhaust gas aftertreatment system.

  17. Sex differences in principal farm operators' tractor driving safety beliefs and behaviors.

    Science.gov (United States)

    Cole, H P; Westneat, S C; Browning, S R; Piercy, L R; Struttmann, T

    2000-01-01

    To examine the widely accepted hypothesis that farm women are more concerned with safety issues and behaviors than their male counterparts are. A telephone survey was administered to a random sample of Kentucky principal farm operators, 90 of whom were women. Participants were questioned about their tractor safety beliefs and practices. No significant sex differences in tractor safety perceptions and behavior were observed. Socialization of women to the role of principal farm operator may override their typically greater sensitivity to safety issues, an important consideration when designing safety campaigns for this population.

  18. TractoR: Magnetic Resonance Imaging and Tractography with R

    Directory of Open Access Journals (Sweden)

    Chris A. Clark

    2011-10-01

    Full Text Available Statistical techniques play a major role in contemporary methods for analyzing magnetic resonance imaging (MRI data. In addition to the central role that classical statistical methods play in research using MRI, statistical modeling and machine learning techniques are key to many modern data analysis pipelines. Applications for these techniques cover a broad spectrum of research, including many preclinical and clinical studies, and in some cases these methods are working their way into widespread routine use. In this manuscript we describe a software tool called TractoR (for “Tractography with R”, a collection of packages for the R language and environment, along with additional infrastructure for straightforwardly performing common image processing tasks. TractoR provides general purpose functions for reading, writing and manipulating MR images, as well as more specific code for fitting signal models to diffusion MRI data and performing tractography, a technique for visualizing neural connectivity.

  19. Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2018-01-01

    BACKGROUNDThere is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores.METHODSThis study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European...... guidelines ("European risk score") versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation.RESULTSThe European score had modest...... predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...

  20. The use of fuzzy logic in quality control testing of automotive and tractor equipment

    Directory of Open Access Journals (Sweden)

    Korobko А.

    2016-08-01

    Full Text Available The article analyzes the relevance of the research topics, defines goals and objectives, subject and object of research. On the basis of the literature analysis, the following eduction was made: not all the test methods in road and agricultural vehicles (tractors contribute to the effective implementation of the requirements of normative documents including international, inter-laboratory comparative tests. The approach in laboratory testing to the synthesis adaptive system of metrological assurance the use of fuzzy logic is proposed. These labs conduct testing of automotive and tractor equipment. The decision is under risk. The scheme of metrological assurance system covers all parties to ensure the necessary accuracy of measurements and tests; the necessary normative-technical documentation is provided; availability of measuring instruments and test equipment, standards and reference measures; availability of qualified personnel; the assurance that test results are accurate (correct and precision; provides effective decisions based on objective information.

  1. A Source-Term Based Boundary Layer Bleed/Effusion Model for Passive Shock Control

    Science.gov (United States)

    Baurle, Robert A.; Norris, Andrew T.

    2011-01-01

    A modeling framework for boundary layer effusion has been developed based on the use of source (or sink) terms instead of the usual practice of specifying bleed directly as a boundary condition. This framework allows the surface boundary condition (i.e. isothermal wall, adiabatic wall, slip wall, etc.) to remain unaltered in the presence of bleed. This approach also lends itself to easily permit the addition of empirical models for second order effects that are not easily accounted for by simply defining effective transpiration values. Two effusion models formulated for supersonic flows have been implemented into this framework; the Doerffer/Bohning law and the Slater formulation. These models were applied to unit problems that contain key aspects of the flow physics applicable to bleed systems designed for hypersonic air-breathing propulsion systems. The ability of each model to predict bulk bleed properties was assessed, as well as the response of the boundary layer as it passes through and downstream of a porous bleed system. The model assessment was performed with and without the presence of shock waves. Three-dimensional CFD simulations that included the geometric details of the porous plate bleed systems were also carried out to supplement the experimental data, and provide additional insights into the bleed flow physics. Overall, both bleed formulations fared well for the tests performed in this study. However, the sample of test problems considered in this effort was not large enough to permit a comprehensive validation of the models.

  2. Analysis of fatal accidents with tractors in the Centre of Portugal: Ten years analysis.

    Science.gov (United States)

    Antunes, Soraia M; Cordeiro, Cristina; Teixeira, Helena M

    2018-06-01

    Tractors have been described as one of the deadliest farming implements concerning agricultural activity. In Portugal, the scientific investigations about this problem are practically non-existent, with only statistical studies performed by entities related to road traffic safety, not in accordance to the study now performed, pinpointing the possibility of an underreporting of these accidents. This work aims to characterize the fatal tractor accidents in Portugal, autopsied at the Forensic Pathology Department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, analysing several variables: gender, age, occupation, survival time, the victim position in the tractor, cause of death, toxicological and histological exams, year/month/day of the week, type of agricultural machine, existence of rollover protective structures (ROPS), type of accident, ground conditions, circumstantial information and geographic distribution of the accidents. All the autopsies between 2005 and 2014 were analysed. The victim profile corresponded to a man (89.5%), between 61 and 70 years old (33.3%), retired (43.9%), being the tractor driver (45.6%). In most of the cases, death occurred in less than 24h after the accident. These fatalities arose mainly in May and October. Rollover in sloping land was the most common type of accident, and cranioencephalic, thoracic and abdominal traumatic injuries were the main cause of death. In 16.2% of the cases, blood alcohol concentration was above the lower limit established in our road traffic law (accidents, and the corresponding circumstances that contributed to the death. Many barriers remain about this matter, but the Portuguese government begin to design several laws to prevent this type of accidents. Future investigations should be performed to understand the real dimension of tractor accidents in Portugal, and to comprehend the efficiency of laws implemented by the government. Copyright © 2018

  3. An improvement of the base bleed unit on base drag reduction and heat energy addition as well as mass addition

    International Nuclear Information System (INIS)

    Xue, Xiaochun; Yu, Yonggang

    2016-01-01

    Highlights: • A 2D axisymmetric Navier-Stokes equation for a multi-component reactive system is solved. • The coupling of the internal and wake flow field with secondary combustion is calculated. • Detailed data with combined effects of boattailing and post-combustion are obtained. • The mechanism of heat energy addition and thermodynamics performances is investigated. - Abstract: Numerical simulations are carried out to investigate the base drag and energy characteristics of a base-bleed projectile with and without containing the effect of a post-combustion process for a boattailed afterbody in a supersonic flow, and then to analyze the key factor of drag reduction and pressure decreasing of base bleed projectile. Detailed chemistry models for H_2−CO combustion have been incorporated into a Navier-Stokes computer code and applied to flow field simulation in the base region of a base-bleed projectile. Detailed numerical results for the flow patterns and heat energy addition as well as mass addition for different conditions are presented and compared with existing experimental data. The results shows that, the post-combustion contributes to energy addition and base drag reduction up to 78% on account of that the heat energy released from the post-combustion using fuel-rich reaction products as the fuel in the wake region is much higher than for the corresponding cold bleed and hot bleed cases. In addition, the temperature distribution regularities are changed under post-combustion effect, presenting that the peak appears in a couple of recirculation regions. The fuel-rich bleed gas flows into the shear layer along the crack between these two recirculation regions and then those can readily burn when mixing with the freestream, thus causing component changes of H_2 and CO in the base flowfield.

  4. The development and validation of an ergonomics index for assessing tractor operator work place

    Directory of Open Access Journals (Sweden)

    Juan Paulo Barbieri

    2018-02-01

    Full Text Available ABSTRACT: This study aimed to develop and validate an ergonomics index for the operator workplace assessment of agricultural tractors sold in the Brazilian market. To develop the ergonomics index, the operator work places were assessed for compliance with current, national and international, safety and ergonomics standards. The following standards were analyzed to develop ergonomics index: ISO 15077 (1996, which regulates the position of operator controls; ABNT NBR ISO 4254-1(2015 and ABNT NBR ISO 4252 (2011, which regulate the access to operator workplaces; and NR 12 (2010, which determines the mandatory items of operator workplaces.Thirty-four operator work places of 152 models of new agricultural tractors sold in the Brazilian market were analyzed in this study. Ergonomics index was developed and validated using these standards, and the findings enabled the ranking of agricultural tractors. Therefore, the proposed ergonomics index proved feasible and may be applied to other agricultural machines.

  5. The mathematical model for the investigation of different influence factors on the economic and ecological indicators of a wheel tractor

    Directory of Open Access Journals (Sweden)

    Zakharchuk V.I.

    2016-08-01

    Full Text Available To solve the problem of oil deficit and reduce emissions of harmful substances from exhaust gases of vehicles alternative motor fuels, including biodiesel may by used. Most of wheel tractors are used as technological transport in agriculture, industry and municipal services. The article aims to clarify the mathematical model to determine the effect of the type of fuel used wheeled tractors on its performance. The mathematical model of the system "operator-wheel tractor-road" for the design research impact type of fuel on harmful emissions and fuel consumption wheeled tractor, is used as technological transport during its movement for driving cycle. Driving cycle showed main modes of motion there are acceleration, motion with constant speed and deceleration. The mathematical model allows to accurately consider peculiarities of the wheel tractor as the vehicle and engine describing its characteristics by polinomial dependencies. In mathematical models specified polynomial dependences that describe the fuel supply cycle indicated torque, fuel consumption and concentrations of main harmful substances in the exhaust gases of diesel during operation on diesel and biodiesel.

  6. Simulação da estabilidade de tratores agrícolas 4x2 Simulation of the stability of 2wd agricultural tractors

    Directory of Open Access Journals (Sweden)

    Joseph Kalil Khoury Junior

    2009-01-01

    Full Text Available O objetivo do trabalho foi simular computacionalmente a estabilidade de tratores agrícolas 4x2. Experimentos de simulação foram realizados visando analisar o comportamento dinâmico de um trator agrícola 4x2 trabalhando em diferentes condições de operação e de terreno. Nas simulações em que se variaram as posições do trator sobre uma pista inclinada até o tombamento lateral, o ângulo de posição igual a 60º foi o de pior situação, o que corresponde ao trator descer por uma diagonal em pista inclinada para a esquerda. A bitola e a localização do centro de gravidade na vertical foram os fatores que mais afetaram a estabilidade do trator em tombamentos laterais. Já, a localização do centro de gravidade na longitudinal e a distância entre eixos afetaram mais a estabilidade do trator em tombamentos para trás. O trator deslizou os rodados do lado do tombamento ou perdeu a dirigibilidade dos pneus frontais com ângulos inferiores aos limites de estabilidade para tombamento.The objective of this work was to predict the loss of 2WD tractors stability. Simulations were done to analyze the dynamic behavior of an agricultural tractor working in different operation and surface conditions. Simulating different tractor positions on an inclined track until its side overturn, the tractor angle position of 60º presented the worst situation, what represented a tractor moving diagonally down on a left inclined track. Changing the tractor geometry and weight in the simulations, the vertical position of tractor central mass and its tread width were the parameters that most affected the tractor stability to side overturn. The longitudinal position of tractor central mass and the distance between its axes influenced on the tractor stability to rearward overturning. The tractor either slip the wheels at the side overturning or lost the front tire controlling at angles less than the overturning limits.

  7. Gravity, two times, tractors, Weyl invariance, and six-dimensional quantum mechanics

    International Nuclear Information System (INIS)

    Bonezzi, R.; Latini, E.; Waldron, A.

    2010-01-01

    Fefferman and Graham showed some time ago that four-dimensional conformal geometries could be analyzed in terms of six-dimensional, ambient, Riemannian geometries admitting a closed homothety. Recently, it was shown how conformal geometry provides a description of physics manifestly invariant under local choices of unit systems. Strikingly, Einstein's equations are then equivalent to the existence of a parallel scale tractor (a six-component vector subject to a certain first order covariant constancy condition at every point in four-dimensional spacetime). These results suggest a six-dimensional description of four-dimensional physics, a viewpoint promulgated by the 2 times physics program of Bars. The Fefferman-Graham construction relies on a triplet of operators corresponding, respectively, to a curved six-dimensional light cone, the dilation generator and the Laplacian. These form an sp(2) algebra which Bars employs as a first class algebra of constraints in a six-dimensional gauge theory. In this article four-dimensional gravity is recast in terms of six-dimensional quantum mechanics by melding the 2 times and tractor approaches. This parent formulation of gravity is built from an infinite set of six-dimensional fields. Successively integrating out these fields yields various novel descriptions of gravity including a new four-dimensional one built from a scalar doublet, a tractor-vector multiplet and a conformal class of metrics.

  8. Optical pulling force on a magneto-dielectric Rayleigh sphere in Bessel tractor polarized beams

    International Nuclear Information System (INIS)

    Mitri, F.G.; Li, R.X.; Yang, R.P.; Guo, L.X.; Ding, C.Y.

    2016-01-01

    The optical radiation force induced by Bessel (vortex) beams on a magneto-dielectric subwavelength sphere is investigated with particular emphasis on the beam polarization and order l (or topological charge). The analysis is focused on identifying the regions and some of the conditions to achieve retrograde motion of the sphere centered on the axis of wave propagation of the incident beam, or shifted off-axially. Exact non-paraxial analytical solutions are established, and computations for linear, circular, radial, azimuthal and mixed polarizations of the individual plane wave components forming the Bessel (vortex) beams by means of the angular spectrum decomposition method (ASDM) illustrate the theory with particular emphasis on the tractor (i.e. reversal) behavior of the force. This effect results in the pulling of the magneto-dielectric sphere against the forward linear momentum density flux associated with the incoming waves. Should some conditions related to the choice of the beam parameters as well as the permittivity and permeability of the sphere be met, the optical force vanishes and reverses sign. Moreover, the beam polarization is shown to affect differently the axial negative pulling force for either the zeroth- or the first-order Bessel beam. When the sphere is centered on the beam′s axis, the axial force component is always negative for the zeroth-order Bessel beam except for the radial and azimuthal polarization configurations. Nonetheless, for the first-order Bessel beam, the axial force is negative for the radial polarization case only. Additional tractor beam effects arise when the sphere departs from the center of the beam. It is also demonstrated that the tractor beam effect arises from the force component originating from the cross-interaction between the electric and magnetic dipoles. Potential applications are in particle manipulation, optical levitation, tractor beam tweezers, and other emergent technologies using polarized Bessel beams on

  9. Gastrointestinal bleeding

    Science.gov (United States)

    ... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...

  10. Value of Adjusted Blood Requirement Index in determining failure to control bleed in patients with variceal bleeding.

    Science.gov (United States)

    Abid, Shahab; Khalid, Abdullah B; Awan, Safia; Shah, Hasnain A; Hamid, Saeed; Jafri, Wasim

    2015-03-01

    Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent. All patients were managed as per the standard protocol with intravenous terlipressin along with band ligation and injection of cyanoacrylate in cases of esophageal and fundal varices, respectively. Hemoglobin and hematocrit were measured every 6 h for 48 h and then every 12 h until 5 days of index bleed in each patient. Packed cells were transfused if hemoglobin decreased below 8 g/dl. The number of blood units transfused, change in hemoglobin values, and ABRI were calculated after each unit of blood transfusion till 120 h. In patients in whom bleed could not be controlled, an ABRI value of 0.75 or more was compared with other Baveno IV-based parameters that define failure to control variceal bleeding. During the study period, 137 eligible patients with variceal bleed were admitted. The mean age of the patients was 52±12 years. The majority of patients (50.4%) were in Child-Pugh class B, followed by 38% in Child-Pugh class C. According to the Baveno IV criteria, overall failure to control acute variceal bleeding occurred in 52 (37.9%) patients. Excluding ABRI, failure to control bleeding was found in 22/137 (16%) patients, whereas ABRI-based criteria showed that in 34/137 (24.8%) patients, bleeding could not be controlled. There were only four (2.9%) patients with variceal bleeding in whom ABRI and

  11. Lubricant flow analysis for effective lubrication of tractor forward/reverse clutch

    Directory of Open Access Journals (Sweden)

    Daekyung Noh

    2017-04-01

    Full Text Available Owing to the high power requirements of tractors, their low-power transmission gears often experience durability problems such as burning of the clutch. The operation of tractors under high load conditions also causes clutch slip, with the consequent longer operation duration exacerbating the burning of the friction plate. Solving this problem requires effective lubricant distribution. This was achieved in the present study by the development of an analysis model for predicting the lubricant flow rate. The reliability of the model was verified by comparing its predictions for various operation conditions with experimental measurements. Using the model, it was determined that effective distribution of the lubricant could be achieved without significant modification of the system, by only adjusting the gaps between the clutch piston and the housing, and between the separation plates and the case. Keywords: Mechanical engineering

  12. Overheating Anomalies during Flight Test Due to the Base Bleeding

    Science.gov (United States)

    Luchinsky, Dmitry; Hafiychuck, Halyna; Osipov, Slava; Ponizhovskaya, Ekaterina; Smelyanskiy, Vadim; Dagostino, Mark; Canabal, Francisco; Mobley, Brandon L.

    2012-01-01

    In this paper we present the results of the analytical and numerical studies of the plume interaction with the base flow in the presence of base out-gassing. The physics-based analysis and CFD modeling of the base heating for single solid rocket motor performed in this research addressed the following questions: what are the key factors making base flow so different from that in the Shuttle [1]; why CFD analysis of this problem reveals small plume recirculation; what major factors influence base temperature; and why overheating was initiated at a given time in the flight. To answer these questions topological analysis of the base flow was performed and Korst theory was used to estimate relative contributions of radiation, plume recirculation, and chemically reactive out-gassing to the base heating. It was shown that base bleeding and small base volume are the key factors contributing to the overheating, while plume recirculation is effectively suppressed by asymmetric configuration of the flow formed earlier in the flight. These findings are further verified using CFD simulations that include multi-species gas environment both in the plume and in the base. Solid particles in the exhaust plume (Al2O3) and char particles in the base bleeding were also included into the simulations and their relative contributions into the base temperature rise were estimated. The results of simulations are in good agreement with the temperature and pressure in the base measured during the test.

  13. A method to evaluate the perceived ease of use of human-machine interface in agricultural tractors equipped with Continuously Variable Transmission (CVT)

    Energy Technology Data Exchange (ETDEWEB)

    Caffaro, F.; Bisaglia, C.; Cutini, M.; Cremasco, M.M.; Cavallo, E.

    2017-07-01

    At the end of the 20th century the adoption of the Continuously Variable Transmission (CVT) was one of the disruptive technological advances in agricultural tractors. Several changes in the Human Machine Interface (HMI) of the tractor cab have been introduced to accommodate this technology. HMIs are known to raise issues about their ease of use; however, this topic has been under-investigated in the agricultural sector. The present study introduces a method to investigate the perceived ease of use of the HMI of agricultural tractors equipped with technological innovations. The HMI required to manage a CVT tractor was evaluated by sixteen tractor drivers (8 novices and 8 experts). During the first contact with the machine and after having performed two targeted tasks with the tractor, participants filled in a questionnaire about the ease of use of the controls and of the touch-screen display, and evaluated the general perception of ease of use, safety, quality and solidity of the machine. The trial pointed out some significant differences between novices and experts, thus confirming the validity of the proposed method. In particular, novice users showed some difficulties when interacting for the first time with the HMI of the CVT tractor working station, whereas experts did not report similar difficulties. Thus, expertise seems to play a role in determining the quality of the interaction with the HMI. Training interventions should be designed to help novices in increasing their expertise effectively, avoiding effort and errors and improving user’s comfort and system performance.

  14. A method to evaluate the perceived ease of use of human-machine interface in agricultural tractors equipped with Continuously Variable Transmission (CVT

    Directory of Open Access Journals (Sweden)

    Federica Caffaro

    2018-02-01

    Full Text Available At the end of the 20th century the adoption of the Continuously Variable Transmission (CVT was one of the disruptive technological advances in agricultural tractors. Several changes in the Human Machine Interface (HMI of the tractor cab have been introduced to accommodate this technology. HMIs are known to raise issues about their ease of use; however, this topic has been under-investigated in the agricultural sector. The present study introduces a method to investigate the perceived ease of use of the HMI of agricultural tractors equipped with technological innovations. The HMI required to manage a CVT tractor was evaluated by sixteen tractor drivers (8 novices and 8 experts. During the first contact with the machine and after having performed two targeted tasks with the tractor, participants filled in a questionnaire about the ease of use of the controls and of the touch-screen display, and evaluated the general perception of ease of use, safety, quality and solidity of the machine. The trial pointed out some significant differences between novices and experts, thus confirming the validity of the proposed method. In particular, novice users showed some difficulties when interacting for the first time with the HMI of the CVT tractor working station, whereas experts did not report similar difficulties. Thus, expertise seems to play a role in determining the quality of the interaction with the HMI. Training interventions should be designed to help novices in increasing their expertise effectively, avoiding effort and errors and improving user’s comfort and system performance.

  15. A method to evaluate the perceived ease of use of human-machine interface in agricultural tractors equipped with Continuously Variable Transmission (CVT)

    International Nuclear Information System (INIS)

    Caffaro, F.; Bisaglia, C.; Cutini, M.; Cremasco, M.M.; Cavallo, E.

    2017-01-01

    At the end of the 20th century the adoption of the Continuously Variable Transmission (CVT) was one of the disruptive technological advances in agricultural tractors. Several changes in the Human Machine Interface (HMI) of the tractor cab have been introduced to accommodate this technology. HMIs are known to raise issues about their ease of use; however, this topic has been under-investigated in the agricultural sector. The present study introduces a method to investigate the perceived ease of use of the HMI of agricultural tractors equipped with technological innovations. The HMI required to manage a CVT tractor was evaluated by sixteen tractor drivers (8 novices and 8 experts). During the first contact with the machine and after having performed two targeted tasks with the tractor, participants filled in a questionnaire about the ease of use of the controls and of the touch-screen display, and evaluated the general perception of ease of use, safety, quality and solidity of the machine. The trial pointed out some significant differences between novices and experts, thus confirming the validity of the proposed method. In particular, novice users showed some difficulties when interacting for the first time with the HMI of the CVT tractor working station, whereas experts did not report similar difficulties. Thus, expertise seems to play a role in determining the quality of the interaction with the HMI. Training interventions should be designed to help novices in increasing their expertise effectively, avoiding effort and errors and improving user’s comfort and system performance.

  16. Effect of Tractor Forward Speed on Sandy Loam Soil Physical ...

    African Journals Online (AJOL)

    Results indicate significant differences in soil physical conditions arising from different levels of tractor forward speed. A forward speed of approximately 7km/h resulted in appreciable amelioration of soil structure as reflected in improvements in the soil strength properties and maximum reduction in clod mean weight ...

  17. Characteristics of paddy operations with biodiesel fuelled tractor

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y.; Park, S.H.; Kim, C.K.; Im, D.H.; Kim, H.J.; Chung, S.C. [National Academy of Agricultural Science, Seodundong, Suwon (Korea, Democratic People' s Republic of); Kim, S.S. [Daedong Industrial Co., Chang Nyong-Kun, Kyungnam (Korea, Democratic People' s Republic of)

    2010-07-01

    This paper reported on a study in which biofuels were tested for their power and competitiveness in various paddy operations, such as plowing and rotary tilling of paddy fields. The study considered the use of diesel fuel as well as 20 per cent biodiesel (BD20) and 100 per cent biodiesel (BD100) as an alternative fuel for tractors. Ignition problems or abrupt stopping were not monitored during operations of plowing, rotary tilling and travelling on the road. According to tractor power take-off (PTO) test codes, there was no considerable power difference between the 3 fuels. However, fuel consumption rates were quite different between the biodiesels and diesel fuel in the paddy works. Fuel consumption increased when biodiesel content increased. Approximately 35 to 40 per cent more fuel was needed for rotary tilling operations than plowing operations. Within the operations, the maximum difference occurred during the rotary tilling of wet paddy fields. This difference was as high as 20 per cent , between BD100 and diesel fuel. In terms of exhaust gases, more carbon dioxide was discharged from diesel fuel than biodiesels, but more nitrous oxide was discharged with biodiesels. It was difficult to differentiate quantities of carbon monoxide between the 3 different fuels.

  18. Noise levels of a track-laying tractor during field operations in the vineyard

    Directory of Open Access Journals (Sweden)

    Pietro Catania

    2013-09-01

    Full Text Available Noise in agriculture is one of the risk factors to be taken into account in the assessment of the health and safety of workers; in particular, it is known that the tractor is a source of high noise. The Italian Low Decree 81/2008 defined the requirements for assessing and managing noise risk identifying a number of procedures to be adopted at different noise levels to limit workers exposure. This paper concerns the analysis of the noise risk arising from the use of a tracklaying tractor during field operations carried out in the vineyard. The objective of this study was to evaluate the noise level that comes close to the ear of the operator driving the tractor measuring the values of equivalent sound level (Leq(A and peak sound pressure (LCpk. We considered four options related to the same tractor coupled with the following tools to perform some farming operations: rototilling, chisel plough, flail mowers and vibro farmer. We considered three test conditions: T1 in flat (slope 0%, T2 uphill and T3 downhill (both 30% slope. The instrument used for the measurements is a precision integrating portable sound level meter, class 1, model HD2110L by Delta OHM, Italy. Each survey lasted 2 minutes, with an interval of measurement equal to 0.5 s. The tests were performed in compliance with the standards ISO 9612 and ISO 9432. The results show that the measured sound levels exceed the limits allowed by the regulations in almost all the test conditions; values exceeding the threshold limit of 80 dB(A were recorded coming up to a maximum value of 92.8 dB(A for flail mowers in test T1. When limits imposed by the regulations are exceeded, the operator is obliged to wear the appropriate Personal Protective Equipment.

  19. Tranexamic Acid in the Management of Upper Gastrointestinal Bleeding: an Evidence-based Case Report

    Directory of Open Access Journals (Sweden)

    Nur Atikah

    2015-04-01

    Full Text Available Aim: to review the effectiveness of tranexamic acid therapy which has been proposed to reduce bleeding and in turn lower mortality rate. Methods: following literature searching based on our clinical question on Cochrane Library, PubMed, Clinical Key, EBSCO, Science Direct and Proquest, one systematic review that includes seven randomized controlled trials is obtained. The article meets validity and relevance criteria. Results: the systematic review found that there is no any clear evidence between intervention and control groups in term of mortality. Conclusion: the use of tranexamic acid to reduce mortality in patients with upper gastrointestinal bleeding is not recommended. Key words: tranexamic acid, mortality, upper gastrointestinal bleeding.

  20. Dynamic-energetic balance of agricultural tractors: active systems for the measurement of the power requirements in static tests and under field conditions

    Directory of Open Access Journals (Sweden)

    Daniele Pochi

    2013-09-01

    Full Text Available Modern tractors are characterized by the introduction of devices designed to increase the operative performances of the machines, such as systems for monitoring and controlling various functions (through a massive use of electronics and hydraulics, or deputed to improve the comfort of the driver (paying more attention to ergonomics, air-conditioning, noise and vibration. Such devices need energy to be operated, affecting the energetic balance of the tractor. In this context, the availability of suitable methodologies and instrumental systems could be useful to provide objective, accurate and reliable measurements of the performances of the tractors under different conditions, also considering the power requirements from ancillary services and/or simulating the coupling with operating machines. The tests on the performances of tractors are now made using different methods, including the trial codes issued by the OECD Codes. Beyond their undoubted validity, they fix standard test conditions that often do not adequately represent the operative reality, so that, much remains to investigate on the actual performances provided by the tractors. From this point of view and with reference to fixed point tests, a test bench was developed for the measurement of the power required by various devices, such as transmission and air conditioning. It was used in experimental tests on a tracked tractor and on a wheeled tractor, aimed at validating the test device, measuring the power absorption related to the rotational speed of the organs of propulsion and to the characteristics curves, in order to quantify the power drawn by the transmission and by the air conditioning and assess the residual power for other tractor functions. As to field conditions, a study is being conducted at CRA-ING, within the project PTO (Mi.P.A.A.F., to develop a mobile test bench aimed at evaluating the power required by different operations, such as self displacement, traction, use of

  1. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy.

  2. Levels of vibration transmitted to the operator of the tractor equipped with front axle suspension

    Directory of Open Access Journals (Sweden)

    Daniele Pochi

    2013-09-01

    Full Text Available In recent years the comfort and the preservation of the health of the operators became central issues in the evolution of agricultural machinery and led to the introduction of devices aimed at improving working conditions. Thereby, for instance, the presence of air conditioner, soundproof cab and driver seat suspension became normal on agricultural tractors. The vibrations are one of the most complex issues to deal with, being determined by the characteristics and interaction of elements such as tyres, axles, mainframe, cab and seat suspension. In this respect, manufacturers are trying to improve their products, even integrating these elements with new devices such as the suspension on the front axle of the tractor, aimed at reducing the level of vibrations during the transfers at high speed. One of these underwent tests at CRA-ING. Since its purpose is to reduce the level of vibration transmitted to the driver, their measurements in different points of the tractor and in different operating conditions, were compared in order to evaluate the effectiveness of the device, expressed as time of exposure. The suspension system of the front axle is designed to absorb the oscillations (especially pitching determined by irregularities in the road surface, allowing an increased control of the vehicle at high speed, as demonstrated by the test results and confirmed by the driving impressions outlined by the operator. The action of the device under these conditions results in an increase of the exposure time, important fact because of the relevance of the road transfer operations of tractors with mounted implements or trailers to tow and of the tendency to increase the speed limit for the road tractors (in Germany were brought to 50 km h–1 for several years. The action just described is less evident with increasing irregularity of the road surface and with the decrease of the travel speed. Nevertheless, in such conditions, the device appears to

  3. Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

    2015-04-01

    The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  4. Coca-Cola Refreshments Class 8 Diesel Electric Hybrid Tractor Evaluation: 13-Month Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Walkowicz, K.; Lammert, M.; Curran, P.

    2012-08-01

    This 13-month evaluation used five Kenworth T370 hybrid tractors and five Freightliner M2106 standard diesel tractors at a Coca Cola Refreshments facility in Miami, Florida. The primary objective was to evaluate the fuel economy, emissions, and operational field performance of hybrid electric vehicles when compared to similar-use conventional diesel vehicles. A random dispatch system ensures the vehicles are used in a similar manner. GPS logging, fueling, and maintenance records and laboratory dynamometer testing are used to evaluate the performance of these hybrid tractors. Both groups drive similar duty cycles with similar kinetic intensity (0.95 vs. 0.69), average speed (20.6 vs. 24.3 mph), and stops per mile (1.9 vs. 1.5). The study demonstrated the hybrid group had a 13.7% fuel economy improvement over the diesel group. Laboratory fuel economy and field fuel economy study showed similar trends along the range of KI and stops per mile. Hybrid maintenance costs were 51% lower per mile; hybrid fuel costs per mile were 12% less than for the diesels; and hybrid vehicle total cost of operation per mile was 24% less than the cost of operation for the diesel group.

  5. Vaginal Bleeding

    Science.gov (United States)

    ... or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It ... therapy) Cancer of the cervix, ovaries, uterus or vagina Thyroid problems Bleeding during pregnancy can have several ...

  6. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. www. ...

  7. Performance of Single Axle Tractors in the Semi-Arid Central Part of ...

    African Journals Online (AJOL)

    user1

    Performance evaluation of three single axle tractors namely Dongfeng15 hp and 12 hp ... On average the agricultural sector accounts for 42.9% gross domestic product and ..... a and b are constant(coefficient) with (+) or (-) sign shown table ...

  8. Enhanced fuel efficiency on tractor-trailers using synthetic jet-based active flow control

    Science.gov (United States)

    Amitay, Michael; Menicovich, David; Gallardo, Daniele

    2016-04-01

    The application of piezo-electrically-driven synthetic-jet-based active flow control to reduce drag on tractor-trailers was explored experimentally in wind tunnel testing as well as full-scale road tests. Aerodynamic drag accounts for more than 50% of the usable energy at highway speeds, a problem that applies primarily to trailer trucks. Therefore, a reduction in aerodynamic drag results in large saving of fuel and reduction in CO2 emissions. The active flow control technique that is being used relies on a modular system comprised of distributed, small, highly efficient actuators. These actuators, called synthetic jets, are jets that are synthesized at the edge of an orifice by a periodic motion of a piezoelectric diaphragm(s) mounted on one (or more) walls of a sealed cavity. The synthetic jet is zero net mass flux (ZNMF), but it allows momentum transfer to flow. It is typically driven near diaphragm and/or cavity resonance, and therefore, small electric input [O(10W)] is required. Another advantage of this actuator is that no plumbing is required. The system doesn't require changes to the body of the truck, can be easily reconfigured to various types of vehicles, and consumes small amounts of electrical power from the existing electrical system of the truck. Preliminary wind tunnel results showed up to 18% reduction in fuel consumption, whereas road tests also showed very promising results.

  9. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

    DEFF Research Database (Denmark)

    Ngu, JH; Laursen, Stig Borbjerg; Chin, YK

    2017-01-01

    Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....

  10. Major bleeding and intracranial hemorrhage risk prediction in patients with atrial fibrillation: Attention to modifiable bleeding risk factors or use of a bleeding risk stratification score? A nationwide cohort study.

    Science.gov (United States)

    Chao, Tze-Fan; Lip, Gregory Y H; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Liao, Jo-Nan; Chung, Fa-Po; Chen, Tzeng-Ji; Chen, Shih-Ann

    2018-03-01

    While modifiable bleeding risks should be addressed in all patients with atrial fibrillation (AF), use of a bleeding risk score enables clinicians to 'flag up' those at risk of bleeding for more regular patient contact reviews. We compared a risk assessment strategy for major bleeding and intracranial hemorrhage (ICH) based on modifiable bleeding risk factors (referred to as a 'MBR factors' score) against established bleeding risk stratification scores (HEMORR 2 HAGES, HAS-BLED, ATRIA, ORBIT). A nationwide cohort study of 40,450 AF patients who received warfarin for stroke prevention was performed. The clinical endpoints included ICH and major bleeding. Bleeding scores were compared using receiver operating characteristic (ROC) curves (areas under the ROC curves [AUCs], or c-index) and the net reclassification index (NRI). During a follow up of 4.60±3.62years, 1581 (3.91%) patients sustained ICH and 6889 (17.03%) patients sustained major bleeding events. All tested bleeding risk scores at baseline were higher in those sustaining major bleeds. When compared to no ICH, patients sustaining ICH had higher baseline HEMORR 2 HAGES (p=0.003), HAS-BLED (pbleeding scores, c-indexes were significantly higher compared to MBR factors (pbleeding. C-indexes for the MBR factors score was significantly lower compared to all other scores (De long test, all pbleeding risk scores for major bleeding (all pbleeding risk scores had modest predictive value for predicting major bleeding but the best predictive value and NRI was found for the HAS-BLED score. Simply depending on modifiable bleeding risk factors had suboptimal predictive value for the prediction of major bleeding in AF patients, when compared to the HAS-BLED score. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  11. La normalización y certificación de tractores agrícolas en México

    OpenAIRE

    Alma Velia Ayala Garay; Rocío Cervantes Osornio; Marco Antonio Audelo Benítez; Noé Velázquez López; José Manuel Vargas Sállago

    2013-01-01

    El tractor agrícola es la principal fuente de potencia dentro de una unidad de producción. Por lo tanto para los usuarios de maquinaria agrícola, resulta una prioridad contar con mecanismos que permitan dar seguridad al usuario final o productor agrícola en el funcionamiento y calidad de los tractores, para esto el objetivo del presente es dar a conocer la evolución de la normalización y certificación de la maquinaria agrícola en México, sus impactos y tendencias, por medio de una descripción...

  12. Performance of an agricultural tractor in no tillage as a function of displacement speed and the seeders' tire inflation pressure

    Energy Technology Data Exchange (ETDEWEB)

    Furlani, Carlos Eduardo Angeli; Cortez, Jorge Wilson; Silva, Rouverson Pereira da; Grotta, Danilo Cesar Checchio; Toledo, Anderson de [Universidade Estadual Paulista (UNESP), Jaboticabal, SP (Brazil)], E-mail: furlani@fcav.unesp.br

    2008-07-01

    The performance of an agricultural tractor under field conditions results from the tire wheel interaction together with its displacement speed. This work was developed to assess the performance of an agricultural tractor under the (75, 70, and 60 psi) tire inflation pressure conditions of a seeder and in two different gears providing speeds of 3.0 and 6.0 km h{sup -1}. The experiment took place at Sao Paulo State University (UNESP), at the Jaboticabal Campus, and was conducted by Laboratory of Machines and Agricultural Mechanization (LAMMA) at the Department of Rural Engineering. The delineation used was entirely randomized in a 2-factor factorial scheme (3 x 2) with 4 repetitions. We also observed that fuel consumption was influenced only by the tractor gear. Energy consumption was greater as speed increased, caused by gear shifting. The displacement speed was greater for the 75-psi pressure due to a lesser slippage in the seeder when under this pressure. Tractor slippage and initial stand did not change with the tested factors. (author)

  13. Automated registration of tail bleeding in rats.

    Science.gov (United States)

    Johansen, Peter B; Henriksen, Lars; Andresen, Per R; Lauritzen, Brian; Jensen, Kåre L; Juhl, Trine N; Tranholm, Mikael

    2008-05-01

    An automated system for registration of tail bleeding in rats using a camera and a user-designed PC-based software program has been developed. The live and processed images are displayed on the screen and are exported together with a text file for later statistical processing of the data allowing calculation of e.g. number of bleeding episodes, bleeding times and bleeding areas. Proof-of-principle was achieved when the camera captured the blood stream after infusion of rat whole blood into saline. Suitability was assessed by recording of bleeding profiles in heparin-treated rats, demonstrating that the system was able to capture on/off bleedings and that the data transfer and analysis were conducted successfully. Then, bleeding profiles were visually recorded by two independent observers simultaneously with the automated recordings after tail transection in untreated rats. Linear relationships were found in the number of bleedings, demonstrating, however, a statistically significant difference in the recording of bleeding episodes between observers. Also, the bleeding time was longer for visual compared to automated recording. No correlation was found between blood loss and bleeding time in untreated rats, but in heparinized rats a correlation was suggested. Finally, the blood loss correlated with the automated recording of bleeding area. In conclusion, the automated system has proven suitable for replacing visual recordings of tail bleedings in rats. Inter-observer differences can be eliminated, monotonous repetitive work avoided, and a higher through-put of animals in less time achieved. The automated system will lead to an increased understanding of the nature of bleeding following tail transection in different rodent models.

  14. Modelling and Simulation of a Hydrostatic Steering System for Agricultural Tractors

    Directory of Open Access Journals (Sweden)

    Barbara Zardin

    2018-01-01

    Full Text Available The steering system of a vehicle impacts on the vehicle performance, safety and on the driver’s comfort. Moreover, in off-road vehicles using hydrostatic steering systems, the energy dissipation also becomes a critical issue. These aspects push and motivate innovation, research and analysis in the field of agricultural tractors. This paper proposes the modelling and analysis of a hydrostatic steering system for an agricultural tractor to calculate the performance of the system and determine the influence of its main design parameters. The focus here is on the driver’s steering feel, which can improve the driver’s behavior reducing unnecessary steering corrections during the working conditions. The hydrostatic steering system is quite complex and involves a hydraulic circuit and a mechanical mechanism to transmit the steering to the vehicle tires. The detailed lumped parameters model here proposed allows to simulate the dynamic behavior of the steering system and to both enhance the understanding of the system and to improve the design through parameters sensitivity analysis.

  15. Computational Flow Modeling of a Simplified Integrated Tractor-Trailer Geometry

    International Nuclear Information System (INIS)

    Salari, K.; McWherter-Payne, M.

    2003-01-01

    For several years, Sandia National Laboratories and Lawrence Livermore National Laboratory have been part of a consortium funded by the Department of Energy to improve fuel efficiency of heavy vehicles such as Class 8 trucks through aerodynamic drag reduction. The objective of this work is to demonstrate the feasibility of using the steady Reynolds-Averaged Navier-Stokes (RANS) approach to predict the flow field around heavy vehicles, with special emphasis on the base region of the trailer, and to compute the aerodynamic forces. In particular, Sandia's computational fluid dynamics code, SACCARA, was used to simulate the flow on a simplified model of a tractor-trailer vehicle. The results are presented and compared with NASA Ames experimental data to assess the predictive capability of RANS to model the flow field and predict the aerodynamic forces

  16. Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

    Science.gov (United States)

    Dowlut-McElroy, Tazim; Williams, Karen B; Carpenter, Shannon L; Strickland, Julie L

    2015-12-01

    To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Prospective analysis of delayed colorectal post-polypectomy bleeding.

    Science.gov (United States)

    Park, Soo-Kyung; Seo, Jeong Yeon; Lee, Min-Gu; Yang, Hyo-Joon; Jung, Yoon Suk; Choi, Kyu Yong; Kim, Hungdai; Kim, Hyung Ook; Jung, Kyung Uk; Chun, Ho-Kyung; Park, Dong Il

    2018-01-17

    Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively. Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy. A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age ( 10 mm (OR 2.45; 95% CI 1.38-4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35-5.12) and immediate bleeding (OR 3.3; 95% CI 1.49-7.30) were significant risk factors for late delayed bleeding. Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.

  18. C-Based Design Methodology and Topological Change for an Indian Agricultural Tractor Component

    Science.gov (United States)

    Matta, Anil Kumar; Raju, D. Ranga; Suman, K. N. S.; Kranthi, A. S.

    2018-06-01

    The failure of tractor components and their replacement has now become very common in India because of re-cycling, re-sale, and duplication. To over come the problem of failure we propose a design methodology for topological change co-simulating with software's. In the proposed Design methodology, the designer checks Paxial, Pcr, Pfailue, τ by hand calculations, from which refined topological changes of R.S.Arm are formed. We explained several techniques employed in the component for reduction, removal of rib material to change center of gravity and centroid point by using system C for mixed level simulation and faster topological changes. The design process in system C can be compiled and executed with software, TURBO C7. The modified component is developed in proE and analyzed in ANSYS. The topologically changed component with slot 120 × 4.75 × 32.5 mm at the center showed greater effectiveness than the original component.

  19. C-Based Design Methodology and Topological Change for an Indian Agricultural Tractor Component

    Science.gov (United States)

    Matta, Anil Kumar; Raju, D. Ranga; Suman, K. N. S.; Kranthi, A. S.

    2018-02-01

    The failure of tractor components and their replacement has now become very common in India because of re-cycling, re-sale, and duplication. To over come the problem of failure we propose a design methodology for topological change co-simulating with software's. In the proposed Design methodology, the designer checks Paxial, Pcr, Pfailue, τ by hand calculations, from which refined topological changes of R.S.Arm are formed. We explained several techniques employed in the component for reduction, removal of rib material to change center of gravity and centroid point by using system C for mixed level simulation and faster topological changes. The design process in system C can be compiled and executed with software, TURBO C7. The modified component is developed in proE and analyzed in ANSYS. The topologically changed component with slot 120 × 4.75 × 32.5 mm at the center showed greater effectiveness than the original component.

  20. Design, Construction and Evaluation of an Interchangeable Digital System to Measure Slip and Ground Speed of Existing 2WD Tractors in Iran

    Directory of Open Access Journals (Sweden)

    M Khosravi

    2012-05-01

    Full Text Available The majority of existing tractors in Iran are not equipped with any tools to measure and display slip and ground speed. This is mainly due to the lack of national standards for measuring tools and instruments of tractors. In current research, an interchangeable system for two wheel drive tractors has been designed. Furthermore, it has been assessed after construction. To measure actual and theoretical ground speed, four rotary encoders for sensing the rotation of front and rear wheels have been utilized. Slip and ground speed were measured by means of software which has been developed in an ATmega16PU microprocessor. The measured slip and speed are digitally displayed on tractor dashboard. To evaluate the performance of the system, the measured values of ground speed and slip were compared with their calculated values obtained from conventional method. The Micro-controller has been programmed in such a way that the effect of front wheel sliding on slip is eliminated. In all evaluation conditions (in field and on asphalt, the maximum difference between system measurements for slip and speed and calculated slip and speed via conventional method was 2.4% and 0.2 km h-1, respectively. With slight alteration this system can be fitted on any kind of exiting two wheel drive tractors in the country.

  1. Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model

    International Nuclear Information System (INIS)

    Thorne, D.A.; Datz, F.L.; Remley, K.; Christian, P.E.

    1987-01-01

    Proponents of [/sup 99m/Tc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [/sup 99m/Tc]sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [/sup 99m/Tc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate

  2. Helping mothers survive bleeding after birth

    DEFF Research Database (Denmark)

    Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

    2014-01-01

    OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...

  3. A History of the Caterpillar Tractor Company's Use of Motion Pictures.

    Science.gov (United States)

    Veeder, Gerry A.

    Film historians have tended to overlook the industrial film even though it has been widely used as a sales tool since early in this century. The Caterpillar Tractor Company was one of the first to adopt this medium as a means of demonstrating what its machines could do in a variety of situations. While other types of films have been made by…

  4. Bleeding during Pregnancy

    Science.gov (United States)

    ... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...

  5. Wavelet-based analysis of gastric microcirculation in rats with ulcer bleedings

    Science.gov (United States)

    Pavlov, A. N.; Rodionov, M. A.; Pavlova, O. N.; Semyachkina-Glushkovskaya, O. V.; Berdnikova, V. A.; Kuznetsova, Ya. V.; Semyachkin-Glushkovskij, I. A.

    2012-03-01

    Studying of nitric oxide (NO) dependent mechanisms of regulation of microcirculation in a stomach can provide important diagnostic markers of the development of stress-induced ulcer bleedings. In this work we use a multiscale analysis based on the discrete wavelet-transform to characterize a latent stage of illness formation in rats. A higher sensitivity of stomach vessels to the NO-level in ill rats is discussed.

  6. Design, development, and evaluation of an automatic guidance system for tractor tracking along the contour line on inclined surfaces

    Directory of Open Access Journals (Sweden)

    S Dehghani

    2016-04-01

    Full Text Available Introduction: Automatic guidance of tractors in the mechanized farming practice has taken the attention of agricultural engineers in the last two decades. For this to be truly practical on the farm, it should be economical, simple to operate and entirely contained on the vehicle. Different types of steering systems such as leader- cable, laser- controlled, radio- operated and contactor- type have been developed for automatic guidance. The automatic leveling system is used on hillside machines to keep the separator level when operating on hillsides. This system has three parts: fluid level system, electrical system and hydraulic system. The fluid level system consists of fluid reservoir and a leveling control switch box. The fluid level system actuates the electrical system of the leveling unit. The electrical system which actuated by the fluid system consist of four micro switches in the leveling control switch box, two micro switches in the limit control box, a solenoid in the hydraulic control level, manual leveling control switch, and a leveling limit warning light. The hydraulic system maintains the level of the separator when the machine is operating on a hillside. The present study was aimed to develop a reliable, versatile and easy to maintain system to fit our economy and low technology level of farmers for hillside- range development or fallow farming. The automatic guidance system has been implemented successfully on agricultural vehicles on the basis of three components, i.e. sensors, processors and actuator elements. The study site (N, latitude; E, longitude; and 1810 m above sea level was located at the Agricultural Research Center, Shiraz University, 15 km northwest of Shiraz, Fars Province, Iran. MF-399 agricultural tractor manufactured by ITMCO, Tabriz, Iran was used for doing the experiments. Materials and Methods:The Level Sensing System: The biaxial tilt industrial sensor (ZCT245AL- China with digital output can be connected

  7. Analysis of swirl recovery vanes for increased propulsive efficiency in tractor propeller aircraft

    NARCIS (Netherlands)

    Veldhuis, L.L.M.; Stokkermans, T.C.A.; Sinnige, T.; Eitelberg, G.

    2016-01-01

    In this paper we address a preliminary assessment of the performance effects of swirl recovery vanes (SRVs) in a installed and uninstalled tractor propeller arrangement. A numerical analysis was performed on a propeller and a propeller-wing configuration after the SRVs were optimized first in a

  8. The role of endoscopy in pediatric gastrointestinal bleeding

    Science.gov (United States)

    Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

  9. Design Issues and in Field Tests of the New Sustainable Tractor LOCOSTRA

    Directory of Open Access Journals (Sweden)

    Emanuela Elisa Cepolina

    2014-03-01

    Full Text Available This paper presents a robotized small tractor designed to perform humanitarian demining operations and agricultural operations when demining is accomplished. This dual use makes this system unique. The focus is on the design of the machine, including the modeling for design and control, the characteristics of the tools operated by the machine, the motion control at tele-operated, and semi-autonomous levels. The mechatronic design process applied uses sustainable design strategies. Technical contributions are in the tractor architecture, designed to make automation easier, and in the control functions implemented on this architecture. Extensive field tests were performed in different sites; first, in Italy, focusing on the agricultural application of the machine, in natural scenarios with different ground and vegetation; then, in two real mine fields in Jordan focusing on the performance for technical survey in humanitarian demining. The tests have confirmed the performance for both task categories (agricultural and demining, confirming the correctness of the statement. For the demining application, the machine has been assessed by professional users confirming the acceptance to field use and the novelty of the concept.

  10. Evaluating tractor performance and exhaust gas emissions using biodiesel from cotton seed oil

    International Nuclear Information System (INIS)

    Al-lwayzy, Saddam H; Yusaf, Talal; Jensen, Troy

    2012-01-01

    Alternative fuels for diesel engines, such as biodiesel, have attracted much attention recently due to increasing fuel prices and the imperative to reduce emissions. The exhaust gas emissions from tractors and other agricultural machinery make a significant contribution to these emissions. The use of biodiesel in internal combustion engines (ICE) has been reported to give comparable performance to conventional diesel (CD), but with generally lower emissions. There is however, contradictory evidence of NO emissions being both higher and lower from the use of biodiesel. In this work, agriculture tractor engine performance and its emission using both CD and biodiesel from cotton seed oil (CSO-B20) mixed at a 20% blend ration has been evaluated and compared. The PTO test results showed comparable exhaust emissions between CD and CSO-B20. However, the use of CSO-B20 led to reductions in the thermal efficiency and exhaust temperature and an increase in the brake specific fuel consumption (BSFC), when compared to CD.

  11. Abnormal Uterine Bleeding: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-07-01

    Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

  12. MATHEMATICAL MODEL AND METHODOLOGY FOR CALCULATION OF MINIMIZATION ON TURNING RADIUS OF TRACTOR UNIT WITH REPLACEABLE SUPPORTING AND MANEUVERING DEVICE

    Directory of Open Access Journals (Sweden)

    P. V. Zeleniy

    2016-01-01

    Full Text Available Smooth plowing with the help of reversible plows has replaced an enclosure method of soil treatment. The method may cause a formation of back ridges or open furrows. Due to this fact turnings of a tractor unit with a minimum radius required in order to ensure shuttle movements each time in the furrow of the preceding operating stroke have become a dominant type of turnings. Non-productive shift time is directly dependent on them and it is on the average 10–12 %, and it is up to 40 % in small contour areas with short run. Large non-productive time is connected with the desire to reduce headland width at field edges, and then a turning is made in several stages while using a complicated maneuvering. Therefore, an increase in efficiency of a plowing unit by means of minimization on its turning radius and execution of turning at one stage in the shortest possible time are considered as relevant objectives. In such a case it is necessary to take into account the fact that potential capabilities of universal tractors having established time-proved designs in respect of reduction of turning radius are practically at the end. So it is expedient to solve the matter at the expense of additional removable devices that ensure transformation of tractor wheel formula at the run end in order to reorient its position. Finally high quality plowing ensured by future-oriented reversible plows will be accompanied not only by output increase per shift, but also by decrease in headland width, their compaction and abrasion due to suspension systems and increase in productivity. The developed design having a novelty which proved by an invention patent and representing an additional supporting and maneuvering device significantly minimizes all the above-mentioned disadvantages and does not require any changes in tractor production design. Investigations have been carried on the following topic: “Minimization of turning radius for universal tractors by transformation

  13. Internal Bleeding

    Science.gov (United States)

    ... Fractures (Part II) Additional Content Medical News Internal Bleeding By Amy H. Kaji, MD, PhD, Associate Professor, ... Emergency First Aid Priorities Cardiac Arrest Choking Internal Bleeding Severed or Constricted Limbs or Digits Soft-Tissue ...

  14. Short-term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population-based case-crossover study.

    Science.gov (United States)

    Tseng, C-L; Chen, Y-T; Huang, C-J; Luo, J-C; Peng, Y-L; Huang, D-F; Hou, M-C; Lin, H-C; Lee, F-Y

    2015-09-01

    Controversy exists regarding glucocorticoids therapy and the risk of peptic ulcer bleeding (PUB). The present study was undertaken to determine whether short-term use of glucocorticoids is associated with the occurrence of peptic ulcer bleeding. The records of adult patients hospitalised for newly diagnosed peptic ulcer bleeding from 2000 to 2012 were retrieved from the Taiwan National Health Insurance Research Database, a nationwide population-based registry system. The association between systemic glucocorticoids usage and peptic ulcer bleeding was determined with a conditional logistic regression model comparing cases and controls during time windows of 7, 14 and 28 days using a case-crossover design. Of the 8894 enrolled patients, the adjusted self-matched odds ratios for peptic ulcer bleeding after exposure to the glucocorticoids were 1.37 (95% CI: 1.12-1.68, P = 0.003) for the 7-day window, 1.66 (95% CI: 1.38-2.00, P peptic ulcer bleeding. Concomitant use of a nonselective nonsteroidal anti-inflammatory drug (NSAID) or aspirin further elevated the risk. However, it does not eliminate the effect of underlying diseases flare-up that may have placed the patients at risk for peptic ulcer bleeding in this kind of study design. Short-term (7-28 days) exposure to glucocorticoids is significantly associated with peptic ulcer bleeding; this risk seems dose-dependent and is higher when nonselective NSAIDs or aspirin are used concurrently. © 2015 John Wiley & Sons Ltd.

  15. Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding.

    Science.gov (United States)

    Fonseca, Jorge; Meira, Tânia; Nunes, Ana; Santos, Carla Adriana

    2014-01-01

    Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.

  16. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.

    Science.gov (United States)

    Bennett, Alyssa R; Gray, Susan H

    2014-08-01

    This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. The readers will learn a practical approach to the evaluation and treatment of mild-to-severe uterine bleeding. In 2011, a new classification system was proposed to standardize the terminology used to describe AUB. This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. The term dysfunctional uterine bleeding has been replaced by AUB. The negative effect of AUB on adolescents' quality of life is now well established. The levonorgestrel-releasing intrauterine system is considered a first-line treatment for heavy menstrual bleeding and should be considered, especially in those adolescents who may also need contraception. AUB is a common adolescent complaint that can vary from mild to life-threatening if not recognized and treated promptly. This article reviews the appropriate assessment and management of AUB and proposes a practical algorithm that can be used in an office or hospital setting.

  17. Outcomes of Propofol Sedation During Emergency Endoscopy Performed for Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun

    2016-03-01

    Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5%, P bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8%, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5%, P = 0.442). Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.

  18. First investigation on the applicability of an active noise control system on a tracked tractor without cab

    Directory of Open Access Journals (Sweden)

    Daniele Pochi

    2013-09-01

    Full Text Available In last years, several research teams pointed their attention on the application of active noise control systems (ANC inside the cabs of agricultural tractor, with the purpose of reducing the driver exposition to noise, that is only partially controlled by the frame of the cab. This paper reports the results of a first experience that aimed at verifying the applicability of an ANC on a medium-high power, tracked tractor without cab. The tested tractor was a Fiat Allis 150 A, equipped with rear power take off, used in the execution of deep primary tillage in compact soils. It is a tracked tractor without cab, with maximum power of 108.8 kW at 1840 min–1 of the engine. The ANC consists of a control unit box based on a digital signal processor (DPS, two microphones, two speakers and a power amplifier. The instrumentation used in noise data collecting and processing consisted of a multichannel signal analyzer (Sinus - Soundbook, a ½” microphone capsule and an acoustic calibrator, both Bruel & Kjaer. The study aimed at evaluating the behaviour of the ANC by means of tests carried out under repeatable conditions, characterized by pre-defined engine speed values. Three replications have been made for each engine speed. The sampling time was 30 s. Two series of tests were performed in order to compare the results observed with the ANC on and off. The engine speed adopted in the study ranged from 600 min– 1, up to 2000 min–1 (maximum speed with steps of 100 min–1. The ANC proved to be effective in the interval of speed between 1400 and 1700 min–1, where the samplings have been intensified, adopting steps of 50 min–1. In such an interval, the attenuation observed with the ANC system on appeared evident both as weighed A sound pressure level (from 1.29 up to 2.46 dB(A and linear (from 4.54 up to 8.53 dB. The best performance has been observed at the engine speed of 1550 min–1, with attenuations, respectively of 2.46 dB(A and 7.67 d

  19. Menstrual bleeding patterns: A community-based cross-sectional study among women aged 18-45 years in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Pereira Guilherme AR

    2011-06-01

    Full Text Available Abstract Background Population variation in the duration and amount of menstrual bleeding has received little attention in the literature. This study describes these characteristics and investigates the distribution of self-perceived amount of menstrual bleeding according to socio-demographic, behavioral, and reproductive characteristics. Methods A community-based cross-sectional study was conducted among 18-45 years old women users of the 31 primary health care (PHC facilities in Pelotas city (Brazil. Interviews with structured questionnaire were carried out in the waiting rooms during two work shifts. Heaviness of menstrual bleeding was determined through the answer to the question: "Usually how much blood do you lose in every period?" Crude and adjusted analyses through Poisson regression took into account the aggregation per PHC facility. Results A total of 865 women were enrolled. Prevalence of heavy menstrual flow was 35.3% (95% CI 32.1-38.6%. In adjusted analyses, heavy menstrual bleeding was higher among the older, less educated and obese women, with higher number of pregnancies and who reported longer menstrual periods, extra-menstrual bleeding and clots in the flow. Use of hormonal contraceptive methods was protective against heavy menses. Conclusion Heavy menstrual bleeding is highly prevalent at the community level, and is associated with socio-demographic and anthropometric women's characteristics, as well as with duration of menstruation, extra-bleeding and presence of clots.

  20. Nonvariceal upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang; Golzarian, Jafar

    2007-01-01

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  1. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  2. Causes of lower gastrointestinal bleeding on colonoscopy

    International Nuclear Information System (INIS)

    Rehman, A.U.; Gul, R.; Khursheed, L.; Hadayat, R.

    2017-01-01

    Background: Bleeding from anus is usually referred as rectal bleeding but actually rectal bleeding is defined as bleeding from lower colon or rectum, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in patients at Ayub Teaching Hospital, Abbottabad. Methods: One hundred and seventy-five patients with evidence of rectal bleed, without gender discrimination were selected by non-probability convenient sampling from the out-patient department and general medical wards. Patients with suspected upper GI source of bleeding; acute infectious bloody diarrhoea and any coagulopathy were excluded from the study. All patients were subjected to fibre optic colonoscopy after preparation of the gut and findings were recorded. Where necessary, biopsy samples were also taken. Diagnosis was based on colonoscopic findings. Results: A total of 175 patients (92 males and 83 females) with mean age 35.81±9.18 years were part of the study. Colonoscopy showed abnormal findings in 150 (85.7%) patients. The commonest diagnosis was haemorrhoids, which was found in 39 (22.3%) patients. It was followed by inflammatory bowel disease (IBD) in 30 (17.1%) patients, solitary rectal ulcer in 13 (7.4%) patients and polyps in 25 (14.3%) patients. Other less frequent findings were non-specific inflammation and fungating growths in rectum. Conclusion: Haemorrhoids was the leading cause of bleeding per rectum in this study, followed by evidence of IBD while infrequent findings of polyps and diverticuli indicate that these are uncommon in this region. (author)

  3. Evaluation of the agricultural tractor using biofuel and diesel oil; Avaliacao de um trator agricola utilizando biocombustivel e oleo diesel

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, Reny Adilmar Prestes; Pinheiro Neto, Raimundo; Meyer, Wagner; Mendonca, Elton Costa de; Roberti, Marcelo [Universidade Estadual de Maringa (UEM), PR (Brazil)], Emails: raplopes@uem.br, rpneto@uem.br

    2009-07-01

    Test with alternative fuels is essential to evaluate the performance of machines and engines. In this paper, the performance of a tractor in chiseling operation was evaluated using oil diesel and biofuel (oil diesel + soybean vegetable oil mixture). Speed of displacement, slip wheels, force traction bar and fuel consumption was evaluated in areas under tillage and no-tillage. The speed of displacement of the set presented similar behavior in tillage and no-tillage. Bigger values mean force in the bar of traction, slip and fuel consumptions had been observed for no-tillage with the tractor operating with diesel. Bigger values mean consumption the biofuel had been observed in areas under tillage. The coverings of the soil had influenced in the values of force bar traction, slip wheels, speed of displacement and fuel consumption. In the studied conditions, the tests demonstrate that the mixture oil diesel + soybean vegetable oil had not influenced in the performance of the tractor. (author)

  4. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  5. Evaluation of the use of low-cost GPS receivers in the autonomous guidance of agricultural tractors

    Energy Technology Data Exchange (ETDEWEB)

    Alonso-Garcia, S.; Gomez-Gil, J.; Arribas, J. I.

    2011-07-01

    This paper evaluates the use of low-cost global positioning system (GPS) receivers in the autonomous guidance of agricultural tractors. An autonomous guidance system was installed in a 6400 John Deere agricultural tractor. A low cost GPS receiver was used as positioning sensor. Three different control laws were implemented in order to evaluate the autonomous guidance of the tractor with the low-cost receiver. The guidance was experimentally tested with the tracking of straight trajectories and with the step response. The total guidance error was obtained from the receiver accuracy and from the guidance error. For the evaluation of the receivers accuracy, positioning data from several low cost receivers were recorded and analyzed. For the evaluation of the guidance error, tests were performed with each control law at three different speeds. The conclusions obtained were that relative accuracy of low-cost receivers decreases with the time; that for an interval lower than 15 min, the error usually remains below 1 m; that all the control laws have a similar behavior and it is conditioned by the control law adjustment; that automatic guidance with low cost receivers is possible with speeds that went up to 9 km h{sup -}1; and finally, that the total error in the guidance is mainly determined by the receivers accuracy. (Author) 46 refs.

  6. Harvesting pulpwood and firewood using a tractor-mounted single-grip harvester

    International Nuclear Information System (INIS)

    Ihonen, M.

    1998-01-01

    The TTS-Institute's Department of Forestry conducted a work study on the AM 240 felling-delimbing-cross-cutting -device. The timber was prepared into pulp- and fuelwood. The tops of the pulpwood stems and stems smaller than pulpwood were made into fuelwood. The base machine used was an agricultural tractor. The study is part of a research project titled Forest Owners' Energy-Wood Harvesting Technology. The combined productivity of preparing pulpwood and fuelwood varied between 2.8-4.1 m 3 per effective hour. Thus, the productivity achieved was of the same order as that reported in an earlier TTS-Institute study on the devices AM 200 model. The outturns on the sample strips included a fair amount of crooked hardwood timber, which iced to reduced productivity. During the work study the felling device functioned reliably. (author) 3 refs

  7. Bleeding Disorders in Women

    Science.gov (United States)

    ... might be heavy, print and use a menstrual chart to track your bleeding and talk to your ... you’re “low in iron.” Heavy bleeding after dental surgery, other surgery, or childbirth. Prolonged bleeding episodes ...

  8. Vaginal bleeding in pregnancy

    Science.gov (United States)

    Pregnancy - vaginal bleeding; Maternal blood loss - vaginal ... Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.

  9. Emission and operating performance of a biomethane tractor with dual fuel engine; Emissions- und Betriebsverhalten eines Biomethan-Traktors mit Zuendstrahlmotor

    Energy Technology Data Exchange (ETDEWEB)

    Mautner, Sebastian [Technologie- und Foerderzentrum (TFZ), Straubing (Germany); Emberger, Peter; Thuneke, Klaus; Remmele, Edgar

    2016-08-01

    The use of biomethane as fuel for agricultural machinery with dual fuel technology is contributing to climate protection and ensures safe fuel supply. So far, hardly any documented operational experiences are known. The aim of the project, funded by the Bavarian Ministry of Economic Affairs and Media, Energy and Technology, was to investigate practicability for daily use and the emission behaviour of a Valtra N101 prototype tractor (exhaust stage IIIA). The retrofitted dual-fuel technology of the former conventional diesel tractor simultaneously uses biomethane or natural gas and diesel as ignition fuel. During the field test over 590 working hours, the tractor showed overall high reliability. On average the operating range in dual-fuel mode with one complete filling of the gas tanks was about 11.5 hours. On the tractor test bench a significant improvement of the exhaust emissions could be observed, since the gas ECU had been optimized and changed by the manufacturer. For dual-fuel operation, nitrogen oxides (NO{sub x}) are lower, whereas carbon monoxide (CO), hydrocarbons (HC) and particulate matter emissions (PM) are higher compared to solely diesel operation. In particular, HC emissions exceed the proposed limiting value, submitted by the European Commission. This is due to incomplete gas combustion and insufficient conversion by the exhaust after-treatment-system (methane slip). A big potential for optimization is expected by adjusting the operating point-specific gasdiesel ratio and improving the exhaust gas aftertreatment system.

  10. [Accident prevention in agriculture in the ASL1 Abruzzo Local Health Service: protection facilities for tractors].

    Science.gov (United States)

    Pompei, Domenico; Rossi, Roberta; Vecchiola, Rita; Angelone, Anna Maria; Fabiani, Leila

    2015-07-08

    The ASL1 workplace prevention and safety service in Abruzzo has been conducting workplace inspections on agricultural and livestock farms in the province of L'Aquila since 2011, mainly in the areas of Avezzano, Sulmona and L'Aquila. The agricultural sector in Abruzzo is characterized by high rates of accidents and the ratio of fatal injuries/total injuries is higher than the industry and services sector. To evaluate the presence or absence of safety devices , i.e. compliance or otherwise with regulations for tractors, and of any variable factor that could be associated with the safety of the vehicle. Between 2011 and 2013, 98 farms in the province of L'Aquila were inspected. The data resulting from the inspections was collected by the use of a checklist. An univariate logistic regression analysis was conducted in which the vehicles that complied with regulations were considered as the dependant variable, and the age of the tractor owner, the acres of worked land and the type of farm were considered as explanatory variables. Statistical elaboration was carried out using the Stata 12 programme. Out of a total of 298 tractors that were checked, 64.8% did not comply with regulations due to absence or unsuitability of one or more safety devices such as: a protective device in case of overturning; retention system of the driver; mounting and dismounting from the vehicle; protection of moving parts and hot parts; PTO (Power Take Off) protection device. A significant association between non-compliance of vehicles and the age of the owner and acres worked was observed, whereas no statistical significance was observed for the association with the farm type variable. Our study showed that farms where the owner's age is between 50 and 64 years and where more acres of land are worked are those where the agricultural or forestry tractors had lower levels of compliance with regulations.

  11. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

    Directory of Open Access Journals (Sweden)

    Lärfars Gerd

    2010-09-01

    Full Text Available Abstract Background Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS. This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group. Methods We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias. Results No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. Conclusion These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients.

  13. Minor Bleeds Alert for Subsequent Major Bleeding in Patients Using Vitamin K Antagonists.

    OpenAIRE

    Veeger , Nic J.G.M.; Piersma-Wichers , Margriet; Meijer , Karina; Hillege , Hans L.

    2011-01-01

    Abstract Vitamin K antagonists (VKA) have shown to be effective in primary and secondary prevention of thromboembolism, but the associated risk of bleeding is an important limitation. The majority of the bleeds are clinically mild. In this study, we assessed whether these minor bleeds are associated with major bleeding, when controlling for other important risk indicators, including the achieved quality of anticoagulation. For this, 5898 patients of a specialised anticoagulation cl...

  14. System-wide electrification and appropriate functions of tractor and implement

    Directory of Open Access Journals (Sweden)

    Sebastian Tetzlaff

    2015-10-01

    Full Text Available The advantages of electric drive technology in industrial applications have been known for a long time. In addition to the flexibility and variability for the system integration, the very good controllability and the overload capacity should be mentioned. To increase the effectiveness of agricultural machinery and equipment crucially, the different electrical/electronic systems, drives and functions have to be interconnected machine internally and also externally, based on a system-wide approach. Thereby single machinery, machinery combinations and finally complete harvest chains can be used in a smarter and more efficient way. Using the example of a tractor-swather combination the suitability of electric drives itself and of the hybrid and interface concept is proven. Newly developed functions for overload protection and prediction of the working process are presented and their integration into the machine overarching energy and operational management is described. The transferability of the results and solutions to cognate applications is ensured. Keywords

  15. The International Bleeding Risk Score

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Laine, L.; Dalton, H.

    2017-01-01

    The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding.......The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding....

  16. Retrofitting tractors with rollover protective structures: perspective of equipment dealers.

    Science.gov (United States)

    Tonelli, S M; Donham, K J; Leedom-Larson, K; Sanderson, W; Purschwitz, M

    2009-10-01

    This study was one of a cluster of studies that originated via requests for proposals from the NIOSH National Agricultural Tractor Safety Initiative. The present study design consisted of several steps: (1) formation of an advisory group, (2) development and testing of a standard paper self-responding survey instrument, (3) sample selection of farm equipment dealers, (4) administration of the survey, (5) assessment and analysis of the survey, and (6) in-person response panel of dealers (n = 80) to review results of the questionnaire for further definition and sharpening of the recommendations from the survey. A key finding is that most dealers do not currently sell or install ROPS retrofit kits. Barriers cited by dealers included (1) actual or perceived lack of farmer demand, (2) injury liability, (3) expensive freight for ordering ROPS, (4) lack of dealer awareness of the magnitude of deaths from tractor overturns and the high life-protective factor of ROPS, and (5) difficulty and incursion of non-recoverable expenses in locating and obtaining specific ROPS. Despite not currently selling or installing ROPS, dealers responded favorably about their future potential role in ROPS promotion and sales. Dealers were willing to further promote, sell, and install ROPS if there was demand from farmers. Recommendations include establishing a ROPS "clearing house" that dealers could contact to facilitate locating and obtaining ROPS orders from customers. Additional recommendations include education and social marketing targeting farm machinery dealers as well farmers, manufacturers, and policy makers.

  17. Monitoring and treatment of acute gastrointestinal bleeding.

    Science.gov (United States)

    Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

    2012-01-01

    Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.

  18. Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding Definition and Effect of the Bleeding on Short-Term Mortality: A Meta-analysis.

    Science.gov (United States)

    Wang, Jiayang; Yu, Wenyuan; Jin, Qi; Li, Yaqiong; Liu, Nan; Hou, Xiaotong; Yu, Yang

    2017-04-01

    In this study we investigated the effect of post-transcatheter aortic valve implantation (TAVI) bleeding (per Valve Academic Research Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality and examined the correlation between pre- or intraoperative variables and bleeding. Multiple electronic literature databases were searched using predefined criteria, with bleeding defined per Valve Academic Research Consortium-2 criteria. A total of 10 eligible articles with 3602 patients were included in the meta-analysis. The meta-analysis revealed that post-TAVI bleeding was associated with a 323% increase in 30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence interval [CI], 2.80-6.40; P logistic regression analysis revealed that atrial fibrillation (AF) was independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI, 1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers like the Society of Thoracic Surgeons (STS) score, mortality, the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic valve area, mean pressure gradient, left ventricular ejection fraction, preoperative hemoglobin and platelet levels, and study design had no significant effects on the results of the meta-analysis. Post-TAVI bleeding, in particular, major bleeding/life-threatening bleeding, increased 30-day postoperative mortality. Transapical access was a significant bleeding risk factor. Preexisting AF independently correlated with TAVI-associated bleeding, likely because of AF-related anticoagulation. Recognition of the importance and determinants of post-TAVI bleeding should lead to strategies to improve outcomes. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Bleeding esophageal varices

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000268.htm Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  20. GI bleeding - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100162.htm GI bleeding - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Gastrointestinal Bleeding A.D.A.M., Inc. is accredited by ...

  1. Scintigraphic evaluation of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Yong Tai; Lee, Choon Keun; Lee, Sun Wha; Choi, Woo Suk; Yoon, Yup; Lim, Jae Hoon

    1988-01-01

    Gastrointestinal bleeding remains a major diagnostic problem. Although advances have been made in the medical and surgical methods of managing gastrointestinal bleeding, the commonly employed techniques of barium radiography, endoscopy, and angiography may not successfully localize the site and define the cause of gastrointestinal bleeding. Two widely available technetium-99m-labeled radiopharmaceuticals, sulfur colloid and red blood cells are currently used in the evaluation of patients who are bleeding from the gastrointestinal tract. Surgically confirmed 19 patients with use of 99m Tc-sulfur colloid (7 cases) and 99m Tc-RBC (12 cases) were retrospectively evaluated. The overall sensitivity of scintigraphy in detection of bleeding and localization of bleeding site was 68% and 84%, respectively. The authors conclude that bleeding scintigraphy is a safe, sensitive, and non-invasive method as an effective screening test before performing angiography or surgery.

  2. Incidence of late rectal bleeding in high-dose conformal radiotherapy of prostate cancer using equivalent uniform dose-based and dose-volume-based normal tissue complication probability models

    International Nuclear Information System (INIS)

    Soehn, Matthias; Yan Di; Liang Jian; Meldolesi, Elisa; Vargas, Carlos; Alber, Markus

    2007-01-01

    Purpose: Accurate modeling of rectal complications based on dose-volume histogram (DVH) data are necessary to allow safe dose escalation in radiotherapy of prostate cancer. We applied different equivalent uniform dose (EUD)-based and dose-volume-based normal tissue complication probability (NTCP) models to rectal wall DVHs and follow-up data for 319 prostate cancer patients to identify the dosimetric factors most predictive for Grade ≥ 2 rectal bleeding. Methods and Materials: Data for 319 patients treated at the William Beaumont Hospital with three-dimensional conformal radiotherapy (3D-CRT) under an adaptive radiotherapy protocol were used for this study. The following models were considered: (1) Lyman model and (2) logit-formula with DVH reduced to generalized EUD (3) serial reconstruction unit (RU) model (4) Poisson-EUD model, and (5) mean dose- and (6) cutoff dose-logistic regression model. The parameters and their confidence intervals were determined using maximum likelihood estimation. Results: Of the patients, 51 (16.0%) showed Grade 2 or higher bleeding. As assessed qualitatively and quantitatively, the Lyman- and Logit-EUD, serial RU, and Poisson-EUD model fitted the data very well. Rectal wall mean dose did not correlate to Grade 2 or higher bleeding. For the cutoff dose model, the volume receiving > 73.7 Gy showed most significant correlation to bleeding. However, this model fitted the data more poorly than the EUD-based models. Conclusions: Our study clearly confirms a volume effect for late rectal bleeding. This can be described very well by the EUD-like models, of which the serial RU- and Poisson-EUD model can describe the data with only two parameters. Dose-volume-based cutoff-dose models performed worse

  3. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... There are many causes of abnormal vaginal bleeding. HORMONES ... Doctors call the problem abnormal uterine bleeding (AUB) . AUB ...

  4. Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting.

    Directory of Open Access Journals (Sweden)

    Lakshmana Ayaru

    Full Text Available There are no widely used models in clinical care to predict outcome in acute lower gastro-intestinal bleeding (ALGIB. If available these could help triage patients at presentation to appropriate levels of care/intervention and improve medical resource utilisation. We aimed to apply a state-of-the-art machine learning classifier, gradient boosting (GB, to predict outcome in ALGIB using non-endoscopic measurements as predictors.Non-endoscopic variables from patients with ALGIB attending the emergency departments of two teaching hospitals were analysed retrospectively for training/internal validation (n=170 and external validation (n=130 of the GB model. The performance of the GB algorithm in predicting recurrent bleeding, clinical intervention and severe bleeding was compared to a multiple logic regression (MLR model and two published MLR-based prediction algorithms (BLEED and Strate prediction rule.The GB algorithm had the best negative predictive values for the chosen outcomes (>88%. On internal validation the accuracy of the GB algorithm for predicting recurrent bleeding, therapeutic intervention and severe bleeding were (88%, 88% and 78% respectively and superior to the BLEED classification (64%, 68% and 63%, Strate prediction rule (78%, 78%, 67% and conventional MLR (74%, 74% 62%. On external validation the accuracy was similar to conventional MLR for recurrent bleeding (88% vs. 83% and therapeutic intervention (91% vs. 87% but superior for severe bleeding (83% vs. 71%.The gradient boosting algorithm accurately predicts outcome in patients with acute lower gastrointestinal bleeding and outperforms multiple logistic regression based models. These may be useful for risk stratification of patients on presentation to the emergency department.

  5. Non-Local Sparse Image Inpainting for Document Bleed-Through Removal

    Directory of Open Access Journals (Sweden)

    Muhammad Hanif

    2018-05-01

    Full Text Available Bleed-through is a frequent, pervasive degradation in ancient manuscripts, which is caused by ink seeped from the opposite side of the sheet. Bleed-through, appearing as an extra interfering text, hinders document readability and makes it difficult to decipher the information contents. Digital image restoration techniques have been successfully employed to remove or significantly reduce this distortion. This paper proposes a two-step restoration method for documents affected by bleed-through, exploiting information from the recto and verso images. First, the bleed-through pixels are identified, based on a non-stationary, linear model of the two texts overlapped in the recto-verso pair. In the second step, a dictionary learning-based sparse image inpainting technique, with non-local patch grouping, is used to reconstruct the bleed-through-contaminated image information. An overcomplete sparse dictionary is learned from the bleed-through-free image patches, which is then used to estimate a befitting fill-in for the identified bleed-through pixels. The non-local patch similarity is employed in the sparse reconstruction of each patch, to enforce the local similarity. Thanks to the intrinsic image sparsity and non-local patch similarity, the natural texture of the background is well reproduced in the bleed-through areas, and even a possible overestimation of the bleed through pixels is effectively corrected, so that the original appearance of the document is preserved. We evaluate the performance of the proposed method on the images of a popular database of ancient documents, and the results validate the performance of the proposed method compared to the state of the art.

  6. Matching design and performance analysis for driving system of solar garden tractor%太阳能园艺拖拉机驱动系统匹配设计与性能分析

    Institute of Scientific and Technical Information of China (English)

    张超; 朱思洪; 王军洋; 高辉松; 邓晓亭

    2015-01-01

    Solar garden tractor not only drives tractor, but also does some garden works, and its driving system has unique requirement. A design method for driving system of solar garden tractor was put forward, which included the overall design and the main parameters of the theoretical calculation. Firstly, for the wheel drive mode’s power transmission chain was short, and its driving and braking force distribution could be controlled and optimized by the energy management and power system, which was helpful to improve the drive system’s efficiency, extend operation time and increase mileage, the wheel drive mode was therefore chosen as solar tractor drive system. Secondly, the components of solar tractor included the hub motor, the moving motor, the reducer, the battery pack and the photovoltaic panel. In order to evaluate solar tractor’s working capacity, the cumulative operation time throughout day was proposed as the evaluation index. The cumulative operation time throughout day refered to the sum of solar tractor working time in a day after the battery was fully charged. According to the principle of solar tractor, i.e. obtained total energy is equal to consumed energy by the tractor, calculate the cumulative operation time throughout day. The obtained total energy by solar tractor was composed of photovoltaic panel output total energy throughout day and battery rated output energy. Based on a large number of test and analysis on solar radiation intensity and environment temperature on horizontal plane in Nanjing, solar radiation intensity model and environment temperature model were established under cloudless weather throughout the day to describe climate change. According to the parameters of photovoltaic panel, solar radiation intensity and environment temperature, the photovoltaic panel’sP-Voutput characteristic curve was obtained, and based on the peak power of photovoltaic panel, total output energy values of 4 photovoltaic panels were calculated to be

  7. Upper GI Bleeding in Children

    Science.gov (United States)

    Upper GI Bleeding in Children What is upper GI Bleeding? Irritation and ulcers of the lining of the esophagus, stomach or duodenum can result in upper GI bleeding. When this occurs the child may vomit blood ...

  8. A New Skid Trail Pattern Design for Farm Tractors Using Linear Programing and Geographical Information Systems

    Directory of Open Access Journals (Sweden)

    Selcuk Gumus

    2016-12-01

    Full Text Available Farm tractor skidding is one of the common methods of timber extraction in Turkey. However, the absence of an optimal skidding plan covering the entire production area can result in time loss and negative environmental impacts. In this study, the timber extraction by farm tractors was analyzed, and a new skid trail pattern design was developed using Linear Programming (LP and Geographical Information Systems (GIS. First, a sample skidding operation was evaluated with a time study, and an optimum skidding model was generated with LP. Then, the new skidding pattern was developed by an optimum skidding model and GIS analysis. At the end of the study, the developed new skid trail pattern was implemented in the study area and tested by running a time study. Using the newly developed “Direct Skid Trail Pattern (DSTP” model, a 16.84% increase in working time performance was observed when the products were extracted by farm tractors compared to the existing practices. On the other hand, the average soil compaction value measured in the study area at depths of 0–5 cm and 5–10 cm was found to be greater in the sample area skid trails than in the control points. The average density of the skid trails was 281 m/ha, while it decreased to 187 m/ha by using the developed pattern. It was also found that 44,829 ton/ha of soil losses were prevented by using the DSTP model; therefore, environmental damages were decreased.

  9. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study

    Science.gov (United States)

    de Abajo, Francisco José; Rodríguez, Luis Alberto García; Montero, Dolores

    1999-01-01

    Objective To examine the association between selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding. Design Population based case-control study. Setting General practices included in the UK general practice research database. Subjects 1651 incident cases of upper gastrointestinal bleeding and 248 cases of ulcer perforation among patients aged 40 to 79 years between April 1993 and September 1997, and 10 000 controls matched for age, sex, and year that the case was identified. Interventions Review of computer profiles for all potential cases, and an internal validation study to confirm the accuracy of the diagnosis on the basis of the computerised information. Main outcome measures Current use of selective serotonin reuptake inhibitors or other antidepressants within 30 days before the index date. Results Current exposure to selective serotonin reuptake inhibitors was identified in 3.1% (52 of 1651) of patients with upper gastrointestinal bleeding but only 1.0% (95 of 10 000) of controls, giving an adjusted rate ratio of 3.0 (95% confidence interval 2.1 to 4.4). This effect measure was not modified by sex, age, dose, or treatment duration. A crude incidence of 1 case per 8000 prescriptions was estimated. A small association was found with non-selective serotonin reuptake inhibitors (relative risk 1.4, 1.1 to 1.9) but not with antidepressants lacking this inhibitory effect. None of the groups of antidepressants was associated with ulcer perforation. The concurrent use of selective serotonin reuptake inhibitors with non-steroidal anti-inflammatory drugs increased the risk of upper gastrointestinal bleeding beyond the sum of their independent effects (15.6, 6.6 to 36.6). A smaller interaction was also found between selective serotonin reuptake inhibitors and low dose aspirin (7.2, 3.1 to 17.1). Conclusions Selective serotonin reuptake inhibitors increase the risk of upper gastrointestinal bleeding. The absolute effect is, however

  10. Vibration energy absorption in the whole-body system of a tractor operator

    OpenAIRE

    Jan Szczepaniak; Wojciech Tanaś; Jacek Kromulski

    2014-01-01

    Many people are exposed to whole-body vibration (WBV) in their occupational lives, especially drivers of vehicles such as tractor and trucks. The main categories of effects from WBV are perception degraded comfort interference with activities-impaired health and occurrence of motion sickness. Absorbed power is defined as the power dissipated in a mechanical system as a result of an applied force. The vibration-induced injuries or disorders in a substructure of the human system are primari...

  11. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) ... Print en español Sangrado uterino anormal What Is Abnormal Uterine Bleeding? Abnormal uterine bleeding (AUB) is the name doctors ...

  12. Treatment and prognosis in peptic ulcer bleeding.

    Science.gov (United States)

    Laursen, Stig Borbjerg

    2014-01-01

    Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of hemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. The aims of the present thesis were: 1. To examine which risk scoring system is best at predicting need of hospital-based intervention, rebleeding, and mortality in patients presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate if supplementary transcatheter arterial embolization (STAE) after

  13. Treatment Modalities in Adolescents Who present With Heavy Menstrual Bleeding.

    Science.gov (United States)

    Alaqzam, Tasneem S; Stanley, Angela C; Simpson, Pippa M; Flood, Veronica H; Menon, Seema

    2018-03-07

    This study sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder. DESIGN, SETTING, PARTICIPANT, INTERVENTION, AND MAIN OUTCOME MEASURES: Retrospective chart review of adolescent <21 years with heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology clinic. Information included demographics, bleeding diathesis, hematologic parameters, treatment, and the diagnosis was extracted from each chart. Subjects were grouped into two categories based on the diagnosis of a bleeding disorder. Hemoglobin level, iron deficiency anemia, and need for transfusion were compared between a bleeding disorder and no bleeding disorder group. Subjects were grouped into categories depending on hormonal modality and treatment success of the groups were compared. 73 subjects tested for a bleeding disorder. Of the subjects completing testing, 34 (46%) were diagnosed with a bleeding disorders. 39 (54%) subjects had heavy menstrual bleeding due to other causes. There was no significant difference in hemoglobin between those with and without a bleeding disorder. Iron deficiency anemia was significantly higher in subjects without bleeding disorder. When comparing hormone therapy success, the levonorgestrel IUD (LNG-IUD) (89%) had the highest rate of menstrual suppression followed by norethindrone acetate 5-10mg/day (83%), and the transdermal patch (80%). All subjects using both tranexamic acid and hormonal therapy had 100% achievement of menstrual suppression. A high frequency of bleeding disorder was found in those tested. Subjects with a bleeding disorder were less likely to present with severe anemia requiring blood transfusion and less likely to have iron

  14. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. © 2016 Japan Gastroenterological Endoscopy Society.

  15. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    : The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  16. Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

    International Nuclear Information System (INIS)

    Asgher, S.; Saleem, M.K.

    2015-01-01

    To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

  17. Repair and maintenance costs of 4WD tractors and self propelled combine harvesters in Italy

    Directory of Open Access Journals (Sweden)

    Aldo Calcante

    2013-09-01

    Full Text Available Purchasing and maintaining tractors and operating machines are two of the most considerable costs of the agricultural sector, which includes farm equipment manufacturers, farm contractors and farms. In this context, repair and maintenance costs (R&M costs generally constitute 10-15% of the total costs related to agricultural equipment and tend to increase with the age of the equipment; hence, an important consideration in farm management is the optimal time for equipment replacement. Classical, R&M cost estimation models, calculated as a function of accumulated working hours, are usually developed by ASAE/ASABE for the United States operating conditions. However, R&M costs are strongly influenced by farming practices, operative conditions, crop and soil type, climatic conditions, etc. which can be specific for individual countries. In this study, R&M cost model parameters were recalculated for the current Italian situation. For this purpose, data related to the R&M costs of 100 4WD tractors with engine power ranging from 59 to 198 kW, and of 20 SP combine harvesters (10 straw walkers combines and 10 axial flow combines with engine power ranging from 159 to 368 kW working in Italy were collected. According to the model, which was obtained by interpolating the data through a two-parameter power function (proposed by ASAE/ASABE, the R&M cost incidence on the list price of Italian tractors at 12,000 working hours (estimated life of the machines was 48.6%, as compared with 43.2% calculated through the most recent U.S. model while, for self propelled combine harvesters, the R&M cost incidence at 3,000 working hours was 23.1 % as compared with 40.2% calculated through the same U.S. model.

  18. iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience.

    Science.gov (United States)

    Faggioni, L; Neri, E; Bargellini, I; Scalise, P; Calcagni, F; Mantarro, A; D'Ippolito, G; Bartolozzi, C

    2015-03-01

    To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding. 24 CTA examinations of patients with suspected acute gastrointestinal bleeding confirmed (19/24, 79.2%) or ruled out (5/24, 20.8%) by digital subtraction angiography (DSA) were retrospectively reviewed by three independent readers on a commercial picture archiving communication system (PACS) workstation and on an iPad with Retina Display® 64 GB (Apple Inc.). The time needed to complete reading of every CTA examination was recorded, as well as the rate of detection of arterial bleeding and identification of suspected bleeding arteries on both devices. Overall, the area under the receiver operating characteristic curve, sensitivity, specificity, positive- and negative-predictive values for bleeding detection were not significantly different while using the iPad and workstation (0.774 vs 0.847, 0.947 vs 0.895, 0.6 vs 0.8, 0.9 vs 0.944 and 0.750 vs 0.667, respectively; p > 0.05). In DSA-positive cases, the iPad and workstation allowed correct identification of the bleeding source in 17/19 cases (89.5%) and 15/19 cases (78.9%), respectively (p > 0.05). Finally, the time needed to complete reading of every CTA study was significantly shorter using the iPad (169 ± 74 vs 222 ± 70 s, respectively; p < 0.01). Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster. The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.

  19. To Bleed or Not to Bleed: That is the Question. The Side Effects of Apixaban.

    Science.gov (United States)

    Ciccone, Marco Matteo; Zito, Annapaola; Devito, Fiorella; Maiello, Maria; Palmiero, Pasquale

    2018-01-01

    Apixaban is a new oral anticoagulant (NOACs: Novel Oral Anticoagulant), like dabigatran, rivaroxaban, and edoxaban. All of them are prescribed to patients with non valvular atrial fibrillation or venous thromboembolism, to replace warfarin, because of the lower probability of bleeding, however they can cause bleeding by themselves. Bleeding is an adverse event in patients taking anticoagulants. It is associated with a significant increase of morbidity and risk of death. However, these drugs should be used only for the time when anticoagulation is strictly required, especially when used for preventing deep vein thrombosis. Prolonged use increases the risk of bleeding. In the ARISTOTLE Trial Apixaban, compared with warfarin, was associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage. Many physicians still have limited experience with new oral anticoagulants and about bleeding risk managment. We reviewed the available literature on extracranial and intracranial bleeding concerning apixaban. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study.

    Science.gov (United States)

    Li, Linxin; Geraghty, Olivia C; Mehta, Ziyah; Rothwell, Peter M

    2017-07-29

    Lifelong antiplatelet treatment is recommended after ischaemic vascular events, on the basis of trials done mainly in patients younger than 75 years. Upper gastrointestinal bleeding is a serious complication, but had low case fatality in trials of aspirin and is not generally thought to cause long-term disability. Consequently, although co-prescription of proton-pump inhibitors (PPIs) reduces upper gastrointestinal bleeds by 70-90%, uptake is low and guidelines are conflicting. We aimed to assess the risk, time course, and outcomes of bleeding on antiplatelet treatment for secondary prevention in patients of all ages. We did a prospective population-based cohort study in patients with a first transient ischaemic attack, ischaemic stroke, or myocardial infarction treated with antiplatelet drugs (mainly aspirin based, without routine PPI use) after the event in the Oxford Vascular Study from 2002 to 2012, with follow-up until 2013. We determined type, severity, outcome (disability or death), and time course of bleeding requiring medical attention by face-to-face follow-up for 10 years. We estimated age-specific numbers needed to treat (NNT) to prevent upper gastrointestinal bleeding with routine PPI co-prescription on the basis of Kaplan-Meier risk estimates and relative risk reduction estimates from previous trials. 3166 patients (1582 [50%] aged ≥75 years) had 405 first bleeding events (n=218 gastrointestinal, n=45 intracranial, and n=142 other) during 13 509 patient-years of follow-up. Of the 314 patients (78%) with bleeds admitted to hospital, 117 (37%) were missed by administrative coding. Risk of non-major bleeding was unrelated to age, but major bleeding increased steeply with age (≥75 years hazard ratio [HR] 3·10, 95% CI 2·27-4·24; pbleeds (5·53, 2·65-11·54; pbleeds (≥75 years HR 4·13, 2·60-6·57; pbleeds were mostly disabling or fatal (45 [62%] of 73 patients vs 101 [47%] of 213 patients with recurrent ischaemic stroke), and outnumbered

  1. Bleeding into the skin

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003235.htm Bleeding into the skin To use the sharing features on this page, please enable JavaScript. Bleeding into the skin can occur from broken blood ...

  2. Heavy Menstrual Bleeding (Menorrhagia)

    Science.gov (United States)

    ... Us Information For… Media Policy Makers Blood Disorders Heavy Menstrual Bleeding Recommend on Facebook Tweet Share Compartir ... It can also be bleeding that is very heavy. How do you know if you have heavy ...

  3. The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

    International Nuclear Information System (INIS)

    Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

    1986-01-01

    Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding

  4. Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Jan Yi-Yin

    2006-01-01

    Full Text Available Abstract Background A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. Methods The medical records of 9 patients (8 males and 1 female; age range, 28 – 71 years; median, 36 years with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78% was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7, computed tomographic (4/7, ultrasound (2/5, and surgical (2/2 findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 – 87 months. Results Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%. Angiography determined correct diagnosis in 7 patients (7/7, 100%. The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4 or elective (n = 3 surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5 and 89% (8/9. Five patients developed pseudocysts before treatment (n = 3 or following intervention (n = 2. Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality

  5. Vaginal bleeding between periods

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003156.htm Vaginal bleeding between periods To use the sharing features ... this page, please enable JavaScript. This article discusses vaginal bleeding that occurs between a woman's monthly menstrual ...

  6. Helping mothers survive bleeding after birth: an educational of simulation-based training in a low resource setting

    NARCIS (Netherlands)

    Nelissen, E.J.T.; Ersdal, H.; Ostergaard, D.; Mduma, E.; Broerse, J.E.W.; Evjen-Olsen, B.; van Roosmalen, J.; Stekelenburg, J.

    2014-01-01

    Objective To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. Design Educational intervention study. Setting Rural referral hospital in Northern Tanzania. Population Clinicians, nurse-midwives, medical attendants, and ambulance

  7. Abnormal Uterine Bleeding FAQ

    Science.gov (United States)

    ... acid —This medication treats heavy menstrual bleeding. • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps. • Antibiotics—If you have an infection, you may be ...

  8. Management of acute gastric varices bleeding

    Directory of Open Access Journals (Sweden)

    Chen-Jung Chang

    2013-10-01

    Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

  9. Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization.

    Science.gov (United States)

    Kamo, Minobu; Fuwa, Sokun; Fukuda, Katsuyuki; Fujita, Yoshiyuki; Kurihara, Yasuyuki

    2016-07-01

    This report describes a novel approach to endoscopically induce bleeding by removing a clot from the bleeding site during angiography for upper gastrointestinal (UGI) hemorrhage. This procedure enabled accurate identification of the bleeding site, allowing for successful targeted embolization despite a negative initial angiogram. Provocative endoscopy may be a feasible and useful option for angiography of obscure bleeding sites in patients with UGI arterial hemorrhage. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  10. Severe Bleeding: First Aid

    Science.gov (United States)

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

  11. Recurrent Bleeding After Perimesencephalic Hemorrhage.

    Science.gov (United States)

    Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-12-01

    Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. An upper gastrointestinal ulcer still bleeding after endoscopy : what comes next?

    NARCIS (Netherlands)

    Craenen, E. M. E.; Hofker, Hendrik; Peters, Frans; Kater, G. M.; Glatman, K. R.; Zijlstra, J. G.

    Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence

  13. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    International Nuclear Information System (INIS)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M.; Al-Wafai, I.; Vallgren, S.

    1989-01-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of 99m Tc-DTPA, 99m Tc-RBCs and 99m Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both 99m Tc-DTPA and 99m Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only 99m Tc-DTPA was successful in detecting the bleeding site. The results indicate that 99m Tc-DTPA is the most useful 99m Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.) [de

  14. [Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

    Science.gov (United States)

    Belanová, Veronika; Gřiva, Martin

    2015-12-01

    The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even

  15. The use of fuzzy logic in quality control testing of automotive and tractor equipment

    OpenAIRE

    Korobko А.; Mykhailova О.; Nazarko О.; Radchenko Yu.

    2016-01-01

    The article analyzes the relevance of the research topics, defines goals and objectives, subject and object of research. On the basis of the literature analysis, the following eduction was made: not all the test methods in road and agricultural vehicles (tractors) contribute to the effective implementation of the requirements of normative documents including international, inter-laboratory comparative tests. The approach in laboratory testing to the synthesis adaptive system of metrological a...

  16. Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project.

    Science.gov (United States)

    Esteve-Pastor, María Asunción; Rivera-Caravaca, José Miguel; Roldan, Vanessa; Vicente, Vicente; Valdés, Mariano; Marín, Francisco; Lip, Gregory Y H

    2017-10-05

    Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. The aim of this study was to analyze the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up. We enrolled 1,120 patients stable on vitamin K antagonist treatment. The HAS-BLED and ABC-Bleeding scores were quantified. Predictive values were compared by c-indexes, IDI, NRI, as well as decision curve analysis (DCA). Median HAS-BLED score was 2 (IQR 2-3) and median ABC-Bleeding was 16.5 (IQR 14.3-18.6). After 6.5 years of follow-up, 207 (2.84 %/year) patients had major bleeding events, of which 65 (0.89 %/year) had intracranial haemorrhage (ICH) and 85 (1.17 %/year) had gastrointestinal bleeding events (GIB). The c-index of HAS-BLED was significantly higher than ABC-Bleeding for major bleeding (0.583 vs 0.518; p=0.025), GIB (0.596 vs 0.519; p=0.017) and for the composite of ICH-GIB (0.593 vs 0.527; p=0.030). NRI showed a significant negative reclassification for major bleeding and for the composite of ICH-GIB with the ABC-Bleeding score compared to HAS-BLED. Using DCAs, the use of HAS-BLED score gave an approximate net benefit of 4 % over the ABC-Bleeding score. In conclusion, in the first "real-world" validation of the ABC-Bleeding score, HAS-BLED performed significantly better than the ABC-Bleeding score in predicting major bleeding, GIB and the composite of GIB and ICH.

  17. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

    NARCIS (Netherlands)

    Cooper, Natalie A. M.; Barton, Pelham M.; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C.; Timmermans, Anne; Mol, Ben W. J.; Khan, Khalid S.; Clark, T. Justin

    2014-01-01

    Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity

  18. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Energy Technology Data Exchange (ETDEWEB)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

    1989-06-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  19. Auxiliary brakes for trucks : research into the behaviour of a tractor-semi-trailer combination during emergency breaking.

    NARCIS (Netherlands)

    Dijks, A. Blijswijk, W.A.M. van Genugten, J. van Meeke, G.J.M. & Schlösser, L.H.M.

    1976-01-01

    The purpose of the research was to obtain an insight into various secondary braking systems for goods vehicles. Practical tests were carried out with a tractor- semi-trailer combination. The performance of various split braking systems as well as spring brake actuators are shown. With nearly all of

  20. Analisis dan Perancangan Aplikasi Pendukung Erp Sap R/3 Modul Sales and Distribution PT. United Tractors, Tbk

    Directory of Open Access Journals (Sweden)

    Johan Johan

    2010-12-01

    Full Text Available The purpose of this research is to analyse sales process having been implementing Sales and Distribution module of ERP SAP R/3 and also to design a supporting application for sales process at PT United Tractor, Tbk. The benefit of this application is to help sales person and customer in doing inquiries, quotation and sales order also material information through short message. The method of this research is data capturing, literature review, object oriented analysis and design and Rational Unified process including UML ( Unified Modeling Language for application design. Based on the problem, we designed a web based and sms gateway application to support Sales and Distribution module ERP SAP R/3 to help customer and sales person in doing sales transaction and information inquiry. 

  1. ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Singh-Bhinder, Nimarta; Kim, David H; Holly, Brian P; Johnson, Pamela T; Hanley, Michael; Carucci, Laura R; Cash, Brooks D; Chandra, Ankur; Gage, Kenneth L; Lambert, Drew L; Levy, Angela D; Oliva, Isabel B; Peterson, Christine M; Strax, Richard; Rybicki, Frank J; Dill, Karin E

    2017-05-01

    Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to

  2. An agricultural tractor test with different proportions of biodiesel; Ensaio de um trator agricola com diferentes proporcoes de biodiesel

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Breno Alves; Castro, Douglas Lourenco de Souza; Volpato, Carlos Eduardo Silva; Barbosa, Jackson Antonio [Universidade Federal de Lavras (UFLA), MG (Brazil)

    2009-07-01

    The globalization of the economy bring as consequence the entry of new equipment and machinery highly competitive in terms of cost. This is the same reality of the Brazilian agricultural sector which today has new options for machines and implements very interesting from the standpoint of cost of acquisition. However, such equipment, due to its recent inclusion in the market, yet do not have parameters that relate to reliability. This work aimed to demonstrated the dynamometer test of an agricultural tractor, recently introduced in the market, to obtain their torque curves and specific fuel consumption using the fuel B{sub 2}, B{sub 5}, B{sub 2}0 and B{sub 1}00. The results showed that the tractor had satisfactory performance for all motor fuels, presenting the best performance with the use of B{sub 5} fuel. (author)

  3. The development and validation of an ergonomics index for assessing tractor operator work place

    OpenAIRE

    Barbieri, Juan Paulo; Schlosser, José Fernando; Farias, Marcelo Silveira de; Negri, Giácomo Müller; Oliveira, Luis Fernando Vargas de

    2018-01-01

    ABSTRACT: This study aimed to develop and validate an ergonomics index for the operator workplace assessment of agricultural tractors sold in the Brazilian market. To develop the ergonomics index, the operator work places were assessed for compliance with current, national and international, safety and ergonomics standards. The following standards were analyzed to develop ergonomics index: ISO 15077 (1996), which regulates the position of operator controls; ABNT NBR ISO 4254-1(2015) and ABNT ...

  4. Postpartum bleeding: efficacy of endovascular management

    International Nuclear Information System (INIS)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki

    2003-01-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12 th and 13 th day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding

  5. Postpartum bleeding: efficacy of endovascular management

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki [Asan Medical Center, Seoul (Korea, Republic of)

    2003-06-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12{sup th} and 13{sup th} day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

  6. Heavy and Overweight Vehicle Brake Testing: Five-Axle Combination Tractor-Flatbed Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Lascurain, Mary Beth [ORNL; Capps, Gary J [ORNL; Franzese, Oscar [ORNL

    2013-10-01

    The Federal Motor Carrier Safety Administration, in coordination with the Federal Highway Administration, sponsored the Heavy and Overweight Vehicle Brake Testing (HOVBT) program in order to provide information about the effect of gross vehicle weight (GVW) on braking performance. Because the Federal Motor Carrier Safety Regulations limit the number of braking system defects that may exist for a vehicle to be allowed to operate on the roadways, the examination of the effect of brake defects on brake performance for increased loads is also relevant. The HOVBT program seeks to provide relevant information to policy makers responsible for establishing load limits, beginning with providing test data for a combination tractor/trailer. This testing was conducted on a five-axle combination vehicle with tractor brakes meeting the Reduced Stopping Distance requirement rulemaking. This report provides a summary of the testing activities, the results of various analyses of the data, and recommendations for future research. Following a complete brake rebuild, instrumentation, and brake burnish, stopping tests were performed from 20 and 40 mph with various brake application pressures (15 psi, 25 psi, 35 psi, 45 psi, 55 psi, and full system pressure). These tests were conducted for various brake conditions at the following GVWs: 60,000, 80,000, 91,000, 97,000, 106,000, and 116,000 lb. The 80,000-lb GVWs included both balanced and unbalanced loads. The condition of the braking system was also varied. To introduce these defects, brakes (none, forward drive axle, or rear trailer axle) were made inoperative. In addition to the stopping tests, performance-based brake tests were conducted for the various loading and brake conditions. Analysis of the stopping test data showed the stopping distance to increase with load (as expected) and also showed that more braking force was generated by the drive axle brakes than the trailer axle brakes. The constant-pressure stopping test data

  7. Excess Long-Term Mortality following Non-Variceal Upper Gastrointestinal Bleeding: A Population-Based Cohort Study

    Science.gov (United States)

    Crooks, Colin John; Card, Timothy Richard; West, Joe

    2013-01-01

    Background It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population. Methods and Findings Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤50 years, 95% CI 3.0%–4.3%) to 15.2% (≥80 years, 14.2%–16.3%), representing an excess over controls of between 3.6% (3.0%–4.2%) and 13.4% (12.4%–14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤50 years, 3.4%–4.8%) to 46.6% (≥80 years, 45.2%–48.1%), representing an excess over controls of between 3.8% (3.1%–4.5%) and 19.0% (17.5%–20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets. Conclusions Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co

  8. Upper gastrointestinal bleeding in patients with CKD.

    Science.gov (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

    2014-08-07

    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  9. Analisi delle vibrazioni su trattori agricoli in normali condizioni di lavoro e in condizioni predefinite - Vibration analysis on agricultural tractors in normal working conditions and in predetermined conditions

    Directory of Open Access Journals (Sweden)

    Alessandro Peretti

    2015-10-01

    Full Text Available Commentata la diffusione dei trattori agricoli in Italia e svolta una rassegna degli effetti delle vibrazioni sui trattoristi, sono riportati i valori delle accelerazioni riscontrati nel nostro Paese, nonché i livelli di esposizione degli operatori. Individuati i parametri che determinano le vibrazioni, sono illustrati gli interventi in grado di contenerle. Sono inoltre riportati i risultati di una ricerca su tre trattori agricoli: i rilievi delle vibrazioni triassiali sul piano e sul basamento del sedile e le misure del rumore in prossimità di ambedue gli orecchi dell’operatore sono stati eseguiti durante l’aratura, l’erpicatura e la traslazione su strada sterrata e asfaltata, a diverse velocità di avanzamento e a differenti valori di pressione di gonfiaggio degli pneumatici. ------ After the assessment of the agricultural tractors fleet characteristics in Italy and a review of the effects of vibration on tractor drivers, the typical acceleration values and consequent operators’ exposure levels in carrying out agricultural operations are reported. Once having ascertained the parameters that produce the vibrations, the actions more suitable to reduce the risk factors are shown. The results of a series of comparative tests on three used tractors of different age are then reported: the levels of tri-axial vibrations on the seat cushion and base and of the noise at both operator’s ears were recorded during ploughing, harrowing and driving on farm and paved roads, at different speeds and varying the tyres inflation pressure.

  10. The usefulness of MDCT in acute intestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won

    2006-01-01

    We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted

  11. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study.

    Science.gov (United States)

    Wada, Tomoki; Hagiwara, Akiyoshi; Uemura, Tatsuki; Yahagi, Naoki; Kimura, Akio

    2016-08-01

    Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.

  12. Endoscopic management of bleeding peptic ulcers

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  13. Scintigraphic detection and localization of gastrointestinal bleeding sites

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  14. Conformidade de acessos e de saídas de postos de operação em tratores agrícolas segundo norma NBR/ISO 4252 Conformity of the accesses and exits of agricultural tractors workplaces according to NBR/ISO 4252 STANDARD

    Directory of Open Access Journals (Sweden)

    Danielle M. P. Mattar

    2010-02-01

    Full Text Available Este trabalho teve como objetivo avaliar a conformidade dos acessos e de saídas dos postos de operação em tratores agrícolas, por meio de população amostral dos tratores fabricados no Brasil. Para a avaliação, diversos itens referentes aos acessos e às saídas dos postos de operação foram analisados qualitativa e quantitativamente com base nos padrões da Norma NBR/ISO 4252. Ao final do trabalho, foi observado que os tratores classificados na Classe III, quanto à potência nominal do motor, atendem ao maior número de requisitos da Norma em comparação a tratores da Classe II. Dentre os itens avaliados, a altura da plataforma até o teto dos postos de operação foi atendida por todos os modelos. As presenças de batentes de proteção sobre os degraus e de corrimão para o operador foram os itens em maior desconformidade sobre os tratores. Como resultado médio, a população amostral foi conforme em 66% dos itens analisados. Os tratores dotados de motores de maior potência apresentaram, em geral, acessos e saídas dos postos de operação mais ergonômicos e seguros. De maneira geral, conclui-se pela baixa conformidade dos itens de ergonomia e de segurança dispostos ao operador sobre os postos de operação em tratores agrícolas nacionais.This work had as objective to evaluate the conformity of agricultural tractors workplaces accesses and exits made in Brazil. For this evaluation, the workplaces were analyzed according to NBR/ISO 4252 Standard. It was observed that the tractors classified in Class III, in relation to power engine, was better then tractors in Class II. Among the parameters evaluated, the platform weight of operator workplace was attended by all the tractors. The items in less conformoty in agricultural tractors are the doorpost of protection on the steps and the handrail to the operator. As results, the sampling population was conformed in 66% of the analyzed items. The tractors with more powerful engines

  15. Design of a New Sensor for Determination of the Effects of Tractor Field Usage in Southern Spain: Soil Sinkage and Alterations in the Cone Index and Dry Bulk Density

    Directory of Open Access Journals (Sweden)

    Diego L. Valera

    2012-10-01

    Full Text Available Variations in sinkage and cone index are of crucial importance when planning fieldwork, and for determining the trafficability of farm machinery. Many studies have highlighted the link between higher values of these parameters and dramatic decreases in crop yield. Variations in the dry bulk density and cone index of clayey soil in Southern Spain were measured following each of five successive passes over the same land with the three types of tractor most widely used in the area (tracked, two-wheel drive and four-wheel drive. In addition, sinkage (rut depth of the running gear was measured using a laser microrelief profile meter. This device, which integrates three sensors, was specifically designed for these experiments, as was an electrical penetrometer to determine the cone index, and both instruments proved reliable and accurate in the field. The main goal of this study was to design, manufacture and test these new devices. The first pass caused most soil alteration when compared to successive passes for all types of tractor tested and soil conditions prevailing during the tests. (Heavier four-wheel drive tractors were found to cause greater soil damage (sinkage, cone index and dry bulk density than two-wheel drive and track tractors. There was no statistically significant difference between the two latter types. The greatest alterations were recorded in the top 10 cm of the soil. The results show that soil compaction should be avoided as much as possible. This can be achieved by ensuring that tractors always travel along the same tracks, especially in the wet season. At present these aspects are not considered by farmers in this area.

  16. Synergistic shortening of the bleeding time by desmopressin and ethamsylate in patients with various constitutional bleeding disorders.

    Science.gov (United States)

    Kobrinsky, N L; Israels, E D; Bickis, M G

    1991-01-01

    Desmopressin and ethamsylate were evaluated for possible synergistic effects on the bleeding time. The drugs were administered individually and together to 12 patients with markedly prolonged bleeding times known to be relatively or absolutely unresponsive to desmopressin alone. The bleeding disorders studied included Glanzmann's thrombasthenia (one), other disorders of platelet function (four), pseudo-von Willebrand disease (one), and von Willebrand disease type I (three), type II (two), and type III (one). Desmopressin alone shortened the bleeding time from 23.9 +/- 1.5 to 19.5 +/- 2.3 min (p = 0.03). Ethamsylate alone was without effect. Desmopressin and ethamsylate together shortened the bleeding time to 11.2 +/- 1.4 min (p less than 0.01 compared to baseline, p = 0.02 compared to desmopressin alone). The combination was ineffective in three patients, with Glanzmann's thrombasthenia (one), and von Willebrand disease type I (one) and type III (one). Toxic effects of the drugs were not observed. Five patients received desmopressin and ethamsylate prior to dental work with mandibular block (one), heart surgery requiring cardiopulmonary bypass (two), and adenotonsillectomy surgery (two). Normal hemostasis was achieved in each case. A synergistic shortening of the bleeding time was observed with the combination of desmopressin and ethamsylate in a wide range of bleeding disorders.

  17. Helical CT in acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine; Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude

    2003-01-01

    The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)

  18. Vaginal bleeding in late pregnancy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing ... JavaScript. One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it ...

  19. On the Modeling of a MEMS Based Capacitive Accelerometer for Measurement of Tractor Seat Vibration

    Directory of Open Access Journals (Sweden)

    M. Alidoost

    2010-04-01

    Full Text Available Drivers of heavy vehicles often face with higher amplitudes of frequencies range between 1-80 Hz. Hence, this range of frequency results in temporary or even sometimes permanent damages to the health of drivers. Examples for these problems are damages to the vertebral column and early tiredness, which both reduce the driver’s performance significantly. One solution to this problem is to decrease the imposed vibration to the driver’s seat by developing an active seat system. These systems require an online measuring unit to sense vibrations transferred to the seat. The measuring unit can include a capacitive micro-accelerometer on the basis of MEMS which measure online vibrations on the seat. In this study, the mechanical behavior of a capacitive micro-accelerometer for the vibration range applied to a tractor seat has been simulated. The accelerometer is capable to measure step, impact and harmonic external excitations applied to the system. The results of the study indicate that, with increasing the applied voltage, the system sensitivity also increases, but the measuring range of vibrations decreases and vice versa. The modeled accelerometer, at damping ratio of 0.67 is capable to measure accelerations within the frequency range of lower than 130 Hz.

  20. Computed tomography angiography in patients with active gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Fatima Regina Silva; D' Ippolito, Giuseppe, E-mail: fatima.rsreis@gmail.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Cardia, P.P. [Hospital Vera Cruz, Campinas, SP (Brazil)

    2015-11-15

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  1. The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

    International Nuclear Information System (INIS)

    Kwak, Hyo Sung; Han, Young Min; Lee, Soo Teik

    2009-01-01

    To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography

  2. Influence of biofuels usage in internal combustion engines of agricultural tractors on output parametrs

    Directory of Open Access Journals (Sweden)

    Tomáš Šmerda

    2010-01-01

    Full Text Available Application of alternative fuels brings the social benefits in terms of reducing dependence on oil industry and its products as well as decreasing of damage of the environment together with using of na­tu­ral resources, especially in field of renewable energy resources. The use of biofuels is the most important part of energy strategy in European Union, whose member states have agreed the content of biofuels will achieve 5.75% of the total energy sum of fuel for transport purposes in 2010. Operation of internal combustion engine fueled by RME brings environmental benefits as described several authors in analysis of the life cycle. The contribution deals with technical difficulties of the RME usage in internal combustion engine used in agricultural tractors. Different fuel causes different process of combustion which means changes in output power and pollution. The aim of this experiment was to determine these effects. Experimental work was divided into two parts according to various fuel systems. The first tractor was equipped with mechanical injection system, the second one was provided with common-rail fuel system. The test procedures consisted of measurement of power- torque curves where the engine load was created by Eddy current dynamometer. Exhaust gas analyzer sampled the pollution of carbon monoxide, carbon dioxide and hydrocarbons as the most important indicators of combustion process.

  3. Bleed-through correction for rendering and correlation analysis in multi-colour localization microscopy

    International Nuclear Information System (INIS)

    Kim, Dahan; Curthoys, Nikki M; Parent, Matthew T; Hess, Samuel T

    2013-01-01

    Multi-colour localization microscopy has enabled sub-diffraction studies of colocalization between multiple biological species and quantification of their correlation at length scales previously inaccessible with conventional fluorescence microscopy. However, bleed-through, or misidentification of probe species, creates false colocalization and artificially increases certain types of correlation between two imaged species, affecting the reliability of information provided by colocalization and quantified correlation. Despite the potential risk of these artefacts of bleed-through, neither the effect of bleed-through on correlation nor methods for its correction in correlation analyses have been systematically studied at typical rates of bleed-through reported to affect multi-colour imaging. Here, we present a reliable method of bleed-through correction applicable to image rendering and correlation analysis of multi-colour localization microscopy. Application of our bleed-through correction shows that our method accurately corrects the artificial increase in both types of correlation studied (Pearson coefficient and pair correlation), at all rates of bleed-through tested, in all types of correlation examined. In particular, anti-correlation could not be quantified without our bleed-through correction, even at rates of bleed-through as low as 2%. While it is demonstrated with dichroic-based multi-colour FPALM here, our presented method of bleed-through correction can be applied to all types of localization microscopy (PALM, STORM, dSTORM, GSDIM, etc), including both simultaneous and sequential multi-colour modalities, provided the rate of bleed-through can be reliably determined. (special issue article)

  4. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

    2008-01-01

    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a reduction...... in portal pressure is associated with a better control of bleeding and may facilitate later endoscopic procedures. Vasopressin and its analogues Terlipressin and somatostatin and analogues are the two types of medicine, which has been evaluated. In meta-analysis, only Terlipressin have demonstrated effects...

  5. Rectal bleeding and its management after irradiation for cervix cancer

    International Nuclear Information System (INIS)

    Chun, Mi Son; Kang, Seung Hee; Kil, Hoon Jong; Oh, Young Taek; Sohn, Jeong Hye; Ryu, Hee Suk; Lee, Kwang Jae; Jung, Hye Young

    2002-01-01

    Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. The study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gy x 7, or 5 Gy x 6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12 ∼ 86 months). The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding: an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor (ρ > 0.0432). The total

  6. Serendipity in scintigraphic gastrointestinal bleeding studies

    International Nuclear Information System (INIS)

    Goergen, T.G.

    1983-01-01

    A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value

  7. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often ...

  8. Risk of bleeding with dabigatran in atrial fibrillation.

    Science.gov (United States)

    Hernandez, Inmaculada; Baik, Seo Hyon; Piñera, Antonio; Zhang, Yuting

    2015-01-01

    It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having atrial fibrillation from October 1, 2010, through October 31, 2011, and who initiated dabigatran or warfarin treatment within 60 days of initial diagnosis. We followed up patients until discontinued use or switch of anticoagulants, death, or December 31, 2011. Dabigatran users (n = 1302) and warfarin users (n = 8102). We identified any bleeding events and categorized them as major and minor bleeding by anatomical site. Major bleeding events included intracranial hemorrhage, hemoperitoneum, and inpatient or emergency department stays for hematuria, gastrointestinal, or other hemorrhage. We used a propensity score weighting mechanism to balance patient characteristics between 2 groups and Cox proportional hazards regression models to evaluate the risk of bleeding. We further examined the risk of bleeding for 4 subgroups of high-risk patients: those 75 years or older, African Americans, those with chronic kidney disease, and those with more than 7 concomitant comorbidities. Dabigatran was associated with a higher risk of bleeding relative to warfarin, with hazard ratios of 1.30 (95% CI, 1.20-1.41) for any bleeding event, 1.58 (95% CI, 1.36-1.83) for major bleeding, and 1.85 (95% CI, 1.64-2.07) for gastrointestinal bleeding. The risk of intracranial hemorrhage was higher among warfarin users, with a hazard ratio of 0.32 (95% CI, 0.20-0.50) for dabigatran compared with warfarin. Dabigatran was consistently associated with an increased risk of major bleeding and gastrointestinal hemorrhage for all subgroups analyzed. The risk of

  9. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

    Anshu Rajnish Sharma; Charan, S.; Silva, I.

    2004-01-01

    Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

  10. Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

    Science.gov (United States)

    Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

    2015-02-09

    In people with haemophilia or other congenital bleeding disorders undergoing surgical interventions, haemostatic treatment is needed in order to correct the underlying coagulation abnormalities and minimise the bleeding risk. This treatment varies according to the specific haemostatic defect, its severity and the type of surgical procedure. The aim of treatment is to ensure adequate haemostatic coverage for as long as the bleeding risk persists and until wound healing is complete. To assess the effectiveness and safety of different haemostatic regimens (type, dose and duration, modality of administration and target haemostatic levels) administered in people with haemophilia or other congenital bleeding disorders for preventing bleeding complications during and after surgical procedures. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the last search: 20 November 2014. Randomised and quasi-randomised controlled trials comparing any hemostatic treatment regimen to no treatment or to another active regimen in children and adults with haemophilia or other congenital bleeding disorders undergoing any surgical intervention. Two authors independently assessed trials (eligibility and risks of bias) and extracted data. Meta-analyses were performed on available and relevant data. Of the 16 identified trials, four (112 participants) were eligible for inclusion.Two trials evaluated 59 people with haemophilia A and B undergoing 63 dental extractions. Trials compared the use of a different type (tranexamic acid or epsilon-aminocaproic acid) and regimen of antifibrinolytic agents as haemostatic support to the initial replacement treatment. Neither trial specifically addressed mortality (one of this review's primary outcomes); however, in the frame

  11. Mortality in high-risk patients with bleeding Mallory-Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study.

    Science.gov (United States)

    Ljubičić, Neven; Budimir, Ivan; Pavić, Tajana; Bišćanin, Alen; Puljiz, Zeljko; Bratanić, Andre; Troskot, Branko; Zekanović, Dražen

    2014-04-01

    The aim of this study was to identify the predictive factors influencing mortality in patients with bleeding Mallory-Weiss syndrome in comparison with peptic ulcer bleeding. Between January 2005 and December 2009, 281 patients with endoscopically confirmed Mallory-Weiss syndrome and 1530 patients with peptic ulcer bleeding were consecutively evaluated. The 30-day mortality and clinical outcome were related to the patients' demographic data, endoscopic, and clinical characteristics. The one-year cumulative incidence for bleeding Mallory-Weiss syndrome was 7.3 cases/100,000 people and for peptic ulcer bleeding 40.4 cases/100,000 people. The age-standardized incidence for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding remained unchanged during the observational five-year period. The majority of patients with bleeding Mallory-Weiss syndrome were male patients with significant overall comorbidities (ASA class 3-4). Overall 30-day mortality rate was 5.3% for patients with bleeding Mallory-Weiss syndrome and 4.6% for patients with peptic ulcer bleeding (p = 0.578). In both patients with bleeding Mallory-Weiss syndrome and peptic ulcer bleeding, mortality was significantly higher in patients over 65 years of age and those with significant overall comorbidities (ASA class 3-4). The incidence of bleeding Mallory-Weiss syndrome and peptic ulcer bleeding has not changed over a five-year observational period. The overall 30-day mortality was almost equal for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding and was positively correlated to older age and underlying comorbid illnesses.

  12. [Related factors to re-bleeding and mortality in cirrhotic patients with acute variceal bleeding at Hipolito Unanue Hospital, Lima, Peru].

    Science.gov (United States)

    Parra Pérez, Víctor Felipe; Raymundo Cajo, Roxana Magali; Gutiérrez de Aranguren, Constantino Fernando

    2013-01-01

    To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding.

  13. Angiographic diagnosis and treatment of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung

    1986-01-01

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  14. Angiographic diagnosis and treatment of gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  15. Radiological diagnosis of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Neufang, K.F.R.; Gross-Fengels, W.; Lorenz, R.

    1990-01-01

    In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations. (orig.) [de

  16. Spironolactone use and the risk of upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Gulmez, Sinem E; Lassen, Annmarie T; Aalykke, Claus

    2008-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. * We conducted this population-based case-control study to confirm the association between spironolactone use and acute nonvaricose UGB alone...... is not modified by high cumulative doses or by concurrent use of antithrombotic or nonsteroidal anti-inflammatory drugs. AIMS Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. The aim was to confirm the association, identify the risk factors...

  17. A rare case of bleeding disorder: Glanzmann's thrombasthenia.

    Science.gov (United States)

    Swathi, Jami; Gowrishankar, A; Jayakumar, S A; Jain, Karun

    2017-01-01

    Glanzmann's thrombasthenia (GT) is a rare bleeding disorder, which is characterized by a lack of platelet aggregation. It is characterized by qualitative or quantitative abnormalities of the platelet membrane glycoprotein IIb/IIIa. Physiologically, this platelet receptor normally binds several adhesive plasma proteins, and this facilitates attachment and aggregation of platelets to ensure thrombus formation at sites of vascular injury. The lack of resultant platelet aggregation in GT leads to mucocutaneous bleeding whose manifestation may be clinically variable, ranging from easy bruising to severe and potentially life-threatening hemorrhages. To highlight this rare but potentially life-threating disorder, GT. We report a case of GT that was first detected because of the multiple episodes of gum bleeding. The patient was an 18-year-old girl who presented with a history of repeated episodes of gum bleeding since childhood. Till the first visit to our hospital, she had not been diagnosed with GT despite a history of bleeding tendency, notably purpura in areas of easy bruising, gum bleeding, and prolonged bleeding time after abrasions and insect stings. GT was diagnosed on the basis of prolonged bleeding time, lack of platelet aggregation with adenosine di phosphate, epinephrine and collagen. GT should always be considered as differential diagnosis while evaluating any case of bleeding disorder.

  18. Photocoagulation in the treatment of bleeding peptic ulcer

    Science.gov (United States)

    Otto, Wlodzimierz; Paczkowski, Pawel M.

    1996-03-01

    The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.

  19. Compaction of loamy soils due to tractor traffic in vineyards and orchards and its effect on infiltration in southern France

    NARCIS (Netherlands)

    Dijck, van S.J.E.; Asch, van T.W.J.

    2002-01-01

    Viticulture and fruit culture in Mediterranean areas demand frequent tractor traffic in vineyards and orchards for tillage and for the application of herbicides and pesticides, resulting in soil compaction. The aim of this study was to investigate theextent of soil compaction and its effect on

  20. The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

    International Nuclear Information System (INIS)

    Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

    2011-01-01

    Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)

  1. THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

    Science.gov (United States)

    Brummel-Ziedins, Kathleen E.; Whelihan, Matthew F.; Gissel, Matthew; Mann, Kenneth G.; Rivard, Georges E.

    2012-01-01

    Introduction Hemophilia A displays phenotypic heterogeneity with respect to clinical severity. Aim To determine if tissue factor (TF)-initiated thrombin generation profiles in whole blood in the presence of corn trypsin inhibitor (CTI) are predictive of bleeding risk in hemophilia A. Methods We studied factor(F) VIII deficient individuals (11 mild, 4 moderate and 12 severe) with a well-characterized five-year bleeding history that included hemarthrosis, soft tissue hematoma and annual FVIII concentrate usage. This clinical information was used to generate a bleeding score. The bleeding scores (range 0–32) were separated into three groups (bleeding score groupings: 0, 0 and ≤9.6, >9.6), with the higher bleeding tendency having a higher score. Whole blood collected by phlebotomy and contact pathway suppressed by 100μg/mL CTI was stimulated to react by the addition of 5pM TF. Reactions were quenched at 20min by inhibitors. Thrombin generation, determined by ELISA for thrombin – antithrombin was evaluated in terms of clot time (CT), maximum level (MaxL) and maximum rate (MaxR) and compared to the bleeding score. Results Data are shown as the mean±SD. MaxL was significantly different (phemophilia A. PMID:19563500

  2. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography

    International Nuclear Information System (INIS)

    Alavi, A.; Ring, E.J.

    1981-01-01

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  3. Development and Evaluation of a Wide-Bed Former for Vegetable Cultivation in Controlled Tractor Traffic

    Science.gov (United States)

    Dixit, Anoop; Khurana, Rohinish; Verma, Aseem; Singh, Arshdeep; Manes, G. S.

    2018-05-01

    India is the second largest producer of vegetables in the world. For vegetable cultivation, a good seed bed preparation is an important task which involves 6-10 different operations. To tackle the issue of multiple operations, a prototype of tractor operated wide bed former was developed and evaluated. The machine comprises of a rotary tiller and a bed forming setup. It forms bed of 1000 mm top width which is suitable as per the track width of an average sized tractor in India. The height of the beds formed is 130 mm whereas the top and bottom width of channel formed on both sides of the bed is 330 and 40 mm respectively at soil moisture content of 12.5-16% (db). The forward speed of 2.75 km/h was observed to be suitable for proper bed formation. The average fuel consumption of the machine was 5.9 l/h. The average bulk density of soil before and after the bed formation was 1.46 and 1.63 g/cc respectively. Field capacity of the machine was found to be 0.31 ha/h. The machine resulted in 93.8% labour saving and 80.4% saving in cost of bed preparation as compared to conventional farmer practice. Overall performance of wide-bed former was found to be satisfactory.

  4. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    Science.gov (United States)

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  5. [The causes of recurrent ulcerative gastroduodenal bleeding].

    Science.gov (United States)

    Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

    To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

  6. Transcatheter arterial embolization for traumatic bleeding control

    International Nuclear Information System (INIS)

    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

    1989-01-01

    Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications

  7. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

    Shin, G. H.; Oh, J. H.; Yoon, Y.

    1996-01-01

    To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding

  8. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Daniela Benedeto-Stojanov

    2015-06-01

    Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

  9. The U.S. Department of Labor's Tractor and Machinery Certification Program: management styles and perceptions held by community stakeholders and instructors.

    Science.gov (United States)

    Jepsen, S D

    2012-07-01

    A mixed-mode, descriptive study was conducted on the U.S. Department of Labor's (DOL) Tractor and Machinery Certification Program. Legislated by the Fair Labors Standards Act, the Hazardous Occupations Order in Agriculture (HOOA) was enacted in 1968 as a public policy measure to reduce the number of injuries to youth on farms. An educational exemption allows youth 14 and 15 years of age to work for hire after they successfully complete a training program. In the 40+ years since the legislation went into effect prescribing such training exemptions, deficiencies and variations have occurred in the quality of the educational program and the system by which agencies certify young people. To gain a better understanding of the DOL Tractor and Machinery Certification program, community stakeholders were asked to identify management practices, curriculum resources, and perceptions of the DOL program. The study design used qualitative data from 49 agricultural representatives participating in regional focus groups and quantitative data from 330 community instructors responding to an electronic-formatted questionnaire (representing a 70.7% response rate) in an effort to answer the question: "What is the current status of the DOL Tractor and Machinery Certification program in the United States?" The findings revealed that 55.2% of the instructors taught a qualifying DOL program. Of these, the certification was administered through an Extension or 4-H program (68.7%), an agricultural education program (24.7%), or as a combination of Extension and agricultural education (6.0%). Course instructors believed the training was beneficial to students and had opportunity to attract more students than currently enrolled These instructors placed a higher value on standardized teaching materials than on standardized testing procedures; they also supported the need for additional teaching aids, which included hands-on activities, videotapes, student workbooks, and DVDs. Study participants

  10. Depreciation Rates for Australian Tractors and Headers - Is Machinery Depreciation a Fixed or Variable Cost?

    OpenAIRE

    Tozer, Peter R.

    2005-01-01

    Seven different remaining value functions for tractors and harvesters were estimated using data from advertised prices for used farm equipment. The generalised Box-Cox model was used to nest six of the seven functions. The more complex Box- Cox function explained the data better, but simpler models such as the sum-of-theyears- digits, or double-square root models were no different and were easier to manipulate to estimate depreciation rates and costs. There were up to three components of depr...

  11. Minimizing the Risk of Infection and Bleeding at Trans-Vaginal Ultrasound-Guided Ovum Pick-up: Results of a Prospective Web-Based World-Wide Survey.

    Science.gov (United States)

    Bhandari, Harish; Agrawal, Rina; Weissman, Ariel; Shoham, Gon; Leong, Milton; Shoham, Zeev

    2015-12-01

    The objective of this study was to identify clinical practices worldwide, which would help in recognizing women at risk of excessive bleeding or of developing pelvic infection following trans-vaginal ovum pick-up (TV-OPU), measures taken to minimize risks and their management. A prospective, web-based questionnaire with distinct questions related to the practice of TV-OPU. A total of 155 units from 55 countries performing 97,200 IVF cycles annually responded to this web-based survey. A majority (65 %) responded that they would routinely carry out full blood count, while 35 % performed coagulation profile. Less than a third agreed screening women for vaginal infections. About a third used both sterile water and antiseptic to minimize ascending infection, and 52 % used antibiotics for prophylaxis. Doppler ultrasound was routinely used by 20 % of clinicians. 73 % of the clinicians preferred conservative management as their first line management for patients diagnosed with intra-abdominal bleeding. The study has identified a wide variation in the practices of minimizing infection and bleeding complications. The dearth of good quality evidence may be responsible for the lack of published guidelines, and therefore a lack of consensus on the optimum practice for minimizing the risk of infection and bleeding during TV-OPU.

  12. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... C ancer I nstitute Managing Chemotherapy Side Effects Bleeding Problems “My nurse said that chemotherapy could make ... with a clean cloth. Keep pressing until the bleeding stops. If you bruise: Put ice on the ...

  13. Bleeding in cancer patients and its treatment: a review.

    Science.gov (United States)

    Johnstone, Candice; Rich, Shayna E

    2017-12-18

    Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

  14. The Association of Gum Bleeding with Respiratory Health in a Population Based Study from Northern Europe.

    Directory of Open Access Journals (Sweden)

    Francisco Gómez Real

    Full Text Available There is little knowledge about how oral and respiratory health is interrelated even though the mucosa of the oral cavity and airways constitutes a continuum and the exposures to these are partly similar.To investigate whether gum bleeding is related to asthma, respiratory symptoms and self-reported COPD.A postal questionnaire including questions about respiratory and oral health was sent to general population samples in seven Northern European centres. In 13,409 responders, gum bleeding when brushing teeth was reported always/often by 4% and sometimes by 20%. Logistic regressions accounted for age, smoking, educational level, centre and gender. Effects of BMI, cardio-metabolic diseases, early life factors, gastro-oesophageal reflux, dental hygiene, nasal congestion, and asthma medication were addressed.Gum bleeding always/often was significantly associated with ≥ 3 asthma symptoms (OR 2.58, 95% CI 2.10-3.18, asthma (1.62 [1.23-2.14] and self-reported COPD (2.02 [1.28-3.18]. There was a dose-response relationship between respiratory outcomes and gum bleeding frequency (≥ 3 symptoms: gum bleeding sometimes 1.42 [1.25-1.60], often/always 2.58 [2.10-3.18], and there was no heterogeneity between centres (p(heterogeneity = 0.49. None of the investigated risk factors explained the associations. The observed associations were significantly stronger among current smokers (p(interaction = 0.004.A consistent link between gum bleeding and obstructive airways disease was observed, not explained by common risk factors or metabolic factors. We speculate that oral pathogens might have unfavourable impact on the airways, and that the direct continuity of the mucosa of the oral cavity and the airways reflects a pathway that might provide novel opportunities for interventions.

  15. Postpolypectomy lower GI bleeding: descriptive analysis

    NARCIS (Netherlands)

    Sorbi, D.; Norton, I.; Conio, M.; Balm, R.; Zinsmeister, A.; Gostout, C. J.

    2000-01-01

    BACKGROUND: Postpolypectomy hemorrhage may warrant intensive care monitoring, transfusions, and surgery. We sought factors predicting significant bleeding requiring blood transfusion and the benefits of critical care monitoring. METHODS: Patients with postpolypectomy bleeding between April 1989 and

  16. Scintigraphic demonstration of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Alavi, A.

    1980-01-01

    Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.

  17. Fuel consumption of tractor for different soil types in semi-arid regions; Consumo de combustivel de um trator agricola para diferentes tipos de solo em regioes semi-aridas

    Energy Technology Data Exchange (ETDEWEB)

    Montanha, Gustavo K. [Universidade Estadual Paulista (FAC/UNESP), Botucatu, SP (Brazil). Fac. de Ciencias Agronomicas. Dept. de Engenharia Rural], E-mail: gmontanha@fca.unesp.br; Guerra, Saulo P.S. [Universidade Estadual Paulista (UNESP), Botucatu, SP (Brazil). Dept. de Gestao e Tecnologia Agroindustrial; Andrade-Sanchez, Pedro; Heun, John [The University of Arizona, Maricopa, AZ (United States); Monteiro, Leonardo A. [The University of Arizona (MAC/UA), Maricopa, AZ (United States). Maricopa Agricultural Center

    2010-07-01

    The appropriate use of agricultural machinery enables greater operational efficiency and higher productivity for the farmer. Some factors such as soil type can influence the fuel consumption, one of the biggest costs. This study aimed to compare the fuel consumption of a tractor operating in two different conditions of soil in semi-arid regions. The area used for testing is located in the city of Maricopa, in Arizona, belonging to 'The University of Arizona'. The area 1 is classified as sandy clay loam soil (52% sand, 35% clay, 13% silt). The area 2 is classified as a sandy loam soil (71% sand, 12% clay and 17% silt). The tractor 4 x 2 TDA, with 88 kw (120 hp) engine power equipped with auto pilot system and an implement for tillage were used in the experiment. A data acquisition system was installed in the tractor to collect the data generated by the GPS and fuel consumption sensor. The results showed significant statistical difference in fuel consumption between soil textures. (author)

  18. Localized hypothermia aggravates bleeding in the collagenase model of intracerebral hemorrhage.

    Science.gov (United States)

    John, Roseleen F; Williamson, Michael R; Dietrich, Kristen; Colbourne, Frederick

    2015-03-01

    Animal studies testing whether therapeutic hypothermia is neuroprotective after intracerebral hemorrhage (ICH) have been inconclusive. In rodents, ICH is often produced in the striatum by infusing collagenase, which causes prolonged hemorrhaging from multiple vessels. Our previous data shows that this bleeding (hematoma) is worsened by systemic hypothermia given soon after collagenase infusion. In this study we hypothesized that localized brain hypothermia would also aggravate bleeding in this model (0.2 U of collagenase in 1.2 μL of saline). We also evaluated cooling after intrastriatal thrombin infusion (1 U in 30 μL of saline)-a simplified model of ICH thought to cause bleeding. Focal hypothermia was achieved by flushing cold water through an implanted cooling device attached to the skull underneath the temporalis muscle of adult rats. Previous work and data at this time shows this method cools the striatum to ∼33°C, whereas the body remains normothermic. In comparison to normothermic groups, cooling significantly worsened bleeding when instituted at 6 hours (∼94 vs. 42 μL, p=0.018) and 12 hours (79 vs. 61 μL, p=0.042) post-ICH (24-hour survival), but not after a 24-hour delay (36-hour survival). Rats were cooled until euthanasia when hematoma size was determined by a hemoglobin-based spectrophotometry assay. Cooling did not influence cerebral blood volume after just saline or thrombin infusion. The latter is explained by the fact that thrombin did not cause bleeding beyond that caused by saline infusion. In summary, local hypothermia significantly aggravates bleeding many hours after collagenase infusion suggesting that bleeding may have confounded earlier studies with hypothermia. Furthermore, these findings serve as a cautionary note on using cooling even many hours after cerebral bleeding.

  19. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

    DEFF Research Database (Denmark)

    Olesen, J B; Lip, G Y H; Hansen, P R

    2011-01-01

    Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme...

  20. [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

    Science.gov (United States)

    de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

    2015-07-01

    To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

  1. Abnormal uterine bleeding in pre-menopausal women.

    Science.gov (United States)

    Singh, Sukhbir; Best, Carolyn; Dunn, Sheila; Leyland, Nicholas; Wolfman, Wendy Lynn

    2013-05-01

    Abnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem. To provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age. Outcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB. Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. Abnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions

  2. Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric-specific bleeding

    NARCIS (Netherlands)

    Sanders, Yvonne V.; Fijnvandraat, Karin; Boender, Johan; Mauser-Bunschoten, Evelien P.; van der Bom, Johanna G.; de Meris, Joke; Smiers, Frans J.; Granzen, Bernd; Brons, Paul; Tamminga, Rienk Y. J.; Cnossen, Marjon H.; Leebeek, Frank W. G.

    2015-01-01

    The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large

  3. Características ergonômicas dos tratores agrícolas utilizados na região central do Rio Grande do Sul Ergonomic characteristics of agricultural tractors used in central region of Rio Grande do Sul State, Brazil

    Directory of Open Access Journals (Sweden)

    Henrique Debiasi

    2004-12-01

    Full Text Available A utilização de tratores agrícolas com boas condições ergonômicas reduz a probabilidade de ocorrência de acidentes e doenças ocupacionais, aumentando a eficiência dos trabalhadores. Neste trabalho, objetivou-se verificar a presença de itens relacionados à ergonomia de tratores agrícolas usados, bem como avaliar o comportamento destas características em função do tempo de uso das referidas máquinas. Foram analisados 175 tratores agrícolas pertencentes às microrregiões gaúchas de Santa Maria, Restinga Seca e Cachoeira do Sul, presentes em 114 propriedades aleatoriamente amostradas. Os resultados mostraram que apenas 3% dos espécimes avaliados eram equipados com cabina, sendo que a maior parte dos mesmos não apresentava isolamento do calor gerado pelo motor e transmissão. Com relação à ergonomia dos comandos, mais de 70% dos tratores tinham alavancas de câmbio centrais, enquanto que apenas 8% eram equipados com volante de direção regulável. Da mesma forma, mais de 20% dos exemplares amostrados possuíam bancos sem estofamento. Além disso, a presença dos itens avaliados foi menor para os tratores mais antigos.It is possible to reduce the probability of work accidents, diseases occurrence and increase the work efficiency using agricultural tractors with good ergonomic conditions. The objective of this research was to verify the presence of ergonomic items in used agricultural tractors and also to evaluate the influence of tractor age in these characteristics. 175 agricultural tractors belonging to 3 regions of Rio Grande do Sul State (Santa Maria, Restinga Seca and Cachoeira do Sul, Brazil, present in 114 farms randomly sampled, were evaluated. The results showed that only 3% of sampled specimens were equipped with a cab, and most part of the tractors did not have protection against the heat produced by tractor transmission and engine. With regard to ergonomics of commands, more than 70% of the tractors had gear levers

  4. Evaluation of tractive performance of four agricultural tractors in laterally inclined terrain Avaliação do desempenho operacional de quatro tratores agrícolas em terreno inclinado lateralmente

    Directory of Open Access Journals (Sweden)

    Fabricio Leite

    2011-10-01

    Full Text Available The present work aimed to evaluate the tractive performance of four agricultural tractors with auxiliary front traction in function of six lateral inclinations in a lateral track of trials, which belongs to the Agronomic Sciences Faculty from the São Paulo State University, Campus of Botucatu. The lateral inclinations were 0; 5; 10; 15; 20 and 25 degrees. In all of these situations, the tractors operated with predetermined load of an imposed traction to the pulled tractor of 40 kN in the inclination of 0 degrees. Hence a delineation in random blocks was used, considering six inclinations and four tractors, and with three repetitions for each treatment. The analyzed variables were slippage, tractive force, hourly fuel consumption, and speed. It was concluded that the pneumatic tire configurations influenced in the tractive performance of the tractors, as they increased the lateral inclinations of the terrain.O presente trabalho teve como objetivo avaliar o desempenho operacional de quatro tratores agrícolas com tração dianteira auxiliar, em função de seis inclinações laterais, em uma pista lateral de ensaios, pertencente à Faculdade de Ciências Agronômicas da Universidade Estadual Paulista, Câmpus de Botucatu. As inclinações laterais foram 0; 5; 10; 15; 20 e 25 graus. Em todas estas situações, os tratores operaram com carga predeterminada de tração imposta ao trator tracionado de 40 kN na inclinação de 0 grau. Portanto, foi utilizado um delineamento em blocos casualizados (DBC, sendo seis inclinações e quatro tratores, e com três repetições para cada tratamento. As variáveis analisadas foram patinhagem, força de tração, consumo horário de combustível e velocidade de deslocamento. Concluiu-se que a configuração dos rodados pneumáticos influenciaram no desempenho operacional dos tratores, conforme aumentaram as inclinações laterais do terreno.

  5. Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding.

    Science.gov (United States)

    Duché, Mathieu; Ducot, Béatrice; Ackermann, Oanez; Guérin, Florent; Jacquemin, Emmanuel; Bernard, Olivier

    2017-02-01

    Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high-risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices. Two hundred forty-six children bled spontaneously and 182 underwent primary prophylaxis. The results of primary prophylaxis were reviewed as well as bleed-free survival, overall survival and life-threatening complications of bleeding. High-risk varices were found in 96% of children who bled spontaneously and in 11% of children who did not bleed without primary prophylaxis (pportal hypertension. Life-threatening complications of bleeding were recorded in 19% of children with cirrhosis and high-risk varices who bled spontaneously. Ten-year probabilities of bleed-free survival after primary prophylaxis in children with high-risk varices were 96% and 72% for non-cirrhotic causes and cirrhosis respectively. Ten-year probabilities of overall survival after primary prophylaxis were 100% and 93% in children with non-cirrhotic causes and cirrhosis respectively. In children with portal hypertension, bleeding is linked to the high-risk endoscopic pattern reported here. Primary prophylaxis of bleeding based on this pattern is fairly effective and safe. In children with liver disease, the risk of bleeding from varices in the esophagus is linked to their large size, the presence of congestion on their surface and their expansion into the stomach but not to the child's age nor to the cause of portal hypertension. Prevention of the first bleed in children with high-risk varices can be achieved by surgery or endoscopic

  6. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon

    2015-01-01

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  7. The role of nuclear medicine in acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Robinson, P.

    1993-01-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. 99 Tc m -sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. 99 Tc m -labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author)

  8. The role of nuclear medicine in acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

    1993-10-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

  9. The capsule endoscopy "suspected blood indicator" (SBI) for detection of active small bowel bleeding: no active bleeding in case of negative SBI.

    Science.gov (United States)

    Tal, Andrea Oliver; Filmann, Natalie; Makhlin, Konstantin; Hausmann, Johannes; Friedrich-Rust, Mireen; Herrmann, Eva; Zeuzem, Stefan; Albert, Jörg G

    2014-09-01

    Capsule endoscopy (CE) is the gold standard to diagnose small bowel bleeding. The "suspected blood indicator" (SBI) offers an automated detection of active small bowel bleeding but validity of this technique is unknown. The objective was to analyze specificity and sensitivity of the SBI using the second small bowel capsule generation for the detection of active bleeding. This is a retrospective analysis of all patients (199) who attended our clinic for CE from June 2008 through March 2013. The second-generation PillCam SB 2 capsule was used for detection of (1) luminal blood content and (2) potentially responsible small bowel lesions. The findings of an independent investigator were correlated to SBI findings and a number of SBI markings were analyzed by a receiver operating characteristic (ROC). In 157/199 cases, no sign of active bleeding or altered blood was detected. One hundred and thirty-seven of these 157 cases provided at least one SBI marking and a mean of 18.4 positive SBI markings per record were found. In 20 cases, neither SBI nor the human investigator detected abnormalities. Thirteen patients showed investigator-detected minor bleeding with mean SBI findings of 36 positive screenshots per record. When major bleeding was diagnosed by the investigator (n = 29), SBI detected a mean of 46.6 SBI-positive markings. SBI turned positive in 179 patients, whereas the investigator detected active bleeding in 42 cases. All patients with active bleeding were detected by SBI (sensitivity 100%, specificity 13%). ROC analysis revealed 51.0 SBI markings being the optimal cutoff for active versus no bleeding (sensitivity 79.1%, specificity 90.4%, misclassification of 15.3%). The new SBI software is a reliable tool to exclude active bleeding and/or major lesions but analysis of the CE video by a trained investigator is still important for the detection of lesions responsible for past bleeding.

  10. Assessing Abnormal Uterine Bleeding: Are Physicians Taking a Meaningful Clinical History?

    Science.gov (United States)

    Lam, Christina; Anderson, Britta; Lopes, Vrishali; Schulkin, Jay; Matteson, Kristen

    2017-07-01

    Women with abnormal uterine bleeding (AUB) report significant reductions in quality of life (QOL), which can be attributed in many cases to the fear of embarrassing episodes of bleeding. We performed this study to determine whether or not during clinical encounters physicians addressed the impact of AUB on patient-reported QOL. Between October 2008 and May 2009, we conducted a cross-sectional study of members of the American College of Obstetricians and Gynecologists. Surveys were distributed using a mixed method (web- and mail-based) and included questions about physician characteristics and types of questions used when obtaining a clinical history from a patient with AUB. We calculated the proportion of physicians who endorsed asking each type of clinical question with 95% confidence intervals (CIs). Four hundred seventeen questionnaires were returned (52%). Ninety-nine percent (95% CI 98.4%-99.9%) reported always asking a bleeding heaviness question, 87.2% (95% CI 83.2%-90.5%) reported always asking a QOL question, and 17.5% (95% CI 13.6%-21.9%) reported always asking a mood associated with bleeding question. Seventy-eight percent specifically asked patients about bleeding through their clothes, and 55% asked about changing social plans because of bleeding. Only 18% endorsed that asking about QOL was most essential for the evaluation of women with AUB. No physician characteristics such as years since completing residency, geography, or gender were associated with how commonly providers reported asking questions regarding impact of bleeding on QOL. Physicians may not be optimizing patient-provider interactions during menstrual history taking with patients with AUB by failing to assess impact of AUB on QOL in a way that is meaningful to patients.

  11. Transfusion strategy for acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Handel, James; Lang, Eddy

    2015-09-01

    Clinical question Does a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding? Article chosen Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21. Study objectives The authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.

  12. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities

    NARCIS (Netherlands)

    Knol, H. Marieke; Mulder, Andre; Bogchelman, Dick H.; Kluin-Nelemans, Hanneke C.; van der Zee, Ate G. J.; Meijer, Karina

    OBJECTIVE: The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities. STUDY DESIGN: We performed a single-center prospective cohort study of 112 consecutive patients who were

  13. Intracranial hemorrhage in congenital bleeding disorders.

    Science.gov (United States)

    Tabibian, Shadi; Motlagh, Hoda; Naderi, Majid; Dorgalaleh, Akbar

    2018-01-01

    : Intracranial hemorrhage (ICH), as a life-threatening bleeding among all kinds of congenital bleeding disorders (CBDs), is a rare manifestation except in factor XIII (FXIII) deficiency, which is accompanied by ICH, early in life, in about one-third of patients. Most inherited platelet function disorders (IPFDs) are mild to moderate bleeding disorders that can never experience a severe bleeding as in ICH; however, Glanzmann's thrombasthenia, a common and severe inherited platelet function disorder, can lead to ICH and occasional death. This bleeding feature can also be observed in grey platelet syndrome, though less frequently than in Glanzmann's thrombasthenia. In hemophilia, intracerebral hemorrhage is affected by various risk factors one of which is the severity of the disease. The precise prevalence of ICH in these patients is not clear but an estimated incidence of 3.5-4% among newborns with hemophilia is largely ascertained. Although ICH is a rare phenomenon in CBDs, it can be experienced by every patient with severe hemophilia A and B, FXIII deficiency (FXIIID), FVIID, FXD, FVD, FIID, and afibrinogenemia. Upon observing the general signs and symptoms of ICH such as vomiting, seizure, unconsciousness, and headache, appropriate replacement therapies and cranial ultrasound scans must be done to decrease ICH-related morbidity and mortality.

  14. Transcatheter arterial embolization for upper gastrointestinal tract bleeding.

    Science.gov (United States)

    Širvinskas, Audrius; Smolskas, Edgaras; Mikelis, Kipras; Brimienė, Vilma; Brimas, Gintautas

    2017-12-01

    Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

  15. Optimal timing of vitamin K antagonist resumption after upper gastrointestinal bleeding. A risk modelling analysis.

    Science.gov (United States)

    Majeed, Ammar; Wallvik, Niklas; Eriksson, Joakim; Höijer, Jonas; Bottai, Matteo; Holmström, Margareta; Schulman, Sam

    2017-02-28

    The optimal timing of vitamin K antagonists (VKAs) resumption after an upper gastrointestinal (GI) bleeding, in patients with continued indication for oral anticoagulation, is uncertain. We included consecutive cases of VKA-associated upper GI bleeding from three hospitals retrospectively. Data on the bleeding location, timing of VKA resumption, recurrent GI bleeding and thromboembolic events were collected. A model was constructed to evaluate the 'total risk', based on the sum of the cumulative rates of recurrent GI bleeding and thromboembolic events, depending on the timing of VKA resumption. A total of 121 (58 %) of 207 patients with VKA-associated upper GI bleeding were restarted on anticoagulation after a median (interquartile range) of one (0.2-3.4) week after the index bleeding. Restarting VKAs was associated with a reduced risk of thromboembolism (HR 0.19; 95 % CI, 0.07-0.55) and death (HR 0.61; 95 % CI, 0.39-0.94), but with an increased risk of recurrent GI bleeding (HR 2.5; 95 % CI, 1.4-4.5). The composite risk obtained from the combined statistical model of recurrent GI bleeding, and thromboembolism decreased if VKAs were resumed after three weeks and reached a nadir at six weeks after the index GI bleeding. On this background we will discuss how the disutility of the outcomes may influence the decision regarding timing of resumption. In conclusion, the optimal timing of VKA resumption after VKA-associated upper GI bleeding appears to be between 3-6 weeks after the index bleeding event but has to take into account the degree of thromboembolic risk, patient values and preferences.

  16. Pelvic artery embolization in gynecological bleeding

    International Nuclear Information System (INIS)

    Hausegger, K.A.; Schreyer, H.; Bodhal, H.

    2002-01-01

    The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90%. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding. (orig.) [de

  17. Upper gastrointestinal bleeding in irbid, jordan

    International Nuclear Information System (INIS)

    Banisalamah, A.A.; Mraiat, Z.M.

    2007-01-01

    To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)

  18. Acquired bleeding disorders

    African Journals Online (AJOL)

    B one marrow aplasia ... Laboratory approach to a suspected acquired bleeding disorder. (LER = leuko- .... lymphocytic leukaemia, and lymphoma). ... cells), a bone marrow aspirate and trephine biopsy (BMAT) is not ..... transplantation.

  19. Gynaecological and obstetric management of women with inherited bleeding disorders.

    Science.gov (United States)

    Demers, Christine; Derzko, Christine; David, Michèle; Douglas, Joanne

    2006-10-01

    The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. This consensus document has been developed by a multidisciplinary committee consisting of an anesthesiologist, 2 hematologists, and an obstetrician/gynaecologist and has been endorsed by their relevant specialty bodies. It has been prepared with the express purpose of providing guidelines for both women with inherited bleeding disorders and for their caregivers regarding the gynaecological and obstetric management of these women, including appropriate anesthesia support where indicated. Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal. Recommendations from other society guidelines were reviewed. 1. Inherited bleeding disorders should be considered in the differential diagnosis of all patients presenting with menorrhagia (II-2B). The graphical scoring system presented is a validated tool which offers a simple yet practical method that can be used by patients to quantify their blood loss (II-2B). 2. Because underlying bleeding disorders are frequent in women with menorrhagia, physicians should consider performing a hemoglobin/hematocrit, platelet count, ferritin, PT (INR) and APTT in women with menorrhagia. In women who have a personal history of other bleeding or a family history of bleeding, further investigation should be considered, including a vWD workup (factor VIII, vWF antigen

  20. Immunosuppressive agents are associated with peptic ulcer bleeding.

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2017-05-01

    Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P=0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P=0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at

  1. Evaluation of rectal bleeding factors associated with prostate brachytherapy

    International Nuclear Information System (INIS)

    Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

    2009-01-01

    The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)

  2. Gastric ulcer bleeding: diagnosis by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-06-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas.

  3. Gastric ulcer bleeding: diagnosis by computed tomography

    International Nuclear Information System (INIS)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-01-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas

  4. Telemetric real-time sensor for the detection of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Schostek, Sebastian; Zimmermann, Melanie; Keller, Jan; Fode, Mario; Melbert, Michael; Schurr, Marc O; Gottwald, Thomas; Prosst, Ruediger L

    2016-04-15

    Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death. A novel telemetric real-time bleeding sensor can help indicate blood in the stomach: the sensor is swallowed to detect active bleeding or is anchored endoscopically on the gastrointestinal wall close to the potential bleeding source. By telemetric communication with an extra-corporeal receiver, information about the bleeding status is displayed. In this study the novel sensor, which measures characteristic optical properties of blood, has been evaluated in an ex-vivo setting to assess its clinical applicability and usability. Human venous blood of different concentrations, various fluids, and liquid food were tested. The LED-based sensor was able to reliably distinguish between concentrated blood and other liquids, especially red-colored fluids. In addition, the spectrometric quality of the small sensor (size: 6.5mm in diameter, 25.5mm in length) was comparable to a much larger and technically more complex laboratory spectrophotometer. The experimental data confirm the capability of a miniaturized sensor to identify concentrated blood, which could help in the very near future the detection of upper gastrointestinal bleeding and to survey high-risk patients for rebleeding. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Prediction of esophageal variceal bleeding in B-viral liver cirrhosis using the P2/MS noninvasive index based on complete blood counts.

    Science.gov (United States)

    Kim, Beom Kyung; Ahn, Sang Hoon; Han, Kwang-Hyub; Park, Jun Yong; Han, Min Seok; Jo, Jung Hyun; Kim, Ja Kyung; Lee, Kwan Sik; Chon, Chae Yoon; Kim, Do Young

    2012-01-01

    Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e., medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9. Copyright © 2012 S. Karger AG, Basel.

  6. Lack of bleeding in patients with severe factor VII deficiency.

    Science.gov (United States)

    Barnett, J Mark; Demel, Kurt C; Mega, Anthony E; Butera, James N; Sweeney, Joseph D

    2005-02-01

    Factor VII deficiency, although rare, is now recognized as the most common autosomal recessive inherited factor deficiency. It is usually considered to be associated with bleeding only in the severely affected subject and heterozygotes (>10%) are not considered at risk. The general recommendation for surgery is to achieve a FVII level in excess of 15% (0.15 1U/mL). We present three cases of severe factor VII deficiency, each of whom appeared hemostatically competent based on clinical history. Subject 1 is a 33 year-old African-American female with a baseline FVII of American female with a factor VII level of 9% who underwent an elective left total hip replacement without any factor replacement and had no excessive bleeding, but who sustained a pulmonary embolism postoperatively. Subject 3 is a 19-year-old African-American male with a baseline FVII of 1% with a history of active participation in football without noticeable injury and who underwent an emergent appendectomy without bleeding. These three cases represent individuals with the severe form of FVII deficiency who did not exhibit excessive bleeding when challenged with surgical procedures. The clinical history would appear the most valuable tool in predicting the likelihood of bleeding in these patients, and we suggest that the presumption that all patients with severe FVII deficiency should receive replacement therapy before surgical procedures may not be valid in all cases. Copyright 2005 Wiley-Liss, Inc.

  7. Bleeding disorders in dental practice: A diagnostic overview

    Directory of Open Access Journals (Sweden)

    Abhirup Goswami

    2014-01-01

    Full Text Available Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Oral care providers must be aware of the impact of bleeding disorders on the management of their patients. These disorders must be recognized from history, clinical examinations, and laboratory investigations, if indicated, prior to surgical procedures including those in dental surgery to prevent bleeding related complications. Safe dental care may require consultation with the patient′s physician, systemic management, and dental treatment modifications. The purpose of this article is how to identify these patients with bleeding disorders.

  8. Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

    Directory of Open Access Journals (Sweden)

    Sebastião Freitas De Medeiros

    2013-01-01

    Full Text Available Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman's characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT, it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.

  9. Timing of onset of gastrointestinal bleeding in the ICU

    DEFF Research Database (Denmark)

    Granholm, A; Lange, T; Anthon, C T

    2018-01-01

    BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...

  10. X-ray diagnostic features of acute bleeding ulcers of the stomach and duodenum

    International Nuclear Information System (INIS)

    Shcherbatenko, M.K.; Selina, I.E.; Chekalina, M.I.

    1996-01-01

    The paper is based on the analysis of clinical, X-ray, and morphological studies in 74 patients with massive gastrointestinal hemorrhage. The paper presents the specific features of X-ray studies of patients with bleeding gastroduodenal ulcers. X-ray studies shout be twice performed in these patients. The first study is conducted if gastroscopic findings are unclear, the repeated one is carried out while assessing changes in disease regression. X-ray diagnosis of bleeding ulcers is determined by their sites and the nature of an ulcerous process. The X-ray diagnosis of chronic callous gastric ulcers accompanied by hemorrhage was based on the detection of two direct symptoms of a niche on the gastric outlines and configuration and an inflammatory mound on the gastric outline and configuration. That of chronic bleeding ulcers of the duodenal bulb is based not only on searches niche, but other signs of the disease - the deformed organ, and the magnitude of a periprocess. 10 refs., 5 figs

  11. The experience of girls and young women with inherited bleeding disorders.

    Science.gov (United States)

    Khair, K; Holland, M; Pollard, D

    2013-09-01

    Haemophilia carriers and women with inherited bleeding disorders (IBD) experience menorrhagia, bleed following dentistry, surgery, injury or childbirth. Symptoms are easily treated leading to full and active lives. Nevertheless, some girls and women suffer with abnormal bleeding for many years before diagnosis. We explored the experiences of girls and young women (aged 9-34 years) with IBD by means of focus groups which consisted of moderated discussion addressing specific aspects of bleeding, management and coping strategies. Subsequently, these issues were explored further though a paper-based questionnaire distributed via five specialist haemophilia centres in the UK. The study suggested that young women with IBD who are managed at haemophilia centres receive appropriate care and feel well supported. Although the clinic-based literature available to these women is "fit for purpose", it does not fully address the perceived needs specifically regarding sex, menorrhagia, conception and childbirth, the Pill, tattoos/piercings and so on, leading many to turn to other information sources. Most of those who responded to our survey are confident in their lives, able to manage their IBD and take pragmatic views towards the inherited nature of their condition. But there is a substantial subgroup of women who experience stigmatization, isolation and bullying and express concerns relating to fertility and conception. Overall, this cohort would benefit from opportunities for mutual support. This could be via Internet-based social networking and may be of particular value to those who are unable to seek help from traditional medical services due to religious or other cultural barriers. © 2013 John Wiley & Sons Ltd.

  12. Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

    Directory of Open Access Journals (Sweden)

    Wei-Chen Lin

    Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each

  13. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  14. Antropometria aplicada aos operadores de tratores agrícolas Anthropometrics applied to the agricultural tractors operators

    Directory of Open Access Journals (Sweden)

    José Fernando Schlosser

    2002-12-01

    height, arms reach, hands reach, kneecap-foot length and seat length were taken. The data showed that there are differences between the operators’ measures used by industry and those taken in this research. The anthropometric measures of the analyzed operators were usually higher than the industrial parameters. For each measure, the lower and bigger upper limits, that included 90% of the operators measured, were lower and higher, respectively, to those used as industrial parameters. This characterizes a major variation. Based on the differences, the commercial agricultural tractors in Brazil can not offer the necessary comfort and ergonomics to the operator of the region.

  15. [Management of intractable epistaxis and bleeding points localization].

    Science.gov (United States)

    Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

    2005-05-01

    To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.

  16. Palm biodiesel: performance of a agricultural tractor in function of differents storage periods; Biodiesel de dende: desempenho de trator agricola em funcao de diferentes periodos de armazenamento

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, Afonso; Oliveira, Melina C.J. [Universidade Estadual Paulista Julio de Mesquita Filho (FCAV/UNESP), Jaboticabal, SP (Brazil). Fac. de Ciencias Agrarias e Veterinarias. Dept. de Engenharia Rural], email: fonso@fcav.unesp.br; Lima, Leomar P. [Instituto Federal do Triangulo Mineiro (IFTM), Uberlandia, MG (Brazil); Camara, Felipe P. [Universidade Federal do Ceara (UFC), Cariri, CE (Brazil)

    2011-07-01

    The use of biofuel for replacement of oil in internal combustion engines is an alternative to seek the reduction of harmful effects that the use of these fuels question to the environment. The objective of this work was to evaluate the performance of a tractor in the light of storage time of the biodiesel of palm oil. The experiment was conducted in the Laboratory of machinery and agricultural mechanization of Rural Engineering Department of UNESP, Jaboticabal, SP. In this study, -if a tractor Valtra BM 110 4x2 TDA 74 kW (100 cv) in engine 2.350 rpm. The experimental design was completely randomized, in factorial scheme 5x3, with 3 repetitions. The first factor represents 5 proportions of mixing biodiesel for diesel (B0, B5, B25, B 50 and B100, that the number indicates the percentage of biodiesel for diesel) and three storage times in condition storage environment in a rural property (0, 3 and 6 months). The mixtures were prepared hours before the test. The results showed that the storage time did not influence the performance of the tractor, occurring biodiesel specific increase in consumption from the proportion of 25% (B25) mixture of biodiesel for diesel. (author)

  17. Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy

    International Nuclear Information System (INIS)

    Cihoric, Nikola; Crowe, Susanne; Eychmüller, Steffen; Aebersold, Daniel M; Ghadjar, Pirus

    2012-01-01

    This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37–93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5–45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 (n = 39), 1 (n = 12), 2 (n = 6), 3 (n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients

  18. Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding.

    Science.gov (United States)

    Parks, Anna L; Fang, Margaret C

    2017-07-01

    Anticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR 2 HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors. However, it is not yet clear how best to integrate bleeding risk tools into clinical practice. Current bleeding risk scores generally have modest predictive ability and limited ability to predict the most devastating complication of anticoagulation, intracranial hemorrhage. In clinical practice, bleeding risk tools should be paired with a formal determination of thrombosis risk, as their results may be most influential for patients at the lower end of thrombosis risk, as well as for highlighting potentially modifiable risk factors for bleeding. Use of bleeding risk scores may assist clinicians and patients in making informed and individualized anticoagulation decisions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  19. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  20. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... especially the progestin-only pill (also called the “mini-pill”) can actually cause abnormal bleeding for some ... Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality ...

  1. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients

    DEFF Research Database (Denmark)

    Wikkelsø, A.; Wetterslev, J.; Møller, A. M.

    2017-01-01

    of publication status, publication date, blinding status, outcomes published or language from date of inception to 5 January 2016 in six bibliographic databases. We included 17 trials (1493 participants), most involving cardiac surgery. Thromboelastography or rotational thromboelastometry seemed to reduce...... strategies guided by thromboelastography or rotational thromboelastometry may reduce the need for blood products in patients with bleeding, but the results are mainly based on trials of elective cardiac surgery involving cardiopulmonary bypass, with low-quality evidence.......Coagulopathy and severe bleeding are associated with high mortality. We evaluated haemostatic treatment guided by the functional viscoelastic haemostatic assays, thromboelastography or rotational thromboelastometry in bleeding patients. We searched for randomised, controlled trials irrespective...

  3. Scintigraphy in gastrointestinal bleeding in the pediatric population

    International Nuclear Information System (INIS)

    Hall, T.R.; Miller, J.H.; Sty, J.R.

    1986-01-01

    Gastrointestinal (GI) tract bleeding in the pediatric population is not uncommon, especially in chronically ill patients. A total of 29 patients with GI tract bleeding were studied scintigraphically using Tc-99m-labeled red blood cells (RBCs) or sulfur colloid (SC). The patients ranged in age from 3 weeks to 20 years, with an equal sex distribution. Of 19 patients studied with Tc-99m-labeled RBCs using an in vitro labeling technique, evidence of GI tract bleeding was documented scintigraphically in 15. Tc-99m-labeled SC scans in the remaining ten patients demonstrated GI tract bleeding in six. The Tc-99m RBC method was slightly more sensitive than the Tc-99m SC method. Advantages of using labeled RBCs include increased sensitivity in detecting upper abdominal bleeding, ability to delay imaging for up to 18-24 hours, and the use of provocative testing

  4. Duodenal diverticular bleeding: an endoscopic challenge

    Directory of Open Access Journals (Sweden)

    Eduardo Valdivielso-Cortázar

    Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

  5. Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

    Science.gov (United States)

    Pingleton, S K; Hadzima, S K

    1983-01-01

    The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

  6. A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding.

    Science.gov (United States)

    Dewan, K R; Patowary, B S; Bhattarai, S

    2014-01-01

    Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality. To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome. This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis. Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score 6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6. Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.

  7. Gastrointestinal bleeding after intracerebral hemorrhage: a retrospective review of 808 cases.

    Science.gov (United States)

    Yang, Tie-Cheng; Li, Jian-Guo; Shi, Hong-Mei; Yu, Dong-Ming; Shan, Kai; Li, Li-Xia; Dong, Xiao-Yan; Ren, Tian-Hua

    2013-10-01

    This study examined the incidence and risk factors for gastrointestinal (GI) bleeding after spontaneous intracerebral hemorrhage (ICH). The available medical records of patients with ICH admitted from June 2008 to December 2009 for any episode of GI bleeding, possible precipitating factors and administration of ulcer prophylaxis were reviewed. The prevalence of GI bleeding was 26.7%, including 3 cases of severe GI bleeding (0.35%). Patients with GI bleeding had significantly longer hospital stay and higher in-hospital mortality compared with patients without GI bleeding. Multivariate logistic regression analyses showed that age, Glasgow Coma Scale scores, sepsis and ICH volume were independent predictors of GI bleeding. About 63.4% of patients with ICH received stress ulcer prophylaxis. GI bleeding occurred frequently after ICH, but severe events were rare. Age, Glasgow Coma Scale score, sepsis and ICH volume were independent predictors of GI bleeding occurring after ICH.

  8. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  9. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

    Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.

  10. Reliability measures in managing GI bleeding.

    Science.gov (United States)

    Sonnenberg, Amnon

    2012-06-01

    Multiple procedures and devices are used in a complex interplay to diagnose and treat GI bleeding. To model how a large variety of diagnostic and therapeutic components interact in the successful management of GI bleeding. The analysis uses the concept of reliability block diagrams from probability theory to model management outcome. Separate components of the management process are arranged in a serial or parallel fashion. If the outcome depends on the function of each component individually, such components are modeled to be arranged in series. If components complement each other and can mutually compensate for each of their failures, such components are arranged in a parallel fashion. General endoscopy practice. Patients with GI bleeding of unknown etiology. All available endoscopic and radiographic means to diagnose and treat GI bleeding. Process reliability in achieving hemostasis. Serial arrangements tend to reduce process reliability, whereas parallel arrangements increase it. Whenever possible, serial components should be bridged and complemented by additional alternative (parallel) routes of operation. Parallel components with low individual reliability can still contribute to overall process reliability as long as they function independently of other pre-existing alternatives. Probability of success associated with individual components is partly unknown. Modeling management of GI bleeding by a reliability block diagram provides a useful tool in assessing the impact of individual endoscopic techniques and administrative structures on the overall outcome. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  11. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes.

    Science.gov (United States)

    Loffroy, R; Favelier, S; Pottecher, P; Estivalet, L; Genson, P Y; Gehin, S; Cercueil, J P; Krausé, D

    2015-01-01

    Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of bleeding for a variety of indications. Transcatheter arterial embolization is a fast, safe, and effective minimally invasive alternative to surgery, when endoscopic treatment fails to control acute bleeding from the upper gastrointestinal tract. This article describes the role of arterial embolization in the management of acute nonvariceal upper gastrointestinal bleeding and summarizes the literature evidence on the outcomes of endovascular therapy in such a setting. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  12. IMPROVEMENT OF WEAR-RESISTANCE AND SERVICE LIFE OF MULTI-DISK BRAKE MECHANISMS OF «BELARUS» TRACTOR BY LASER THERMAL HARDENING OF FAST WEARING PARTS

    Directory of Open Access Journals (Sweden)

    O. S. Kobjakov

    2008-01-01

    Full Text Available Problems concerning wear resistance improvement of «Belarus» tractor brake mechanism parts are considered in the paper. Properties of ВЧ-50-pig iron are investigated as a result of laser thermal hardening by various technological methods.

  13. Rare acquired hemostatic disorders as a cause of prolonged bleeding – presentation of two case reports

    Directory of Open Access Journals (Sweden)

    Polona Novak

    2011-10-01

    Full Text Available BACKGROUNDPatient’s anamnesis is of primary importance in determining hemostatic disorders. Based on anamnestic data, a clinician may decide for further laboratory tests. We must consider an acquired bleeding disorder in a patient with unusual, unexpected and prolonged bleeding episodes. In this article we will describe two rare acquired hemostatic disordes.TWO CASE REPORTSOur first patient had prolonged bleeding after a pacemaker implantation. We diagnosed him with acquired von Willebrand syndrome. Further on, the patient required a planned surgical procedure. In our second case we describe a patient with unusual and excessive skin bruising and prolonged bleeding after teeth extractions. He was diagnosed with acquired hemophilia.CONCLUSIONIn the assessment of a patient with a potential acquired bleeding disorder we must first rule out the most common causes, such as iatrogenic ones. But, because of high morbidity and mortality rates, we must also be aware of some rare acquired bleeding disorders. In case of uncertainty, we should consult with a hematologist.

  14. Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

    Directory of Open Access Journals (Sweden)

    Wessel Jens

    2009-07-01

    Full Text Available Abstract Background The aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs. Methods We used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries. The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed. Results The method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated. Conclusion Using this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.

  15. Rectal bleeding after hypofractionated radiotherapy for prostate cancer: Correlation between clinical and dosimetric parameters and the incidence of grade 2 or worse rectal bleeding

    International Nuclear Information System (INIS)

    Akimoto, Tetsuo; Muramatsu, Hiroyuki; Takahashi, Mitsuhiro; Saito, Jun-ichi; Kitamoto, Yoshizumi; Harashima, Koichi; Miyazawa, Yasushi; Yamada, Masami; Ito, Kazuto; Kurokawa, Kouhei; Yamanaka, Hidetoshi; Nakano, Takashi; Mitsuhashi, Norio; Niibe, Hideo

    2004-01-01

    Purpose: To investigate the incidence and severity of rectal bleeding after high-dose hypofractionated radiotherapy (RT) for prostate cancer, and to explore the factors affecting the incidence of Grade 2 or worse rectal bleeding. Methods and materials: The data of 52 patients who had been treated by external beam RT for localized prostate cancer between 1999 and 2002 were analyzed. All the patients had received hypofractionated external beam RT to a total dose of 69 Gy in 3-Gy fractions, three fractions weekly. The clinical and dosimetric factors affecting the incidence of Grade 2 or worse late rectal bleeding were analyzed by univariate and multivariate analyses. The effect of the percentage of the whole rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose (V 30 , V 50 , V 80 , and V 90 , respectively) on the incidence of rectal bleeding was evaluated. Results: Of the 52 patients, 13 (25%) developed Grade 2 or worse rectal bleeding. One patient who needed laser coagulation and blood transfusion for the treatment of rectal bleeding was classified as having Grade 3 rectal bleeding. The median time to the development of Grade 2 or worse rectal bleeding was 11 months. The results of the univariate analysis revealed that the presence of a history of diabetes mellitus (p 30 ≥ 60%, V 50 ≥ 40% (p 80 ≥ 25%, and V 90 ≥ 15% (p < 0.001) were statistically significant risk factors for the occurrence of Grade 2 or worse rectal bleeding. The results of the multivariate analysis revealed that a history of diabetes mellitus was the most statistically significant risk factor for the occurrence of rectal bleeding after hypofractionated RT for prostate cancer (p < 0.05). Conclusion: A history of diabetes mellitus was the most statistically significant risk factor for the occurrence of Grade 2 or worse rectal bleeding after high-dose hypofractionated RT, although dosimetric factors were also closely associated with the risk of rectal bleeding

  16. Frequency of von willebrand disease in patients of heavy menstrual bleeding

    International Nuclear Information System (INIS)

    Anjum, N.; Shaheen, Z.; Altaf, C.

    2016-01-01

    Objective: To determine the frequency of Von Willebrand disease (vWD) in patients of heavy menstrual bleeding (HMB). Study Design: Hospital based cross sectional study. Place and Duration of Study: Study was conducted at the Gynecology and Obstetrics department, Military Hospital, Rawalpindi in collaboration with Haematology Department of Armed Forces Institute of Pathology (AFIP) Rawalpindi, from Jul to Dec 2015. Material and Methods: Women presenting with HMB were enrolled in the study after informed consent. HMB was defined as cyclical bleeding at normal intervals but patient is using more than 5 pads per day or increase in duration 8/28 or more for at least last 06 months. Venous blood samples were taken and screened for the hemoglobin level (Hb), platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and Von Willebrand antigen (vWF:Ag) in addition to bleeding time (BT) at the Armed Forces Institute of Pathology (AFIP). The demographic details (age, age at menarche), clinical features (menstrual history, quantity of bleeding) and laboratory findings were recorded on the study proforma. Results: A total of 200 patients were enrolled in this study with mean age of 32.3 +- 8.5 years. Mean flow of menstrual blood was 9.8 +- 2.5 pads / day. Mean Hb percent was 8.1 +- 1.4 g/dl. Twenty nine (14.5 percent) patients were having low level of vWF:Ag. Conclusion: There is high frequency of von Willebrand disease among females presenting with heavy menstrual bleeding in our set up. Therefore all patients with heavy menstrual bleeding except those with obvious causes like multiple fibroid should be screened for von Willebrand disease. (author)

  17. Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

    Science.gov (United States)

    Liu, Juan; Sun, Xicai; Guo, Limin; Wang, Dehui

    2016-01-01

    Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).

  18. Spontaneous bleeding from liver after open heart surgery.

    Science.gov (United States)

    Mir, Najeeb H; Shah, Mian T; Obeid, Mahmoud Ali; Gallo, Ricardo; Aliter, Hashem

    2013-01-01

    Intra-abdominal hemorrhage after open heart surgery is very uncommon in routine clinical practice. There are case reports of having bleeding from spleen or liver after starting low molecular weight heparin (LMWH) postoperatively. Our patient is a 58-year-old man with mitral valve regurgitation, who underwent mitral valve repair and developed intra-abdominal hemorrhage 8h after open heart surgery. The exploratory laparotomy revealed the source of bleeding from ruptured sub-capsular liver hematoma and oozing from raw areas of the liver surface. Liver packing was done to control the bleeding. The gastrointestinal complications after open heart surgery are rare and spontaneous bleeding from spleen has been reported. This is the first case from our hospital to have intra-abdominal hemorrhage after open heart surgery. Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Resin bleed improvement on surface mount semiconductor device

    Science.gov (United States)

    Rajoo, Indra Kumar; Tahir, Suraya Mohd; Aziz, Faieza Abdul; Shamsul Anuar, Mohd

    2018-04-01

    Resin bleed is a transparent layer of epoxy compound which occurs during molding process but is difficult to be detected after the molding process. Resin bleed on the lead on the unit from the focused package, SOD123, can cause solderability failure at end customer. This failed unit from the customer will be considered as a customer complaint. Generally, the semiconductor company has to perform visual inspection after the plating process to detect resin bleed. Mold chase with excess hole, split cavity & stepped design ejector pin hole have been found to be the major root cause of resin bleed in this company. The modifications of the mold chase, changing of split cavity to solid cavity and re-design of the ejector pin proposed were derived after a detailed study & analysis conducted to arrive at these solutions. The solutions proposed have yield good results during the pilot run with zero (0) occurrence of resin bleed for 3 consecutive months.

  20. Analisis dan Perancangan Aplikasi Pendukung Erp Sap R/3 Modul Sales And Distribution PT. United Tractors, Tbk

    OpenAIRE

    Johan, Johan; Susanto, Yokie; Joe, Yusmin; Robby, Robby

    2010-01-01

    The purpose of this research is to analyse sales process having been implementing Sales and Distribution module of ERP SAP R/3 and also to design a supporting application for sales process at PT United Tractor, Tbk. The benefit of this application is to help sales person and customer in doing inquiries, quotation and sales order also material information through short message. The method of this research is data capturing, literature review, object oriented analysis and design and Rational Un...

  1. Long-term experiences in the use of rapeseed oil fuel in tractors of the emissions levels I and II; Langzeiterfahrungen zum Einsatz von Rapsoelkraftstoff in Traktoren der Abgasstufe I und II

    Energy Technology Data Exchange (ETDEWEB)

    Emberger, Peter; Thuneke, Klaus; Remmele, Edgar

    2013-06-01

    The operational behavior as well as the emission behavior should be clarified in long-term use by means of tractors which are powered by rapeseed oil fuel. This is based on the following measures: review of the quality of rapeseed oil fuel used; testing of the quality of the engine oil on a random basis; documentation of failures, maintenance and repair work; measurement of performance and fuel economy; measurement of exhaust emissions; diagnosis of engines.

  2. The role of endoscopy in pediatric gastrointestinal bleeding

    OpenAIRE

    Franke, Markus; Gei?, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-J?rgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20?% of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediat...

  3. Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

    Science.gov (United States)

    Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

    2016-08-01

    We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  4. Bleeding tendency in dual antiplatelet therapy with aspirin/clopidogrel: rescue of the template bleeding time in a single-center prospective study

    Directory of Open Access Journals (Sweden)

    Altman Raul

    2012-01-01

    Full Text Available Abstract Background Patients with heightened platelet reactivity in response to antiplatelet agents are at an increased risk of recurrent ischemic events. However, there is a lack of diagnostic criteria for increased response to combined aspirin/clopidogrel therapy. The challenge is to identify patients at risk of bleeding. This study sought to characterize bleeding tendency in patients treated with aspirin and clopidogrel. Patients/methods In a single-center prospective study, 100 patients under long-term aspirin/clopidogrel treatment, the effect of therapy was assayed by template bleeding time (BT and the inhibition of platelet aggregation (IPA by light transmission aggregometry (LTA. Arachidonic acid (0.625 mmol/L and adenosine diphosphate (ADP; 2, 4, and 8 μmol/L were used as platelet agonists. Results Bleeding episodes (28 nuisance, 2 hematuria [1 severe], 1 severe proctorrhagia, 1 severe epistaxis were significantly more frequent in patients with longer BT. Template BT ≥ 24 min was associated with bleeding episodes (28 of 32. Risk of bleeding increased 17.4% for each 1 min increase in BT. Correlation was found between BT and IPAmax in response to ADP 2 μmol/L but not to ADP 4 or 8 μmol/L. Conclusion In patients treated with dual aspirin/clopidogrel therapy, nuisance and internal bleeding were significantly associated with template BT and with IPAmax in response to ADP 2 μmol/L but not in response to ADP 4 μmol/L or 8 μmol/L.

  5. Rectal bleeding in children: endoscopic evaluation revisited

    NARCIS (Netherlands)

    de Ridder, Lissy; van Lingen, Anna V.; Taminiau, Jan A. J. M.; Benninga, Marc A.

    2007-01-01

    Objectives Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding. Study

  6. Bleeding score in Type 1 von Willebrand disease patients using the ISTH-BAT questionnaire.

    Science.gov (United States)

    Pathare, A; Al Omrani, S; Al Hajri, F; Al Obaidani, N; Al Balushi, B; Al Falahi, K

    2018-04-01

    Bleeding assessment tools have evolved in the last decade to standardize the assessment of the severity of bleeding symptom in a consistent way. In 2010, the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) was developed and validated. Our aim was to administer ISTH-BAT questionnaire to the Omani patients with type 1 VWD and obtain the bleeding score (BS). We also studied the severity of their bleeding symptoms and correlated it with the BS as well as with the laboratory parameters. Forty-eight type I VWD index cases and 52 normal subjects were interviewed and the ISTH-BAT questionnaire administered. The BS was calculated based on a history of bleeding symptoms from 12 different sites according to the standard ISTH-BAT questionnaire. Laboratory parameters were obtained from patient's medical records. The mean age of this cohort was 27 years (range, 6-49) with 60% being females. The median time to administer this questionnaire was 10 minutes with an interquartile range (IQR) from 8 to 17 minutes. Overall, the median BS was 7 (IQR; 2,11) although individual scores ranged between 0 and 36. The BS was negatively correlated with VWF: Ag, VWF: RCo, and VWF: CB and the Spearman's correlation coefficient "rho" was, respectively, -0.15, -0.08, and -0.22. The ISTH-BAT BS is designed to reflect the severity of bleeding. Our results demonstrate the inherent variability of this bleeding pattern. We also found that the ISTH-BAT BS significantly correlated with VWF: Ag and VWF: CB. © 2017 John Wiley & Sons Ltd.

  7. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  8. Pseudoxanthoma elasticum: A rare cause of gastrointestinal bleed

    Directory of Open Access Journals (Sweden)

    Ishrat H Dar

    2015-01-01

    Full Text Available Causes of obscure gastrointestinal (GI bleed are diverse and rare. The most common cause for GI bleeding of small bowel origin is angiodysplasia, followed by tumors of the small intestine, and various other causes, including small bowel ulcers and aortienteric fistulas. Pseudoxanthoma elasticum (PXE is a rare cause of GI bleed. It is an inherited elastic tissue disorder with degeneration of elastic fibers involving mainly skin, eyes and the cardiovascular system. Upper GI hemorrhage occurs in 13% of cases and is often resistant to nonsurgical methods of treatment. Presented herein is a case of GI bleed in a 65-year-old woman who had PXE and hyperplastic polyps in the stomach.

  9. Use of heparin in the investigation of obscure gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Mernagh, J.R.; O'Donovan, N.; Somers, S.; Gill, G.; Sridhar, S.

    2001-01-01

    To determine if the administration of heparin improves the predictive value of angiography in the investigation of obscure gastrointestinal (GI) bleeding. 18 patients with a history of chronic GI bleeding were investigated with angiography. For 6 patients, the cause of GI bleeding was established with angiography; the 12 patients who had negative results were given heparin for 24 h and were reassessed with angiography. After heparin administration, the source of GI bleeding was determined with angiography for 6 of the remaining 12 patients. Thus, heparinization increased diagnostic yield from 33% (6 of 18) to 67% (12 of 18). No significant complications, such as uncontrolled GI bleeding, occurred. Heparinization improves the diagnostic yield of angiography when obscure GI bleeding is being investigated. (author)

  10. Small Bowel Bleeding

    Science.gov (United States)

    ... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

  11. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Huei-Lung, E-mail: hlliang@vghks.gov.tw [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China); Chiang, Chia-Ling [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); Chen, Matt Chiung-Yu [Department of Radiology, Yuan' s General Hospital, Kaohsiung. Taiwan (China); Lin, Yih-Huie; Huang, Jer-Shyung; Pan, Huay-Ben [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China)

    2014-10-15

    Purpose: To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). Materials and methods: Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3–5 units/h) for 3 h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. Results: Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. Conclusions: Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.

  12. Objectives and Design of BLEEDS: A Cohort Study to Identify New Risk Factors and Predictors for Major Bleeding during Treatment with Vitamin K Antagonists.

    Science.gov (United States)

    van Rein, Nienke; Lijfering, Willem M; Bos, Mettine H A; Herruer, Martien H; Vermaas, Helga W; van der Meer, Felix J M; Reitsma, Pieter H

    2016-01-01

    Risk scores for patients who are at high risk for major bleeding complications during treatment with vitamin K antagonists (VKAs) do not perform that well. BLEEDS was initiated to search for new biomarkers that predict bleeding in these patients. To describe the outline and objectives of BLEEDS and to examine whether the study population is generalizable to other VKA treated populations. A cohort was created consisting of all patients starting VKA treatment at three Dutch anticoagulation clinics between January-2012 and July-2014. We stored leftover plasma and DNA following analysis of the INR. Of 16,706 eligible patients, 16,570 (99%) were included in BLEEDS and plasma was stored from 13,779 patients (83%). Patients had a mean age of 70 years (SD 14), 8713 were male (53%). The most common VKA indications were atrial fibrillation (10,876 patients, 66%) and venous thrombosis (3920 patients, 24%). 326 Major bleeds occurred during 17,613 years of follow-up (incidence rate 1.85/100 person years, 95%CI 1.66-2.06). The risk for major bleeding was highest in the initial three months of VKA treatment and increased when the international normalized ratio increased. These results and characteristics are in concordance with results from other VKA treated populations. BLEEDS is generalizable to other VKA treated populations and will permit innovative and unbiased research of biomarkers that may predict major bleeding during VKA treatment.

  13. Acquired Inhibitors: A Special Case of Bleeding in Older Adults

    Directory of Open Access Journals (Sweden)

    Richard G. Stefanacci

    2012-01-01

    Full Text Available This literature review is intended to familiarize physicians and healthcare providers of older adults with the potential causes of acute bleeding in older adults and to review diagnostic approaches that can produce prompt identification of acute bleeding and facilitate timely treatment. Adverse events from anticoagulant treatment and nonsteroidal anti-inflammatory drug (NSAID and aspirin use and abuse are among the most common causes of bleeding in older adults. Diagnoses infrequently considered—mild congenital hemophilia, acquired hemophilia, von Willebrand disease, and platelet dysfunction—can contribute to acute bleeding in older adults. The approach to management of bleeding varies. Management of acute bleeding in older adults can be challenging because these patients often have chronic comorbidity and have been prescribed long-term concomitant medications that can complicate diagnosis and treatment. Prompt recognition of acquired hemophilia, referral to an expert hematologist, and timely initiation of treatment could improve outcome in older patients who experience bleeding episodes resulting from this condition.

  14. Endometrial biopsy findings in postmenopausal bleeding

    International Nuclear Information System (INIS)

    Sarfraz, T.; Tariq, H.

    2007-01-01

    To study endometrial histopathology in women presenting with postmenopausal bleeding. A two-year study from January 2003 to December 2004 of 100 cases of postmenopausal bleeding was conducted at Combined Military Hospital, Sialkot. The histopathology of endometrial biopsy specimens was done to find out the causes of postmenopausal bleeding in these ladies. All these 100 patients had confirmed menopause and the average age was 55 years and above. The most common histopathological diagnosis was senile endometrial atrophy (27%), followed by simple cystic hyperplasia in (17%). Three cases of simple cystic hyperplasia had coexistent ovarian tumors. Glandular hyperplasia without atypia was seen in 6% and with atypia in 4%. Other causes were endometritis (13%), endometrial polyps (8%), proliferative phase endometrium (6%) and secretary phase endometrium (5%). Endometrial carcinoma was seen in (6%) cases, (8%) biopsy specimens were non-representative. Although senile endometrial atrophy was most commonly found in these ladies but a significant percentage of endometrial hyperplasia and endometrial cancer implies the need for investigating all cases of postmenopausal bleeding. Bimanual examination and pelvic ultrasonography should be combined with endometrial sampling so that rare pelvic pathologies may not be missed. (author)

  15. Radiotherapy Can Cause Haemostasis in Bleeding Skin Malignancies

    Directory of Open Access Journals (Sweden)

    Helena Sung-In Jang

    2012-01-01

    Full Text Available Radiotherapy (RT can cause haemostasis in select cases of malignant bleeding. We present two cases where RT was used to prevent fatal exsanguination from bleeding skin malignancies. Treatment was with radical intent in one case and palliative intent in the other. The dose used in both cases was 20 Gray (Gy in 5 fractions. To our knowledge, this is the first report of radiation-induced haemostasis in bleeding skin malignancies.

  16. Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

    Science.gov (United States)

    Pham, Phuong-Anh; Pham, Phuong-Thu; Pham, Phuong-Chi; Miller, Jeffrey M; Pham, Phuong-Mai; Pham, Son V

    2011-01-01

    The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%–10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%–14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed. PMID:21915172

  17. Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients

    DEFF Research Database (Denmark)

    Johansen, Mathias; Wikkelsø, Anne; Lunde, Jens

    2015-01-01

    BACKGROUND: Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions......, as well as patients at high risk of bleeding. Evidence is lacking regarding indication, dosing, efficacy and safety. OBJECTIVES: We assessed the benefits and harms of PCC compared with fresh frozen plasma in the acute medical and surgical setting involving vitamin K antagonist-treated bleeding and non...... finding a beneficial effect of PCC in reducing the volume of fresh frozen plasma (FFP) transfused to reverse the effect of vitamin K antagonist treatment. The number of new occurrences of transfusion of red blood cells (RBCs) did not seem to be associated with the use of PCC (RR 1.08, 95% CI 0.82 to 1...

  18. Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.

    Science.gov (United States)

    Guntipalli, Prathima; Chason, Rebecca; Elliott, Alan; Rockey, Don C

    2014-12-01

    We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis. We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis. We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions. Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p bleeding than those without cirrhosis. We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.

  19. RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

    African Journals Online (AJOL)

    Portal hypertension due to intrahepatic disease or extrahepatic portal vein obstruction (EHPVO) is an important cause of upper gastro- intestinal bleeding in children. About 50% of children with EHPVO present with bleeding from oesophageal varices.1-3 Improvements in the management of children with intrahepatic ...

  20. Genetic algorithm based on optimization of neural network structure for fault diagnosis of the clutch retainer mechanism of MF 285 tractor

    Directory of Open Access Journals (Sweden)

    S. F Mousavi

    2016-09-01

    and error procedure was used to minimize the mean square error of the network output and the desired amount of training step. During the training step, four neural networks including Db4, Db30, Db35 and Db40 achieved a gradient descent weight in the learning bias and four neural networks including Db9, Db15, Db20 and Db25 achieved a gradient descent with momentum weight in the learning bias. The two of the achieved neural networks including Db4, Db20 have circular logarithm function and the remaining networks have annular hyperbolic tangent transfer function. The most appropriate networks configuration was acquired when the network exhibited the minimal error with the training and testing data sets. The results show that the highest accuracy of the GA-ANN Artificial neural networks for all rotational speeds (1000, 1500 and 2000 rpm, and working conditions (intact gear and shaft, damaged bearing and worn shaft observed for the network family of Db4. The highest error observed for the family of Db20 with MSE of 0.011. Conclusions Artificial neural networks can somewhat think and make decisions similar to an expert person. In this project in order to predict the occurrence of a failure of the clutch mechanism of MF 285 tractor, the experimental data were obtained using some sensors, and the data were transferred to a computer by means of a data analytical. By training of the neural networks, the errors were identified separately. The output data from the combined Neural Network and Genetic Algorithm shows that the performance of the prediction model is enhanced. Based on the experiments and calculations, the best data set belongs to the family of Db4 network with the least MSE equal to 4.09E-07 and r equal to 0.99999, indicating that the model could precisely detect the faulty bearings or shafts.

  1. Truck Rollover Characterization for Class-8 Tractor-Trailers Utilizing Standard Dual Tires and New-Generation Single Tires

    Energy Technology Data Exchange (ETDEWEB)

    Capps, Gary [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). National Transportation Research Center; Knee, Bill [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). National Transportation Research Center; Franzese, Oscar [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). National Transportation Research Center; Pollock, Paul [Dana Corporation, Kalamazoo, MI (United States). Commercial Vehicle Systems Division; Coleman, Daniel [Dana Corporation, Kalamazoo, MI (United States). Commercial Vehicle Systems Division; Janajreh, Ibrahim [Michelin Americas Research and Development Corporation, Greenville, SC (United States); Haas, Steven [Michelin Americas Research and Development Corporation, Greenville, SC (United States); Frey, Norm [Michelin Americas Research and Development Corporation, Greenville, SC (United States); Law, Harry [Clemson Univ., SC (United States). Fluor Daniel Engineering Innovation Building; Johnson, Eric [Clemson Univ., SC (United States). Fluor Daniel Engineering Innovation Building; Lawson, Robert [Clemson Univ., SC (United States). Fluor Daniel Engineering Innovation Building; Petrolino, Joe [National Transportation Research Center, Inc., Knoxville, TN (United States); Rice, Dave [National Transportation Research Center, Inc., Knoxville, TN (United States)

    2005-07-30

    of the tests that are a part of this study was to understand how different elements (e.g., dual tires and wide-base, new-generation single tires, different trailer suspension types, etc.) affect the overall vehicle roll stability. Tilt-table tests were also performed to characterize the static rollover propensity if the tractor trailer. For all of the tests, the vehicle was loaded with ballast for a gross vehicle weight rating of 79,000 lbs., and the speeds were gradually increased so that wheel lift-off was experienced both visually and via instrumentation. A significant amount of data was collected on all maneuvers performed (1.2 Gigabytes of data from 45 data channels sampled at 0.01 sec) and information was also captured via videotaping (one camera inside the cabin and three others outside; plus one off-board camera). Due to a number of issues related to the sensors, and idiosyncrasies in the data itself, a statistically meaningful data set was not possible. However sufficient data was collected to demonstrate the trends and patterns in the heavy truck rollover phenomenon.

  2. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from.......i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence....

  3. Tamoxifen treatment of bleeding irregularities associated with Norplant use.

    Science.gov (United States)

    Abdel-Aleem, Hany; Shaaban, Omar M; Amin, Ahmed F; Abdel-Aleem, Aly M

    2005-12-01

    To evaluate the possible role of tamoxifen (selective estrogen receptor modulators, SERM) in treating bleeding irregularities associated with Norplant contraceptive use. Randomized clinical trial including 100 Norplant users complaining of vaginal bleeding irregularities. The trial was conducted in the Family Planning Clinic of Assiut University Hospital. Women were assigned at random to receive tamoxifen tablets (10 mg) twice daily for 10 days or similar placebo. Women were followed-up for 3 months. The end points were percentage of women who stopped bleeding during treatment, bleeding/spotting days during the period of follow-up, effect of treatment on their lifestyle, and side effects and discontinuation of contraception. There was good compliance with treatment. At the end of treatment, a significantly higher percentage of tamoxifen users stopped bleeding in comparison to the control group (88% vs. 68%, respectively; p=.016). Women who used tamoxifen had significantly less bleeding and/or spotting days than women who used placebo, during the first and second months. During the third month, there were no significant differences between the two groups. Women who used tamoxifen reported improvement in performing household activities, religious duties and in sexual life, during the first 2 months. In the third month, there were no differences between the two groups. There were no significant differences between tamoxifen and placebo groups in reporting side effects. In the group who used tamoxifen, two women discontinued Norplant use because of bleeding vs. nine women in the placebo group. Tamoxifen use at a dose of 10 mg twice daily orally, for 10 days, has a beneficial effect on vaginal bleeding associated with Norplant use. In addition, the bleeding pattern was better in women who used tamoxifen for the following 2 months after treatment. However, these results have to be confirmed in a larger trial before advocating this line of treatment.

  4. Recent pharmacological management of oral bleeding in hemophilic patient

    Directory of Open Access Journals (Sweden)

    Monica Widyawati Setiawan

    2011-09-01

    Full Text Available Background: Hemophilia is a hereditary bleeding disorder that can increase the risk of disease in oral cavity. Sometimes hemophilia is not always established already in a patient. The lack of awareness of hemophilia presence can cause serious problem. Purpose: The purpose of this review is to explain about dental bleeding manifestation and management in hemophilic patient. Reviews: Hemophilia can be manifested as dental bleeding that cannot stop spontaneously. It should be treated with factor VIIII either by giving whole blood, fresh plasma, fresh frozen plasma, cryoprecipitate, and factor VIII concentrate. Factor VIII dose for hemophilia treatment can be calculated based on factor VIII present in hemophilia patient’s body. Factor VIII can also be given as prophylaxis to prevent bleeding. Complications that can be caused by factor VIII replacement therapy are the presence of factor VIII inhibitor and transfusion related diseases. Treatment of dental bleeding due to hemophilia consists of factor replacement therapy and supportive therapy. Conclusion: Treatment of dental bleeding due to hemophilia consists of factor replacement therapy and supportive therapy. There are complications that can happen due to factor VIII replacement therapy that should be considered and anticipated.Latar belakang: Hemofilia adalah kelainan pembekuan darah yang diturunkan. Hemophilia dapat meningkatkan resiko penyakit rongga mulut. Hemofilia tidak selalu sudah terdiagnosa saat penderita melakukan kunjungan ke dokter gigi. Kurangnya kewaspadaan akan adanya hemofilia dapat menyebabkan masalah serius. Tujuan: Tujuan dari kajian pustaka ini adalah memaparkan tentang manifestasi dan penanganan perdarahan gigi pada penderita hemofilia. Tinjauan pustaka: hemofilia dapat bermanifestasi sebagai perdarahan gigi yang tidak dapat berhenti secara spontan. Pada keadaan perdarahan tersebut, pemberian faktor VIII yang diberikan sebagai whole blood, fresh plasma, fresh frozen plasma

  5. Acidentes de trabalho envolvendo conjuntos tratorizados em propriedades rurais do Rio Grande do Sul, Brasil Work accidents involving tractor-implement systems in farms of Rio Grande do Sul State, Brazil

    Directory of Open Access Journals (Sweden)

    Henrique Debiasi

    2004-06-01

    Full Text Available O presente trabalho teve como objetivo determinar as causas genéricas e específicas dos acidentes de trabalho envolvendo conjuntos tratorizados, no intuito de subsidiar a tomada de medidas mais efetivas de prevenção dos mesmos. A pesquisa foi executada em 21 municípios pertencentes a três microregiões geográficas do Rio Grande do Sul: Santa Maria, Restinga Seca e Cachoeira do Sul. Foram amostradas aleatoriamente 114 propriedades, dentro das quais 141 operadores foram entrevistados. Os acidentes analisados foram tanto aqueles ocorridos com o proprietário ou empregados da propriedade amostrada como aqueles ocorridos com operadores não pertencentes à propriedade, mas dos quais os entrevistados tinham conhecimento. 82% dos acidentes de trabalho envolvendo conjuntos tratorizados foram causados por atitudes inseguras e 18% por condições inseguras. As principais causas específicas de acidentes foram a operação do trator em condições para as quais não foi projetado, a perda de controle em aclives/declives, a permissão de carona e o consumo excessivo de álcool. Com base nestes resultados, pode-se concluir que as ações visando à prevenção dos acidentes de trabalho envolvendo conjuntos tratorizados devem dar ênfase à eliminação das causas específicas apuradas.The objective of this work was to determine generic and specific causes of work accidents involving tractor-implement systems, to help taking more effective prevetion measures. The research was carried out in twenty-one municipal districts belonging to three regions of Rio Grande do Sul State, Brazil: Santa Maria, Restinga Seca e Cachoeira do Sul. 114 farms were randomly sampled in these regions, in which 141 operators were evaluated. The accidents analyzed were both te ones that occurred with the owner or employees of the same farm and the ones that occured with operators not belonging that farm - but whose cases were known by the interwiees - 82% of the work accidents

  6. 21 CFR 864.6100 - Bleeding time device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bleeding time device. 864.6100 Section 864.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6100 Bleeding time device...

  7. Effect of the load of drive axles and high of the curtain on stress-strain properties of the tractor

    Directory of Open Access Journals (Sweden)

    Tomáš Šmerda

    2007-01-01

    Full Text Available The goal of the experimental measurement was determination of relation among weight load of the tractor together, hitch height changes and drawbar characteristic. The measurement was realized on chassis dynamometer at MUAF in Brno. The first step consisted of rated speed characteristics measurement in conformity with OECD demands. The drawbar characteristic was measured under two selected gears. Adding 980 kg to the nominal wight of the tractor brought increasing maximal drawbar power and drawbar force together with decreasing of slip. The highest differences were observed during the mesurement of fifth gear shifted. The drawbar force grew up to 18.9% as well as the maximal drawbar power (15.2%. The maximal drawbar power at ninth gear gave 62.8 kW. The hitch height was setting to 0.54 m; 0.64 m and 0.74 m. When the hitch height was set from 0.54 m to 0.74 m the drawbar force an power on front axle was lower by reason of load reduction. As can be noticed from the final drawbar characteristics, both curves are identical up to border of maximal drawbar power. Small differences in the area of the highest slips can be ascribed to the rolling resistance.

  8. Upper gastrointestinal bleeding: Five-year experience from one centre

    Directory of Open Access Journals (Sweden)

    Jovanović Ivan

    2008-01-01

    Full Text Available Introduction Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. Objective To assess the frequency of erosive gastropathy and duodenal ulcer as a cause of upper gastrointestinal (GI bleeding as well as its relation to age, gender and known risk factors. METHOD We conducted retrospective observational analysis of emergency endoscopy reports from the records of the Emergency Department of Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, during the period from 2000 to 2005. Data consisted of patients' demographics, endoscopic findings and potential risk factors. Results During the period 2000-2005, three thousand nine hundred and fifty four emergency upper endoscopies were performed for acute bleeding. In one quarter of cases, acute gastric erosions were the actual cause of bleeding. One half of them were associated with excessive consumption of salicylates and NSAIDs. In most of the examined cases, bleeding stopped spontaneously, while 7.6% of the cases required endoscopic intervention. Duodenal ulcer was detected as a source of bleeding in 1320 (33.4% patients and was significantly associated with a male gender (71.8% and salicylate or NSAID abuse (59.1% (χ2-test; p=0.007. Conclusion Erosive gastropathy and duodenal ulcer represent a significant cause of upper gastrointestinal bleeding accounting for up to 60% of all cases that required emergency endoscopy during the 5- year period. Consumption of NSAIDs and salicylates was associated more frequently with bleeding from a duodenal ulcer than with erosive gastropathy leading to a conclusion that we must explore other causes of erosive gastropathy more thoroughly. .

  9. Dosimetric Analysis of Radiation-induced Gastric Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Normolle, Daniel [Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Pan, Charlie C. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Amarnath, Sudha [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Ensminger, William D. [Department of Internal Medicine, Division of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Lawrence, Theodore S.; Ten Haken, Randall K. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)

    2012-09-01

    Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of {>=}grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD{sub 50} (normal) = 56 Gy and TD{sub 50} (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD{sub 50} value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

  10. Dosimetric Analysis of Radiation-induced Gastric Bleeding

    International Nuclear Information System (INIS)

    Feng, Mary; Normolle, Daniel; Pan, Charlie C.; Dawson, Laura A.; Amarnath, Sudha; Ensminger, William D.; Lawrence, Theodore S.; Ten Haken, Randall K.

    2012-01-01

    Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of ≥grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD 50 (normal) = 56 Gy and TD 50 (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD 50 value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

  11. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    International Nuclear Information System (INIS)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

    2012-01-01

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  12. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  13. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

    Science.gov (United States)

    Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

    2013-09-21

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation.

  14. Management of bleeding in acquired hemophilia A: results from the European Acquired Haemophilia (EACH2) Registry.

    Science.gov (United States)

    Baudo, Francesco; Collins, Peter; Huth-Kühne, Angela; Lévesque, Hervé; Marco, Pascual; Nemes, László; Pellegrini, Fabio; Tengborn, Lilian; Knoebl, Paul

    2012-07-05

    Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies to coagulation FVIII. Bleeding episodes at presentation are spontaneous and severe in most cases. Optimal hemostatic therapy is controversial, and available data are from observational and retrospective studies only. The EACH2 registry, a multicenter, pan-European, Web-based database, reports current patient management. The aim was to assess the control of first bleeding episodes treated with a bypassing agent (rFVIIa or aPCC), FVIII, or DDAVP among 501 registered patients. Of 482 patients with one or more bleeding episodes, 144 (30%) received no treatment for bleeding; 31 were treated with symptomatic therapy only. Among 307 patients treated with a first-line hemostatic agent, 174 (56.7%) received rFVIIa, 63 (20.5%) aPCC, 56 (18.2%) FVIII, and 14 (4.6%) DDAVP. Bleeding was controlled in 269 of 338 (79.6%) patients treated with a first-line hemostatic agent or ancillary therapy alone. Propensity score matching was applied to allow unbiased comparison between treatment groups. Bleeding control was significantly higher in patients treated with bypassing agents versus FVIII/DDAVP (93.3% vs 68.3%; P = .003). Bleeding control was similar between rFVIIa and aPCC (93.0%; P = 1). Thrombotic events were reported in 3.6% of treated patients with a similar incidence between rFVIIa (2.9%) and aPCC (4.8%).

  15. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    International Nuclear Information System (INIS)

    Jain, T.P.; Gulati, M.S.; Makharia, G.K.; Bandhu, S.; Garg, P.K.

    2007-01-01

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding

  16. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

    2007-07-15

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.

  17. First trimester bleeding and maternal cardiovascular morbidity

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Langhoff-Roos, Jens

    2012-01-01

    First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....

  18. Risk of Gastrointestinal Bleeding with Rivaroxaban: A Comparative Study with Warfarin

    Directory of Open Access Journals (Sweden)

    Muhammed Sherid

    2016-01-01

    Full Text Available Introduction. The risk of gastrointestinal (GI bleeding with rivaroxaban has not been studied extensively. The aim of our study was to assess this risk in comparison to warfarin. Methods. We examined the medical records for patients who were started on rivaroxaban or warfarin from April 2011 to April 2013. Results. We identified 300 patients (147 on rivaroxaban versus 153 on warfarin. GI bleeding occurred in 4.8% patients with rivaroxaban when compared to 9.8% patients in warfarin group (p=0.094. GI bleeding occurred in 8% with therapeutic doses of rivaroxaban (>10 mg/d compared to 9.8% with warfarin (p=0.65. Multivariate analysis showed that patients who were on rivaroxaban for ≤40 days had a higher incidence of GI bleeding than those who were on it for >40 days (OR = 2.8, p=0.023. Concomitant use of dual antiplatelet agents was associated with increased risk of GI bleeding in the rivaroxaban group (OR = 7.4, p=0.0378. Prior GI bleeding was also a risk factor for GI bleeding in rivaroxaban group (OR = 15.5. Conclusion. The incidence of GI bleeding was similar between rivaroxaban and warfarin. The risk factors for GI bleeding with rivaroxaban were the first 40 days of taking the drug, concomitant dual antiplatelet agents, and prior GI bleeding.

  19. The medical management of abnormal uterine bleeding in reproductive-aged women.

    Science.gov (United States)

    Bradley, Linda D; Gueye, Ndeye-Aicha

    2016-01-01

    In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Klingenberg, S.L.; Langholz, S.E.; Gluud, Lise Lotte

    2008-01-01

    BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE...... and Science Citation Index were combined. Intention-to-treat random effect meta-analyses were performed and results presented as RRs with 95% confidence intervals. RESULTS: Seven double-blind randomized trials on tranexamic acid vs. placebo were included. Of 1754 patients randomized, 21% were excluded. Only...... one trial included endoscopic treatments or proton pump inhibitors. Five per cent of patients on tranexamic acid and 8% of controls died (RR: 0.61, 95% CI: 0.42-0.89). No significant differences were found on bleeding, bleeding-related mortality, surgery or transfusion requirements. Adverse events...

  1. Anode reactive bleed and injector shift control strategy

    Science.gov (United States)

    Cai, Jun [Rochester, NY; Chowdhury, Akbar [Pittsford, NY; Lerner, Seth E [Honeoye Falls, NY; Marley, William S [Rush, NY; Savage, David R [Rochester, NY; Leary, James K [Rochester, NY

    2012-01-03

    A system and method for correcting a large fuel cell voltage spread for a split sub-stack fuel cell system. The system includes a hydrogen source that provides hydrogen to each split sub-stack and bleed valves for bleeding the anode side of the sub-stacks. The system also includes a voltage measuring device for measuring the voltage of each cell in the split sub-stacks. The system provides two levels for correcting a large stack voltage spread problem. The first level includes sending fresh hydrogen to the weak sub-stack well before a normal reactive bleed would occur, and the second level includes sending fresh hydrogen to the weak sub-stack and opening the bleed valve of the other sub-stack when the cell voltage spread is close to stack failure.

  2. Medical treatment for heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Yi-Jen Chen

    2015-10-01

    Full Text Available Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a “complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles” and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL. During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.

  3. No increased systemic fibrinolysis in women with heavy menstrual bleeding

    NARCIS (Netherlands)

    Wiewel-Verschueren, S.; Knol, H. M.; Lisman, T.; Bogchelman, D. H.; Kluin-Nelemans, J. C.; van der Zee, A.G.J.; Mulder, A.B.; Meijer, K.

    BackgroundBleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of

  4. [High risk factors of upper gastrointestinal bleeding after neurosurgical procedures].

    Science.gov (United States)

    Zheng, Kang; Wu, Gang; Cheng, Neng-neng; Yao, Cheng-jun; Zhou, Liang-fu

    2005-12-21

    To analyze high risk factors of postoperative upper gastrointestinal (GI) bleeding after neurosurgery so as to give guidance for prevention of GI bleeding. A questionnaire was developed to investigate the medical records of 1500 patients who were hospitalized and underwent neurosurgical operations in 1997. Logistic regression analysis was made. 1430 valid questionnaires were obtained. Postoperative upper GI bleeding occurred in 75 patients (5.24%). The incidence of upper GI bleeding were 6.64% (54/813) in the male patients and 3.40% (21/617) in the female persons (P = 0.007); 9.88% (41/415) in those aged > 50 and 3.35% in those aged hematoma, intraventricular hemorrhage, subdural hematoma, and extradural hematoma were 15.7%, 10.0%, 6.00%, and 2.94% respectively (P = 0.02). The incidence of upper GI bleeding of the patients with tumors of fourth ventricle of cerebrum, brainstem, cerebral hemisphere, and sellar hypothalamus were 15.79% (3/19), 7.89%, 5.71%, and 3.74% respectively. In the emergent cases, the incidence of upper GI bleeding was higher in those with hypertension. The incidence of upper GI bleeding was 5.46% in the patients undergoing adrenocortical hormone treatment, significantly higher than that in those who did not receive such treatment (2.13%). Patients who are at high risk of developing postoperative upper GI bleeding including that: age greater than 50 years; male; Glasgow Coma Score less than 10 pre and post operation; The lesion was located in brain stem and forth ventricle; Hypertensive cerebral hemorrhage; Intracerebral and intraventricular hemorrhagic brain trauma; Postoperative pneumonia, brain edema, encephalic high pressure, pyogenic infection of the central nervous system and other postoperative complications. The mortality of patients with postoperative upper GI bleeding was evidently higher than that of the patients without postoperative upper GI bleeding.

  5. Tests of Nacelle-Propeller Combinations in Various Positions with Reference to Wings V : Clark Y Biplane Cellule - NACA Cowled Nacelle - Tractor Propeller

    Science.gov (United States)

    Valentine, E Floyd

    1935-01-01

    This report is the fifth of a series giving the results obtained from wind tunnel tests on the interference drag and propulsive efficiency of nacelle-propeller-wing combinations. This report gives results of tests of an NACA cowled air-cooled engine nacelle with tractor propeller located in 12 positions with reference to a Clark Y biplane cellule.

  6. Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients.

    Science.gov (United States)

    Batman, B; van Bladel, E R; van Hamersveld, M; Pasker-de Jong, P C M; Korporaal, S J A; Urbanus, R T; Roest, M; Boven, L A; Fijnheer, R

    2017-11-01

    Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric evaluation of platelet function might aid the clinician in identifying patients at risk of bleeding. This evaluation can be performed within the hour and is not hampered by low platelet count. Our objective was to assess a possible correlation between bleeding and platelet function in thrombocytopenic haemato-oncological patients. Inclusion was possible for admitted haemato-oncology patients aged 18 years and above. Furthermore, an expected need for platelet transfusions was necessary. Bleeding was graded according to the WHO bleeding scale. Platelet reactivity to stimulation by either adenosine diphosphate (ADP), cross-linked collagen-related peptide (CRP-xL), PAR1- or PAR4-activating peptide (AP) was measured using flow cytometry. A total of 114 evaluations were available from 21 consecutive patients. Platelet reactivity in response to stimulation by all four studied agonists was inversely correlated with significant bleeding. Odds ratios (OR) for bleeding were 0·28 for every unit increase in median fluorescence intensity (MFI) [95% confidence interval (CI) 0·11-0·73] for ADP; 0·59 [0·40-0·87] for CRP-xL; 0·59 [0·37-0·94] for PAR1-AP; and 0·43 [0·23-0·79] for PAR4-AP. The platelet count was not correlated with bleeding (OR 0·99 [0·96-1·02]). Agonist-induced platelet reactivity was significantly correlated to bleeding. Platelet function testing could provide a basis for a personalized transfusion regimen, in which platelet transfusions are limited to those at risk of bleeding. © 2017 International Society of Blood Transfusion.

  7. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...

  8. Importance of histopathological examination of endometrium in Dysfunctional Uterine Bleeding.

    Directory of Open Access Journals (Sweden)

    Dr. Yaminee Rana

    2017-12-01

    Full Text Available Introduction: Abnormal uterine bleeding is a common condition affecting women of reproductive age that has significant social and economic impact. Dysfunctional uterine bleeding (DUB is defined as abnormal uterine bleeding in the absence of organic disease. Dysfunctional uterine bleeding is one of the most commonly encountered gynaecological problems. Objectives: This study is done to evaluate the histopathological pattern of the endometrial biopsies of patients with dysfunctional uterine bleeding and its correlation with clinical data. Methods: The present prospective study included evaluation of 208 cases of dysfunctional uterine bleeding in the Department of Pathology, B. J. Medical College, Ahmedabad over a period of 10 months, from January 2017 to October 2017. Women presenting with abnormal uterine bleeding were included in the study. Those women in which bleeding is secondary to systemic causes, organic causes and due to cervical and vaginal causes were excluded. The specimens were processed, embedded and cut into sections of 3-4 microns. The histopathological patterns were studied. Results: Age distribution varied from 18 years to 70 years, majority of the patients were between 21 to 30 years. Among the cases of DUB, proliferative phase accounted for 66.3% and secretory phase accounted for 21.3%. 18 cases (8.6% of atrophic endometrium, four cases (1.9% of irregular shedding and two cases of luteal phase insufficiency were received. Conclusion: Dysfunctional uterine bleeding is a common and debilitating condition in women of reproductive age. Endometrial biopsy could be effectively used as the first diagnostic step in DUB and thus ensures correct management.

  9. Bleeding points in cerebral hemorrhage caused by Moyamoya disease in adults

    International Nuclear Information System (INIS)

    Sasaki, Tatsuya; Sakurai, Yoshiharu; Shimizu, Yukihiko; Ogawa, Akira; Komatsu, Shinro.

    1983-01-01

    Even before the introduction of CT we reported that the intracranial hemorrhage in Moyamoya disease was not subarachnoid hemorrhage but intraventricular hemorrhage and that the bleeding point was the paraventricular subependymal region of lateral ventricles; these findings were based on our experience with three Moyamoya cases in which ventricular hemorrhage occurred and pseudoaneurysms were revealed in the territory of the posterior choroidal artery. Twelve cases with intracranial hemorrhage caused by Moyamoya disease have now been studied by CT in order to determine (1) whether the hemorrhage is subarachnoid or intraventricular, and (2) where the bleeding point is. In the results for the eight cases for which the CT scan was performed within one day after the onset, intraventricular hemorrhage was shown in all cases. The bleeding point was examined in twelve cases; in four cases it was recognized by initial CT only, but if five cases in which ventricular hemorrhage only appeared in the initial CT,follow-up plain and contrast-enhanced CT were necessary. In a total of nine cases, then, bleeding points were recognized. In one case putaminal hemorrhage penetrated into the lateral ventricle, while in eight cases the intracerebral hematoma was located in the paraventricular region of the lateral ventricle, such as at the head of the caudate nucleus or the thalamus. In some cases, small subependymal hematoma projected into the lateral ventricle. In cases with symptoms of intracranial hemorrhage at the onset, the bleeding points were at the paraventricular parenchyma of the lateral ventricle in almost all cases. (author)

  10. Diagnosis and management of upper gastrointestinal bleeding in children.

    Science.gov (United States)

    Owensby, Susan; Taylor, Kellee; Wilkins, Thad

    2015-01-01

    Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. © Copyright 2015 by the American Board of Family Medicine.

  11. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    Science.gov (United States)

    Kim, Young-Il

    2015-01-01

    Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

  12. Determination of the curves, torque harnesses of performance of an agricultural tractor Massey Ferguson MF 275

    Energy Technology Data Exchange (ETDEWEB)

    Paula, Vanderson Rabelo de [Universidade de Sao Paulo (ESALQ/USP), Piracicaba, SP (Brazil). Escola Superior de Agricultura Luiz de Queiroz; Silva, Breno Alves; Santos, Thiago Castro Vidal dos; Porto, Rodrigo Padovani; Volpato, Carlos Eduardo Silva; Barbosa, Jackson Antonio [Universidade Federal de Lavras (UFLA), MG (Brazil)

    2008-07-01

    The globalization of the economy has approached the markets and one of the consequences of this approach is the entrance of new equipment and highly competitive machines in cost terms. This is the same reality of the Brazilian agricultural sector that today counts on new options of machines and very interesting implements of the point of view of the acquisition cost. In this context, this work aimed at the dynamometric assay of an agricultural tractor for attainment of its curves of torque, power using the B100 soybean fuels, B100 olive, B100 diesel. (author)

  13. Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

    Science.gov (United States)

    Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

    2017-12-01

    The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.

  14. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist.

    Science.gov (United States)

    Loor, Gabriel; Vivacqua, Alessandro; Sabik, Joseph F; Li, Liang; Hixson, Eric D; Blackstone, Eugene H; Koch, Colleen G

    2013-11-01

    High-performing health care organizations differentiate themselves by focusing on continuous process improvement initiatives aimed at enhancing patient outcomes. Reoperation for bleeding is an event associated with considerable morbidity risk. Hence, our primary objective was to develop and implement a formal operative checklist to reduce technical reasons for postoperative bleeding. From January 1, 2011, through June 30, 2012, 5812 cardiac surgical procedures were performed at Cleveland Clinic (Cleveland, OH). A multidisciplinary team developed a simple, easy-to-perform hemostasis checklist based on the most common sites of bleeding. An extensive educational in-service was performed before limited, then universal, checklist implementation. Geometric charts were used to track the number of cases between consecutive reoperations for bleeding. We compared these before (phase 0) and after the first limited implementation phase (phase 1) and the universal implementation phase (phase 2) of the checklist. The average number of cases between consecutive reoperations for bleeding increased from 32 in phase 0 to 53 in both phase 1 (P = .002) and phase 2 (P = .01). A substantial reduction in reoperation for bleeding cases followed implementation of a formalized hemostasis checklist. Our findings underscore the important influence of memory aids that focus attention on surgical techniques to improve patient outcomes in a complex, operative work environment. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.

    Science.gov (United States)

    Lee, Lois K; Dayan, Peter S; Gerardi, Michael J; Borgialli, Dominic A; Badawy, Mohamed K; Callahan, James M; Lillis, Kathleen A; Stanley, Rachel M; Gorelick, Marc H; Dong, Li; Zuspan, Sally Jo; Holmes, James F; Kuppermann, Nathan

    2011-06-01

    To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders. Copyright © 2011 Mosby, Inc. All rights reserved.

  16. Fuel efficiency of conventional design tractors diesel engines in relation to new design

    Directory of Open Access Journals (Sweden)

    Jevtić Jeremija

    2006-01-01

    Full Text Available Total consumption of all types of energies is rather high nowadays with constant tendency of increasing. Transport section is one of the highest consumers of energy obtained from fossil fuels. It is absolutely clear that the reduction of energy consumption and the protection of environment - exhaust emission reduction, i. e. cleaner air, will be one of the main tasks of automotive industry in the first decades of the 21st century. In spite of its superiority over the petrol engine in respect of the fuel consumption, a diesel engine "suffers" from the increased exhaust emission, particles and NOx first of all and also from the noise and vibrations. The paper gives a review of fuel efficiency of conventional design tractors diesel engines in relation to new design. .

  17. DSA diagnosis and interventional management of postoperative bleeding

    International Nuclear Information System (INIS)

    Li Yuwei; Zhang Fuqiang; Li Yunhui; Yuan Liang; Si Guangyan; Liu Lili

    2009-01-01

    Objective: To discuss the clinical application of DSA and interventional management in diagnosing and treating the bleeding after surgery. Methods: The clinical data and the interventional management of 14 patients with DSA-proved postoperative bleeding, encountered during the period of Aug. 2005-Jan. 2008, were retrospectively analyzed. The surgeries included subtotal gastrectomy (n=4), pancreatoduodenectomy (n=3), cesarean section (n=2), nephrolithotomy (n=3), heminephrectomy (n=1), internal hemorrhoidectomy (n=1). Results: Seventeen arterial bleeding sites were demonstrated, including gastroduodenal (n=2), left gastric (n=4), phrenic (n=1), short gastric (n=1), superior mesenteric (n=2), renal (n=4), uterine (n=2) and internal pudendal (n=1) artery. The diagnosis was confirmed with DSA in all 14 patients, of which embolization was successfully carried out in 13 in one session (92.8%). The remaining one case had to be operated again to stop the bleeding because of the failure of the superselective catheterization. No serious complications, such as organ necrosis or visceral dysfunction, occurred. Conclusion: As a safe, minimally-invasive and effective technique, DSA and interventional management are very helpful in diagnosing and treating the bleeding after surgery. (authors)

  18. Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology.

    Science.gov (United States)

    García-Iglesias, Pilar; Botargues, Josep-Maria; Feu Caballé, Faust; Villanueva Sánchez, Càndid; Calvet Calvo, Xavier; Brullet Benedi, Enric; Cánovas Moreno, Gabriel; Fort Martorell, Esther; Gallach Montero, Marta; Gené Tous, Emili; Hidalgo Rosas, José-Manuel; Lago Macía, Amelia; Nieto Rodríguez, Ana; Papo Berger, Michel; Planella de Rubinat, Montserrat; Saló Rich, Joan; Campo Fernández de Los Ríos, Rafel

    2017-05-01

    In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  19. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

    Ramon Banos Madrid; Fernando Alberca de las Parras; Angel Vargas Acosta and others

    2006-01-01

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  20. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

    Banos Madrid, Ramon; Alberca de las Parras, Fernando; Vargas Acosta, Angel and others

    2006-01-01

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach the habitual is to diagnose this entity of occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  1. Chronic liver disease and 90-day mortality in 21,359 patients following peptic ulcer bleeding--a Nationwide Cohort Study.

    Science.gov (United States)

    Holland-Bill, L; Christiansen, C F; Gammelager, H; Mortensen, R N; Pedersen, L; Sørensen, H T

    2015-03-01

    Bleeding is a serious and frequent complication of peptic ulcer disease. Hepatic dysfunction can cause coagulopathy and increases the risk of peptic ulcer bleeding. However, whether chronic liver disease increases mortality after peptic ulcer bleeding remains unclear. To examine the prognostic impact of chronic liver disease on mortality after peptic ulcer bleeding. We used population-based medical registries to conduct a cohort study of all Danish residents hospitalised with incident peptic ulcer bleeding from 2004 through 2011. We identified patients diagnosed with liver cirrhosis or non-cirrhotic chronic liver disease before their admission for peptic ulcer bleeding. We then computed 90-day mortality after peptic ulcer bleeding based on the Kaplan-Meier method (1 - survival function) and used a Cox regression model to estimate mortality rate ratios (MRRs), controlling for potential confounders. We identified 21,359 patients hospitalised with peptic ulcer bleeding. Among these, 653 (3.1%) had a previous diagnosis of liver cirrhosis and 474 (2.2%) had a history of non-cirrhotic chronic liver disease. Patients with liver cirrhosis and non-cirrhotic chronic liver disease had a cumulative 90-day mortality of 25.3% and 20.7%, respectively, compared to 18.3% among patients without chronic liver disease. Liver cirrhosis was associated with an adjusted 90-day MRR of 2.38 (95% CI: 2.02-2.80), compared to 1.49 (95% CI: 1.22-1.83) among patients with non-cirrhotic chronic liver disease. Patients with chronic liver disease, particularly liver cirrhosis, are at increased risk of death within 90 days after hospitalisation for peptic ulcer bleeding compared to patients without chronic liver disease. © 2015 John Wiley & Sons Ltd.

  2. The effects of fennel on menstrual bleeding: A systematic review and meta-analysis.

    Science.gov (United States)

    Abdollahi, Nafiseh Ghassab; Mirghafourvand, Mojgan; Mollazadeh, Sanaz

    2018-03-02

    Introduction Fennel has many medicinal properties and is used in the treatment of dysmenorrhea. Given the widespread use of herbal medicine among women for menstrual problems and considering the fact that there has been no study to date about the effect of fennel on menstrual bleeding and duration of menstrual bleeding through systematic review, the present study was conducted to determine the effect of fennel on the amount (primary outcome) and duration of menstrual bleeding and its side-effects (secondary outcomes). Materials All articles, including Persian and English, with no time limit were searched for in the following databases: Medline (through PubMed), Scopus, EMBASE (through Ovid), Cochrane Library, Web of Sciences, Google Scholar, ProQuest, Clininaltrial.gov, SID, Magiran, Irandoc, and Iranmedex, using MeSH terms, including menstrual bleeding, menstruation, severity of bleeding, hypermenorrhea, menorrhagia, fennel, fennelin, Foeniculum vulgare, dysmenorrhea, and painful menstruation, which were searched separately or in combination. Two authors separately reviewed articles to determine the inclusion criteria, and any disagreement was resolved by reaching consensus with a third person. Results A total of 7993 articles were identified through searching the databases, of which 7327 were excluded as duplicates and 666 were screened for inclusion. Six hundread and forty six were excluded by title and abstract based on not being relevant to the review and being conducted on animals. Eventually, six articles were included in the study and four articles entered into the meta-analysis. The results from meta-analysis showed that using fennel caused a significant increase in mean menstrual bleeding in the first cycle after treatment in the intervention group compared to the control (Std. mean difference: 0.46; 95 % CI: 0.18-0.73; p = 0.001; I2 = 9 %). However, it had no significant effect on menstrual bleeding in the second cycle after treatment (Mean

  3. Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies

    Science.gov (United States)

    García Rodríguez, Luis A.; Martín-Pérez, Mar; Hennekens, Charles H.; Rothwell, Peter M.; Lanas, Angel

    2016-01-01

    Background Low-dose aspirin has proven effectiveness in secondary and primary prevention of cardiovascular events, but is also associated with an increased risk of major bleeding events. For primary prevention, this absolute risk must be carefully weighed against the benefits of aspirin; such assessments are currently limited by a lack of data from general populations. Methods Systematic searches of Medline and Embase were conducted to identify observational studies published between 1946 and 4 March 2015 that reported the risks of gastrointestinal (GI) bleeding or intracranial hemorrhage (ICH) with long-term, low-dose aspirin (75–325 mg/day). Pooled estimates of the relative risk (RR) for bleeding events with aspirin versus non-use were calculated using random-effects models, based on reported estimates of RR (including odds ratios, hazard ratios, incidence rate ratios and standardized incidence ratios) in 39 articles. Findings The incidence of GI bleeding with low-dose aspirin was 0.48–3.64 cases per 1000 person-years, and the overall pooled estimate of the RR with low-dose aspirin was 1.4 (95% confidence interval [CI]: 1.2–1.7). For upper and lower GI bleeding, the RRs with low-dose aspirin were 2.3 (2.0–2.6) and 1.8 (1.1–3.0), respectively. Neither aspirin dose nor duration of use had consistent effects on RRs for upper GI bleeding. The estimated RR for ICH with low-dose aspirin was 1.4 (1.2–1.7) overall. Aspirin was associated with increased bleeding risks when combined with non-steroidal anti-inflammatory drugs, clopidogrel and selective serotonin reuptake inhibitors compared with monotherapy. By contrast, concomitant use of proton pump inhibitors decreased upper GI bleeding risks relative to aspirin monotherapy. Conclusions The risks of major bleeding with low-dose aspirin in real-world settings are of a similar magnitude to those reported in randomized trials. These data will help inform clinical judgements regarding the use of low-dose aspirin

  4. Bleeding stomal varices in portal hypertension

    Directory of Open Access Journals (Sweden)

    Karen Tran-Harding, MD

    2018-04-01

    Full Text Available We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, to the best of our knowledge, there are no cases in the current literature in which treatment of this entity is performed with a combination of TIPS shunt placement and N-butyl cyanoacrylate variceal embolization. Keywords: Stomal varices, TIPS, Cirrhosis, Colon cancer, Embolization, NBCA

  5. Compactação causada pelo tráfego de trator em diferentes manejos de solo = Soil compaction induced by tractor traffic in different soil managements

    Directory of Open Access Journals (Sweden)

    João Paulo Arantes Rodrigues da Cunha

    2009-07-01

    Full Text Available O objetivo deste trabalho foi avaliar a compactação do solo causada pelo tráfego de trator, em um Latossolo Vermelho distroférrico submetido a diferentes tipos de preparo. O delineamento experimental utilizado foi o de blocos casualizados, com arranjo de parcelassubdivididas, considerando os tipos de preparo de solo como tratamentos principais e o número de passadas do trator como tratamentos secundários. Como tratamentos de preparo de solo, além de uma testemunha sem movimentação, foram avaliados: aração com 18 cmde profundidade, aração com 18 cm de profundidade, seguida de gradagem a 10 cm e subsolagem a 40 cm de profundidade. Após o preparo, foi avaliada a resistência do solo à penetração, por meio de um penetrômetro eletrônico, antes da passagem do trator e apósuma, três, cinco e sete vezes a passagem do trator na mesma linha de tráfego. Também se realizou a avaliação de densidade do solo. Concluiu-se que quanto maior a pulverização do solo, maior foi o potencial de compactação. Solos recentemente arados e gradeados forammais susceptíveis à compactação do que solos somente arados ou subsolados. O efeito do tráfego do trator concentrou-se principalmente na camada superficial, e a primeira passada foi a que mais provocou compactação do solo.The objective of this work was to evaluate soil compaction induced bytractor traffic in a Red Latosol (Typic Acrustox, submitted to different soil managements. The experiment was arranged in a subdivided parcel scheme, with types of soil tillage as theprimary soil treatments and the number of tractor passes as secondary treatments. In addition to a control treatment without soil tillage, the treatments were: tilling to a depth of 18 cm, a tilling to a depth of 18 cm followed by harrow use at a depth of 10 cm, and a 40-cm deep subsoil tilling. After preparing the parcels, soil penetration resistance was measured with an electronic penetrometer, before tractor passes and

  6. Appendiceal hemorrhage – An uncommon cause of lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ching-Chung Chiang

    2011-06-01

    Full Text Available Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn’s disease, neoplasms, inflammatory bowel disease, hemorrhoids, and ischemic colitis. Lower gastrointestinal bleeding arising from the appendix is an extremely rare condition. We report a case of appendiceal hemorrhage in a young male. Diagnosis was made by multidetector computerized tomography during survey for hematochezia. The patient recovered well after appendectomy. The histological finding revealed focal erosion of appendix mucosa with bleeding.

  7. Therapeutic options to manage bleeding in a dentist’s office

    Science.gov (United States)

    Rostetter, Claudio; Finkenstädt, Tim; Rücker, Martin; Lübbers, Heinz-Theo

    2018-06-18

    This manuscript provides an overview of therapeutic options for the problem of bleeding in a dentist’s office. Bleeding after tooth extraction is a very common finding in dental medicine and persistent blood in the mouth is obviously uncomfortable and sometimes terrifying for the patient. Most bleedings can be stopped simply with compression, in some cases a homeostatic therapy is necessary. For local compression, a swab with tranexamic acid is useful. If local compression is not sufficient, sutures are often an option. A very effective therapy would also be Tabotamp®, a local hemostypticum which is placed onto the bleeding and should increase the thrombocytic aggregation. In the worst case Floseal®, a human Thrombin, can be placed locally. It stops the bleeding very fast and sufficiently.

  8. Double blind, placebo-controlled trial of Tranexamic acid on recent internal hemorrhoid bleeding

    Directory of Open Access Journals (Sweden)

    Abdul A. Rani

    2002-12-01

    Full Text Available Double blind randomized placebo controlled trial was conducted to evaluate the efficacy of Tranexamic acid in 54 patients with recent hemorrhoid bleeding. Age, gender, body weight, height, grade of hemorrhoid, time of onset of recent bleeding were comparable between two groups. Analysis of haemostatic effect or stop bleeding as an immediate outcome of this study revealed that in the grade 2 patients, 23/23 (100% of tranexamic group and 18/23(78.26% of placebo group the bleeding stop. After 3 days of observation, there was statistically significant different for the rate of stop bleeding as well as at the end of observation. Bleeding stop earlier in the Tranexamic group with median 4 days (3-5 days, compare to placebo, median 11(9.55-12.45. Analysis of recurrent bleeding as an outcome of this study revealed that in the placebo group 9/18(50% of grade 2 patients and all grade 3 (100%patients suffered from recurrent bleeding. Since the days 4, both group have significant different time for recurrent bleeding and at the end of observation, cumulative probability of free of bleeding between two groups significantly different. Median still stop bleeding in the placebo group was 36 days, and the tranexamic group never reaches the median until the end of observation. Conclusion: tranexamic acid was an effective drug to stop recent hemorrhoid bleeding and prevent further recurrent bleeding, significantly better than placebo. (Med J Indones 2002;11: 215-21Keywords: Tranexamic acid, hemorrhoid bleeding, haemostatic effect, recurrent bleeding.

  9. Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

    Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques

  10. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Kjeldsen, J

    2000-01-01

    Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....

  11. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Uflacker, R.

    1987-01-01

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  12. A statistical description of the types and severities of accidents involving tractor semi-trailers

    International Nuclear Information System (INIS)

    Clauss, D.B.; Wilson, R.K.; Blower, D.F.; Campbell, K.L.

    1994-06-01

    This report provides a statistical description of the types and severities of tractor semi-trailer accidents involving at least one fatality. The data were developed for use in risk assessments of hazardous materials transportation. Several accident databases were reviewed to determine their suitability to the task. The TIFA (Trucks Involved in Fatal Accidents) database created at the University of Michigan Transportation Research Institute was extensively utilized. Supplementary data on collision and fire severity, which was not available in the TIFA database, were obtained by reviewing police reports for selected TIFA accidents. The results are described in terms of frequencies of different accident types and cumulative distribution functions for the peak contact velocity, rollover skid distance, fire temperature, fire size, fire separation, and fire duration

  13. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  14. Sensitivity Study for Feed and Bleed Operation for Domestic CANDU Nuclear Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, K. S; Kim, B. S.; Yoo, H. K.; Kim, H. J. [Atomic Creative Technology Co., Daejeon (Korea, Republic of); Whang, S. W. [Korea Hydro and Nuclear Power Co., Daejeon (Korea, Republic of)

    2016-05-15

    The purpose of this paper is to evaluate the effects of the feed and bleed operation using DCT(Degassing Condenser Tank) over-pressure protection valves when LOCL4 with LOCL3 occurs during LPSD mid-loop operation. The CDF(Core Damage Frequency) of Level-1 Internal Event for Wolsong NPP Unit 1 during LPSD POS5A/5B accounts for about 89.08%(POS5A: 30.04%, POS5B: 59.04%) of the total CDF. For Wolsong NPP Unit 1 LPSD External Event, seismic analysis is excluded from this study because it is PSA-based SMA(Seismic Margin Assessment based Probabilistic Safety Assessment). For the domestic CANDU NPP, the feed and bleed operation using DCT over-pressure protection valves has been incorporated as an additional measure to mitigate the consequences during LPSD mid-loop operation. Since LOCL4 with LOCL3 is considered to be the event with highest frequency among all initial events, the effect of the feed and bleed operation on the safety of Nuclear Power Plant has been evaluated using PSA methodology.

  15. Prognostic Significance of Bleeding Location and Severity Among Patients With Acute Coronary Syndromes

    Science.gov (United States)

    Vavalle, John P.; Clare, Robert; Chiswell, Karen; Rao, Sunil V.; Petersen, John L.; Kleiman, Neal S.; Mahaffey, Kenneth W.; Wang, Tracy Y.

    2013-01-01

    Objectives This study sought to determine if there is an association between bleed location and clinical outcomes in acute coronary syndromes (ACS) patients. Background The prognostic significance of bleeding location among ACS patients undergoing cardiac catheterization is not well known. Methods We analyzed in-hospital bleeding events among 9,978 patients randomized in the SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors) study. Bleeding events were categorized by location as access site, systemic, surgical, or superficial, and severity was graded using the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definition. We assessed the association of each bleeding location and severity with 6-month risk of death or myocardial infarction using a multicovariate-adjusted Cox proportional hazard model. Results A total of 4,900 bleeding events were identified among 3,694 ACS patients with in-hospital bleeding. Among 4,679 GUSTO mild/moderate bleeding events, only surgical and systemic bleeds were associated with an increased risk of 6-month death or myocardial infarction (adjusted hazard ratio [HR]: 2.52 [95% confidence interval (CI): 2.16 to 2.94, and 1.40 [95% CI: 1.16 to 1.69], respectively). Mild/moderate superficial and access-site bleeds were not associated with downstream risk (adjusted HR: 1.17 [95% CI: 0.97 to 1.40], and 0.96 [95% CI: 0.82 to 1.12], respectively). Among 221 GUSTO severe bleeds, surgical bleeds were associated with the highest risk (HR: 5.27 [95% CI: 3.80 to 7.29]), followed by systemic (HR: 4.48 [95% CI: 2.98 to 6.72]), and finally access-site bleeds (HR: 3.57 [95% CI: 2.35 to 5.40]). Conclusions Among ACS patients who develop in-hospital bleeding, systemic and surgical bleeding are associated with the highest risks of adverse outcomes regardless of bleeding severity. Although the most frequent among bleeds, GUSTO mild/moderate access-site bleeding is not

  16. Gene polymorphisms and the risk of warfarin-induced bleeding complications at therapeutic international normalized ratio (INR)

    Energy Technology Data Exchange (ETDEWEB)

    Pourgholi, Leyla [Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran (Iran, Islamic Republic of); Department of Pharmacology & Toxicology, School of Pharmacy, Kerman University of Medical Sciences, P.O. Box 7616911319, Kerman (Iran, Islamic Republic of); Goodarzynejad, Hamidreza [Department of Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran (Iran, Islamic Republic of); Mandegary, Ali [Department of Pharmacology & Toxicology, School of Pharmacy, Kerman University of Medical Sciences, P.O. Box 7616911319, Kerman (Iran, Islamic Republic of); Gastroenterology and Hepatology Research Center, Afzalipour' s Hospital, Imam Highway, P.O. Box 7616913911, Kerman (Iran, Islamic Republic of); Ziaee, Shayan [Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran (Iran, Islamic Republic of); Talasaz, Azita Hajhosseini [Department of Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran (Iran, Islamic Republic of); Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of); Jalali, Arash [Department of Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran (Iran, Islamic Republic of); Boroumand, Mohammadali, E-mail: maboroumand@yahoo.com [Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran (Iran, Islamic Republic of)

    2016-10-15

    Background: Bleeding episodes commonly occur in patients on warfarin treatment even in those within therapeutic range of international normalized ratio (INR). The objective of this study was to investigate the effects of the 8 examined polymorphisms on the risk of bleeding complications in a sample of Iranian patients. Methods: A total of 552 warfarin treated patients who maintained on a target INR level of 2.0–3.5 for at least three consecutive intervals were enrolled from those attended our anticoagulation clinics. Ninety-two bleeding events were observed in 87 patients. The presences of the examined polymorphisms were analyzed using polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). Results: Patients with the T allele in NQO1*2 (CT or TT genotypes) had a higher risk of bleeding than patients with the CC genotype (adjusted OR: 2.25, 95% CI: 1.37 to 3.70, P = 0.001). Those who were carriers of CYP2C9 one-variant haplotypes (*1/*2 or *1/*3) were also found to be associated with the higher risk of bleeding events. Compared to reference group (*1/*1), the odds of bleeding increased for carriers of one variant allele (*1/*2 or *1/*3) (adjusted OR: 1.75, 95% CI: 1.03 to 2.97, P = 0.039). Variant VKORC1, Factor VII, and EPHX1 genotypes were not significantly associated with the risk of bleeding events. Conclusion: The SNP C609T within NQO1 and haplotypes of CYP2C9 (1*2 or 1*3) are independently associated to bleeding complications of warfarin at normal INR. Further studies are required to confirm such associations in diverse racial and ethnic populations. - Highlights: • NQO1 C609T variant is associated with warfarin induced bleeding at therapeutic INR. • Haplotypes of CYP2C9 (1*2 or 1*3) are also associated with bleeding events. • VKORC1, Factor VII, and EPHX1 genotypes were not associated with bleeding risk.

  17. Gene polymorphisms and the risk of warfarin-induced bleeding complications at therapeutic international normalized ratio (INR)

    International Nuclear Information System (INIS)

    Pourgholi, Leyla; Goodarzynejad, Hamidreza; Mandegary, Ali; Ziaee, Shayan; Talasaz, Azita Hajhosseini; Jalali, Arash; Boroumand, Mohammadali

    2016-01-01

    Background: Bleeding episodes commonly occur in patients on warfarin treatment even in those within therapeutic range of international normalized ratio (INR). The objective of this study was to investigate the effects of the 8 examined polymorphisms on the risk of bleeding complications in a sample of Iranian patients. Methods: A total of 552 warfarin treated patients who maintained on a target INR level of 2.0–3.5 for at least three consecutive intervals were enrolled from those attended our anticoagulation clinics. Ninety-two bleeding events were observed in 87 patients. The presences of the examined polymorphisms were analyzed using polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). Results: Patients with the T allele in NQO1*2 (CT or TT genotypes) had a higher risk of bleeding than patients with the CC genotype (adjusted OR: 2.25, 95% CI: 1.37 to 3.70, P = 0.001). Those who were carriers of CYP2C9 one-variant haplotypes (*1/*2 or *1/*3) were also found to be associated with the higher risk of bleeding events. Compared to reference group (*1/*1), the odds of bleeding increased for carriers of one variant allele (*1/*2 or *1/*3) (adjusted OR: 1.75, 95% CI: 1.03 to 2.97, P = 0.039). Variant VKORC1, Factor VII, and EPHX1 genotypes were not significantly associated with the risk of bleeding events. Conclusion: The SNP C609T within NQO1 and haplotypes of CYP2C9 (1*2 or 1*3) are independently associated to bleeding complications of warfarin at normal INR. Further studies are required to confirm such associations in diverse racial and ethnic populations. - Highlights: • NQO1 C609T variant is associated with warfarin induced bleeding at therapeutic INR. • Haplotypes of CYP2C9 (1*2 or 1*3) are also associated with bleeding events. • VKORC1, Factor VII, and EPHX1 genotypes were not associated with bleeding risk.

  18. Predictors for the need for endoscopic therapy in patients with presumed acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Kim, Su Sun; Kim, Kyung Up; Kim, Sung Jun; Seo, Seung In; Kim, Hyoung Su; Jang, Myoung Kuk; Kim, Hak Yang; Shin, Woon Geon

    2017-12-15

    Selecting patients with an urgent need for endoscopic hemostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding. The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled patients' medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comorbidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment. A total of 613 patients were analyzed, including 329 patients in the endoscopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p upper gastrointestinal bleeding.

  19. Common management issues in pediatric patients with mild bleeding disorders.

    Science.gov (United States)

    O'Brien, Sarah H

    2012-10-01

    Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  20. Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

    DEFF Research Database (Denmark)

    Vinholt, Pernille J; Alnor, Anne; Nybo, Mads

    2016-01-01

    Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer ...... platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine....... or warfarin OR = 2.34, 95% CI 1.23–4.48; urea nitrogen OR = 1.15, 95% CI 1.07–1.25; creatinine OR = 1.01, 95% CI 1.01–1.01; and haemoglobin OR = 0.62, 95% CI 0.41–0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19–9.34 and haematuria OR = 3.00, 95% CI 1...

  1. Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

    Energy Technology Data Exchange (ETDEWEB)

    So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)

    2012-01-15

    The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

  2. Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

    International Nuclear Information System (INIS)

    So, Young Ho; Choi, Young Ho; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung; Song, Soon Young

    2012-01-01

    The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; ± 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

  3. Focal intestinal lymphangiectasia: An unusual cause of acute overt obscure gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ashish Kumar Jha

    2014-01-01

    Full Text Available Detection of bleeding lesion in a patient of acute overt obscure gastrointestinal bleeding is a real challenge. Recently, authors have showed superiority of urgent capsule endoscopy (CE over angiography in patients with acute overt obscure gastrointestinal bleeding. Focal type of intestinal lymphangiectasia is a rare cause of acute gastrointestinal bleeding. Here, we describe a case of focal lymphangiectasia who presented to us with acute overt obscure gastrointestinal bleeding and diagnosed by urgent CE.

  4. The Effects of the Tractor and Semitrailer Routing Problem on Mitigation of Carbon Dioxide Emissions

    Directory of Open Access Journals (Sweden)

    Hongqi Li

    2013-01-01

    Full Text Available The incorporation of CO2 emissions minimization in the vehicle routing problem (VRP is of critical importance to enterprise practice. Focusing on the tractor and semitrailer routing problem with full truckloads between any two terminals of the network, this paper proposes a mathematical programming model with the objective of minimizing CO2 emissions per ton-kilometer. A simulated annealing (SA algorithm is given to solve practical-scale problems. To evaluate the performance of the proposed algorithm, a lower bound is developed. Computational experiments on various problems generated randomly and a realistic instance are conducted. The results show that the proposed methods are effective and the algorithm can provide reasonable solutions within an acceptable computational time.

  5. Risk Factors for and Management of MPN-Associated Bleeding and Thrombosis.

    Science.gov (United States)

    Martin, Karlyn

    2017-10-01

    The Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) are characterized by both thrombotic and bleeding complications. The purpose of this review is to describe the risk factors associated with bleeding and thrombosis in MPN, as well as to review prevention strategies and management of these complications. Well-described risk factors for thrombotic complications include older age and history of prior thrombosis, along with traditional cardiovascular and venous thromboembolic risk factors. More recently, JAK2 V617F mutation has been found to carry an increased risk of thrombotic complications, whereas CALR has a lower risk than JAK2 mutation. Factors associated with an increased risk of bleeding in MPN include a prior history of bleeding, acquired von Willebrand syndrome, and primary myelofibrosis. Recent findings suggest that thrombocytosis carries a higher risk of bleeding than thrombosis in MPN, and aspirin may exacerbate this risk of bleeding, particularly in CALR-mutated ET. Much of the management of MPN focuses on predicting risk of bleeding and thrombosis and initiating prophylaxis to prevent complications in those at high risk of thrombosis. Emerging evidence suggests that sub-populations may have bleeding risk that outweighs thrombotic risk, particularly in setting of antiplatelet therapy. Future work is needed to better characterize this balance. At present, a thorough assessment of the risks of bleeding and thrombosis should be undertaken for each patient, and herein, we review risk factors for and management of these complications.

  6. The bleeding time may be longer in children than in adults.

    Science.gov (United States)

    Sanders, J M; Holtkamp, C A; Buchanan, G R

    1990-01-01

    The bleeding time, the most frequently performed test reflecting in vivo platelet function, is the duration of blood flow from a standardized incision on the volar surface of the forearm. Normal values have been determined in adult subjects, but with the exception of neonates, data on the range of bleeding time values in pediatric patients are unavailable. Standard hematology textbooks imply that bleeding time values in children are similar to those of adults. We have reviewed our 9 years of experience with 137 children (mean age 6.5 years) who were referred for diagnostic evaluation of a bleeding disorder but whose history and physical examination were felt by us to be inconsistent with an abnormality of hemostasis. Bleeding time values in these individuals (mean 6.0 min, 95th percentile 9.0 min) were compared with those of 85 normal adult volunteers (mean 4.4 min, 95th percentile 6.5 min). The Simplate-I disposable device and vertical (perpendicular to elbow crease) incision direction were used in both groups. This difference between the pediatric and adult bleeding time values is statistically significant (p less than 0.0001). Neither age nor sex had a significant effect on the pediatric bleeding time measurements. We conclude that the bleeding time, when performed as described, is longer in children than in adults and that pediatric standards for bleeding time should be used in order to avoid a spurious diagnosis of a primary hemostatic disorder in some normal children.

  7. Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy.

    Science.gov (United States)

    Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae

    2013-12-07

    Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.

  8. Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

    Science.gov (United States)

    Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E.; Paik, Jane; Chertow, Glenn M.; Desai, Manisha

    2012-01-01

    Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; Pupper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial. PMID:22266666

  9. EPIDEMIOLOGICAL CORRELATES OF POSTMENOPAUSAL BLEEDING IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sonia Arora

    2012-06-01

    Full Text Available Background: A woman is considered menopausal after 12 months of amenorrhea. The most feared symptom during menopause is postmenopausal bleeding which unless proved otherwise indicates genital malignancy. Objectives: To study Socio-demographic factors related to postmenopausal bleeding and to find time lapse between bleeding and reporting of these cases. Material and Methods: This cross sectional was done in the Department of Obstetrics & Gynecology, Pt. J. N. M. Medical College & DR. B. R. Ambedkar Memorial, Hospital, Raipur (C. G. The participants were 146 women who came with the complaint of postmenopausal bleeding. A detailed, preceded, pre-tested, structured, close ended questionnaire was used to collect the data. By interviewing these women, information was collected about different demographic factors like age, socio-economic status, parity etc. The collected data was put in the master chart and analyzed. Results: The proportion of postmenopausal bleeding cases was 3.5% .Maximum cases(50% with postmenopausal bleeding were found in the age group of 45-54yrs . 60 % of patients were from rural areas and 62% were illiterate. 65% of the patients were grand multipara (Parity4. Most of the patients belonged to lower socioeconomic strata. Almost half (48% of patients presented after, more than 6 months since the first episode of bleeding . Conclusions: The proportion of postmenopausal bleeding is high, requiring immediate investigation. Lack of awareness led to very late presentation of most of the patients, so education at community level is required to reduce this time lapse for earlier diagnosis and management

  10. [Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study?].

    Science.gov (United States)

    Lee, Su Hyun; Jung, Jin Tae; Lee, Dong Wook; Ha, Chang Yoon; Park, Kyung Sik; Lee, Si Hyung; Yang, Chang Heon; Park, Youn Sun; Jeon, Seong Woo

    2015-08-01

    Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n = 62), hemoclipping only; group 2 (n = 88), hemoclipping plus epinephrine injection; and group 3 (n = 36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p bleeding associated mortality and total mortality) were not different among groups. Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.

  11. Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

    International Nuclear Information System (INIS)

    D'Othee, Bertrand Janne; Surapaneni, Padmaja; Rabkin, Dmitry; Nasser, Imad; Clouse, Melvin

    2006-01-01

    Purpose. To assess outcomes after microcoil embolization for active lower gastrointestinal (GI) bleeding. Methods. We retrospectively studied all consecutive patients in whom microcoil embolization was attempted to treat acute lower GI bleeding over 88 months. Baseline, procedural, and outcome parameters were recorded following current Society of Interventional Radiology guidelines. Outcomes included technical success, clinical success (rebleeding within 30 days), delayed rebleeding (>30 days), and major and minor complication rates. Follow-up consisted of clinical, endoscopic, and pathologic data. Results. Nineteen patients (13 men, 6 women; mean age ± 95% confidence interval = 70 ± 6 years) requiring blood transfusion (10 ± 3 units) had angiography-proven bleeding distal to the marginal artery. Main comorbidities were malignancy (42%), coagulopathy (28%), and renal failure (26%). Bleeding was located in the small bowel (n = 5), colon (n 13) or rectum (n = 1). Technical success was obtained in 17 patients (89%); 2 patients could not be embolized due to vessel tortuosity and stenoses. Clinical follow-up length was 145 ± 75 days. Clinical success was complete in 13 (68%), partial in 3 (16%), and failed in 2 patients (11%). Delayed rebleeding (3 patients, 27%) was always due to a different lesion in another bowel segment (0 late rebleeding in embolized area). Two patients experienced colonic ischemia (11%) and underwent uneventful colectomy. Two minor complications were noted. Conclusion. Microcoil embolization for active lower GI bleeding is safe and effective in most patients, with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischemia and late rebleeding

  12. Percutaneous transsplenic varices embolization for upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Zhang Qiang; Li Jingyu; Lu Junliang; Xu Liyang; Liu Tao

    2010-01-01

    Objective: To investigate the value of percutaneous transsplenic varices embolization (PTSVE) for treatment of upper gastrointestinal bleeding. Methods: Twenty cases with liver cirrhosis and portal hypertension suffered upper gastrointestinal bleeding. PTSVE was administered to them with hardener and coils. Among them, 8 cases had massive hepatocellular carcinoma (HCC) in right lobe; 10 cases with hepatocellular carcinoma had portal vein tumor thrombus and occlusion; the other two cases with liver cirrhosis had portal vein thrombosis. All of these cases were not suitable for percutaneous transhepatic varices embolization (PTHVE). PTSVE was performed under the guidance of fluoroscopy. Results: Technical success was achieved in 18 patients. A total of 35 gastric coronary veins were embolized. In all these cases, upper gastrointestinal bleeding stopped after PTSVE. There was no recurrence within 1 month follow-up. No serious complication occurred. Conclusion: PTSVE is a safe and efficient alternative treatment for upper gastrointestinal bleeding, especially for cases with portal vein occlusion or with massive HCC in right lobe of liver. (authors)

  13. Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients

    NARCIS (Netherlands)

    Batman, B.; van Bladel, E. R.; van Hamersveld, M.; Pasker-De Jong, Pieternel C M; Korporaal, S. J.A.; Urbanus, R. T.; Roest, M.; Boven, Leonie A; Fijnheer, R.

    2017-01-01

    Background and objective: Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric

  14. Bleed water testing program for controlled low strength material

    International Nuclear Information System (INIS)

    Langton, C.A.

    1996-01-01

    Bleed water measurements for two Controlled Low Strength Material (CLSM) mixes were conducted to provide engineering data for the Tank 20F closure activities. CLSM Mix 1 contained 150 pounds of cement per cubic yard whereas CLSM Mix 2 contained 50 pounds per cub yard. SRS currently used CLSM Mix 2 for various applications. Bleed water percentages and generation rates were measured along with flow and compressive strength. This information will be used to select a mix design for the Tank 20F closure activities and to establish the engineering requirements, such as, lift height, time required between lifts and quantity of bleed water to be removed from the tank during the placement activities. Mix 1 is recommended for placement within Tank 20F because it has better flow characteristics, less segregation, lower percentage of bleed water and slightly higher strength. Optimization of Mix 1 was beyond the scope of this study. However, further testing of thickening additives, such as clays (bentonite), sodium silicate or fine silicas maybe useful for decreasing or eliminating bleed water

  15. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration.

    Science.gov (United States)

    Singh, Pratibha

    2018-01-01

    Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41-45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of

  16. Recombinant activated factor VII in the treatment of bleeds and for the prevention of surgery-related bleeding in congenital haemophilia with inhibitors.

    Science.gov (United States)

    Santagostino, Elena; Escobar, Miguel; Ozelo, Margareth; Solimeno, Luigi; Arkhammar, Per; Lee, Hye Youn; Rosu, Gabriela; Giangrande, Paul

    2015-06-01

    The availability of recombinant activated factor VII (rFVIIa, eptacog alfa activated) has greatly advanced the care of patients with haemophilia A or B who have developed inhibitors against the infused replacement factor. Recombinant FVIIa is licensed for the on-demand treatment of bleeding episodes and the prevention of bleeding in surgery or invasive procedures in patients with congenital haemophilia with inhibitors. This article attempts to review in detail the extensive evidence of rFVIIa in congenital haemophilia patients with inhibitors. Patients with acute bleeding episodes are best treated on demand at home, to achieve the short- and long-term benefits of rapid bleed control. Key prospective studies have shown that rFVIIa achieves consistently high efficacy rates in the management of acute (including joint) bleeds in inhibitor patients in the home treatment setting. Substantial post-approval data from key registries also support the on-demand efficacy profile of rFVIIa established by the prospective clinical trials. The availability of rFVIIa has allowed major surgery to become a reality for inhibitor patients. Studies in key surgery, including orthopaedic procedures, have found that rFVIIa provides consistently high efficacy rates. Importantly, the wealth of data does not raise any unexpected safety concerns surrounding rFVIIa use; this is likely because rFVIIa is a recombinant product with a localised mechanism of action at the site of vascular injury. In summary, rFVIIa is established as an effective and well-tolerated first-line treatment for on-demand bleeding control and bleed prevention during minor and major (including elective orthopaedic) surgery in inhibitor patients. Use of rFVIIa has been a major step towards narrowing the gap in outcomes between inhibitor patients and non-inhibitor patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women.

    Science.gov (United States)

    Singh, Sukhbir; Best, Carolyn; Dunn, Sheila; Leyland, Nicholas; Wolfman, Wendy Lynn

    2018-05-01

    Abnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem. To provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age. Outcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB. Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. Abnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions

  18. Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Subramaniam, Kavitha; Spilsbury, Katrina; Ayonrinde, Oyekoya T; Latchmiah, Faye; Mukhtar, Syed A; Semmens, James B; Leahy, Michael F; Olynyk, John K

    2016-04-01

    Blood products are commonly transfused for patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). While concerns exist about further bleeding and mortality in subsets of patients receiving red blood cell (RBC) transfusion, the impact of non-RBC blood products has not previously been systematically investigated. The aim of the study was to investigate the associations between blood products transfusion, further bleeding, and mortality after acute NVUGIB. A retrospective cohort study examined further bleeding and 30-day and 1-year mortality in adult patients who underwent gastroscopy for suspected acute NVUGIB between 2008 and 2010 in three tertiary hospitals in Western Australia. Survival analysis was performed. A total of 2228 adults (63% male) with 2360 hospital admissions for NVUGIB met the inclusion criteria. Median age at presentation was 70 years (range, 19-99 years). Thirty-day mortality was 4.9% and 1-year mortality was 13.9%. Transfusion of 4 or more units of RBCs was associated with greater than 10 times the odds of further bleeding in patients with a hemoglobin level of more than 90 g/L (odds ratio, 11.9; 95% confidence interval [CI], 3.1-45.7; p ≤ 0.001), but was not associated with mortality. Administration of 5 or more units of fresh-frozen plasma (FFP) was associated with increased 30-day (hazard ratio, 2.8; 95% CI, 1.3-5.9; p = 0.008) and 1-year (hazard ratio, 2.6; 95% CI, 1.3-5.0; p = 0.005) mortality after adjusting for coagulopathy, comorbidity, Rockall score, and other covariates. In this large, multicenter study of NVUGIB, RBC transfusion was associated with further bleeding but not mortality, while FFP transfusion was associated with increased mortality in a subset of patients. © 2015 AABB.

  19. Operational performance of agricultural tractor in function of interior and metropolitano diesel mixture in mamona biodiesel

    Energy Technology Data Exchange (ETDEWEB)

    Tabile, Rubens Andre [Universidade de Sao Paulo (EESC/USP), Sao Carlos, SP (Brazil). Escola de Engenharia; Lopes, Afonso; Toledo, Anderson de; Reis, Gustavo Naves dos; Silva, Rouverson Pereira da [Universidade Estadual Paulista (DER/UNESP), Jaboticabal, SP (Brazil). Dept. de Engenharia Rural

    2008-07-01

    The great demand for energy sources by production systems allied to scarcity of fossil fuels has motivated the development and production of biodiesel, this is a fuel produced from renewable sources. Given that, the objective of this study was to compare the operating performance of an agricultural tractor, operating with interior and metropolitano diesel mixed to mamona biodiesel, in seven proportions. The tests were conducted in the Departamento de Engenharia Rural of UNESP/Jaboticabal - SP. The results showed that the kind of diesel did influence fuel consumption, and diesel metropolitano showed best quality. It was also observed that as biodiesel proportion increased, fuel consumption increased as well. (author)

  20. Bleeding gastrointestinal stromal tumour of the stomach complicated ...

    African Journals Online (AJOL)

    Inferior vena cava filter insertion was not possible due to non-availability. Coexistence of DVT needing anticoagulation and bleeding gastric GIST requiring urgent resection presented a management dilemna. Despite the risk, the patient was taken for an emergency tumor resection primarily to stop the bleeding and facilitate ...

  1. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  2. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A

    2014-01-01

    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies...

  3. Premenopausal abnormal uterine bleeding and risk of endometrial cancer.

    Science.gov (United States)

    Pennant, M E; Mehta, R; Moody, P; Hackett, G; Prentice, A; Sharp, S J; Lakshman, R

    2017-02-01

    Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy. © 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal

  4. Costs of major intracranial, gastrointestinal and other bleeding events in patients with atrial fibrillation - a nationwide cohort study.

    Science.gov (United States)

    Jakobsen, Marie; Kolodziejczyk, Christophe; Klausen Fredslund, Eskild; Poulsen, Peter Bo; Dybro, Lars; Paaske Johnsen, Søren

    2017-06-12

    Use of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events. Different anticoagulation therapies have different safety profiles and data on the societal costs of both ischemic stroke and bleeding events are necessary for assessing the cost-effectiveness and budgetary impact of different treatment options. To our knowledge, no previous studies have estimated the societal costs of bleeding events in patients with AF. The objective of this study was to estimate the 3-years societal costs of first-incident intracranial, gastrointestinal and other major bleeding events in Danish patients with AF. The study was an incidence-based cost-of-illness study carried out from a societal perspective and based on data from national Danish registries covering the period 2002-2012. Costs were estimated using a propensity score matching and multivariable regression analysis (first difference OLS) in a cohort design. Average 3-years societal costs attributable to intracranial, gastrointestinal and other major bleeding events were 27,627, 17,868, and 12,384 EUR per patient, respectively (2015 prices). Existing evidence shows that the corresponding costs of ischemic stroke were 24,084 EUR per patient (2012 prices). The average costs of bleeding events did not differ between patients with AF who were on oral anticoagulation therapy prior to the event and patients who were not. The societal costs attributable to major bleeding events in patients with AF are significant. Intracranial haemorrhages are most costly to society with average costs of similar magnitude as the costs of ischemic stroke. The average costs of gastrointestinal and other major bleeding events are lower than the costs of intracranial haemorrhages, but still substantial. Knowledge about the relative size of the costs of bleeding events compared to ischemic stroke in patients with AF constitutes

  5. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

    Energy Technology Data Exchange (ETDEWEB)

    Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Wildi, Stefan [University Hospital Zurich, Department of Visceral and Transplant Surgery, Zurich (Switzerland); Bauerfeind, Peter [University Hospital Zurich, Division of Gastroenterology, Zurich (Switzerland)

    2007-06-15

    This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)

  6. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

    International Nuclear Information System (INIS)

    Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem; Wildi, Stefan; Bauerfeind, Peter

    2007-01-01

    This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)

  7. Mortality caused by intracranial bleeding in non-severe hemophilia A patients.

    Science.gov (United States)

    Loomans, J I; Eckhardt, C L; Reitter-Pfoertner, S E; Holmström, M; van Gorkom, B Laros; Leebeek, F W G; Santoro, C; Haya, S; Meijer, K; Nijziel, M R; van der Bom, J G; Fijnvandraat, K

    2017-06-01

    Essentials Data on bleeding-related causes of death in non-severe hemophilia A (HA) patients are scarce. Such data may provide new insights into areas of care that can be improved. Non-severe HA patients have an increased risk of dying from intracranial bleeding. This demonstrates the need for specialized care for non-severe HA patients. Background Non-severe hemophilia (factor VIII concentration [FVIII:C] of 2-40 IU dL -1 ) is characterized by a milder bleeding phenotype than severe hemophilia A. However, some patients with non-severe hemophilia A suffer from severe bleeding complications that may result in death. Data on bleeding-related causes of death, such as fatal intracranial bleeding, in non-severe patients are scarce. Such data may provide new insights into areas of care that can be improved. Aims To describe mortality rates, risk factors and comorbidities associated with fatal intracranial bleeding in non-severe hemophilia A patients. Methods We analyzed data from the INSIGHT study, an international cohort study of all non-severe hemophilia A patients treated with FVIII concentrates during the observation period between 1980 and 2010 in 34 participating centers across Europe and Australia. Clinical data and vital status were collected from 2709 patients. We report the standardized mortality rate for patients who suffered from fatal intracranial bleeding, using a general European male population as a control population. Results Twelve per cent of the 148 deceased patients in our cohort of 2709 patients died from intracranial bleeding. The mortality rate between 1996 and 2010 for all ages was 3.5-fold higher than that in the general population (95% confidence interval [CI] 2.0-5.8). Patients who died from intracranial bleeding mostly presented with mild hemophilia without clear comorbidities. Conclusion Non-severe hemophilia A patients have an increased risk of dying from intracranial bleeding in comparison with the general population. This demonstrates the

  8. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  9. No impact of fish oil supplements on bleeding risk

    DEFF Research Database (Denmark)

    Begtrup, Katrine Munk; Krag, Andreas Engel; Hvas, Anne-Mette

    2017-01-01

    Abstract Introduction: Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether...... of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. Conclusion: Fish oil...... supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior...

  10. Modern issues on the treatment of peptic ulcer bleedings

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2014-03-01

    Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

  11. Post-biliary sphincterotomy bleeding despite covered metallic stent deployment

    Directory of Open Access Journals (Sweden)

    Gianfranco Donatelli

    2016-05-01

    Full Text Available Objectives: Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail. Methods-results: We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding. Conclusions: Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist.

  12. What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding?

    NARCIS (Netherlands)

    van Doorn, H. C.; Timmermans, A.; Opmeer, B. C.; Kruitwagen, R. F. M. P.; Dijkhuizen, F. P. H. L. J.; Kooi, G. S.; van de Weijer, P. H. M.; Mol, B. W. J.

    2008-01-01

    Objective. To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness <= 4 mm after a first episode of postmenopausal bleeding. Methods. Consecutive patients not using hormone replacement therapy (HRT) presenting with a first

  13. Risk factors for bleeding complications after nephrologist-performed native renal biopsy.

    Science.gov (United States)

    Lees, Jennifer S; McQuarrie, Emily P; Mordi, Natalie; Geddes, Colin C; Fox, Jonathan G; Mackinnon, Bruce

    2017-08-01

    Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding. We identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding. There were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P 30). The risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy.

  14. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study

    Directory of Open Access Journals (Sweden)

    Lash Timothy L

    2010-01-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors (SSRI decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association. Methods We conducted a population-based study of the risk of re-operation due to post-surgical bleeding within two weeks of primary surgery among Danish women with primary breast cancer. Patients were categorised according to their use of SSRI: never users, current users (SSRI prescription within 30 days of initial breast cancer surgery, and former users (SSRI prescription more than 30 days before initial breast cancer surgery. We calculated the risk of re-operation due to post-surgical bleeding within 14 days of initial surgery, and the relative risk (RR of re-operation comparing SSRI users with never users of SSRI adjusting for potential confounders. Results 389 of 14,464 women (2.7% were re-operated. 1592 (11% had a history of SSRI use. Risk of re-operation was 2.6% among never users, 7.0% among current SSRI users, and 2.7% among former users. Current users thus had an increased risk of re-operation due to post-operative bleeding (adjusted relative risk = 2.3; 95% confidence interval (CI = 1.4, 3.9 compared with never users. There was no increased risk of re-operation associated with former use of SSRI (RR = 0.93, 95% CI = 0.66, 1.3. Conclusions Current use of SSRI is associated with an increased risk of re-operation due to bleeding after surgery for breast cancer.

  15. Endovascular management for significant iatrogenic portal vein bleeding.

    Science.gov (United States)

    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-11-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  16. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

    Energy Technology Data Exchange (ETDEWEB)

    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  17. Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke.

    Science.gov (United States)

    Stone, David H; Nolan, Brian W; Schanzer, Andres; Goodney, Philip P; Cambria, Robert A; Likosky, Donald S; Walsh, Daniel B; Cronenwett, Jack L

    2010-03-01

    Controversy persists regarding the use of protamine during carotid endarterectomy (CEA) based on prior conflicting reports documenting both reduced bleeding as well as increased stroke risk. The purpose of this study was to determine the effect of protamine reversal of heparin anticoagulation on the outcome of CEA in a contemporary multistate registry. We reviewed a prospective regional registry of 4587 CEAs in 4311 patients performed by 66 surgeons from 11 centers in Northern New England from 2003-2008. Protamine use varied by surgeon (38% routine use, 44% rare use, 18% selective use). Endpoints were postoperative bleeding requiring reoperation as well as potential thrombotic complications, including stroke, death, and myocardial infarction (MI). Predictors of endpoints were determined by multivariate logistic regression after associated variables were identified by univariate analysis. Of the 4587 CEAs performed, 46% utilized protamine, while 54% did not. Fourteen patients (0.64%) in the protamine-treated group required reoperation for bleeding compared with 42 patients (1.66%) in the untreated cohort (P = .001). Protamine use did not affect the rate of MI (1.1% vs 0.91%, P = .51), stroke (0.78% vs 1.15%, P = .2), or death (0.23% vs 0.32%, P = .57) between treated and untreated patients, respectively. By multivariate analysis, protamine (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.17-0.63; P = .001) and patch angioplasty (OR 0.46, 95% CI, 0.26-0.81; P = .007) were independently associated with diminished reoperation for bleeding. A single center was associated with a significantly higher rate of reoperation for bleeding (OR 6.47, 95% CI, 3.02-13.9; P < .001). Independent of protamine use, consequences of reoperation for bleeding were significant, with a four-fold increase in MI, a seven-fold increase in stroke, and a 30-fold increase in death. Protamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke

  18. Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding.

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2015-05-28

    To distinguish upper from lower gastrointestinal (GI) bleeding. Patient records between April 2011 and March 2014 were analyzed retrospectively (3296 upper endoscopy, and 1520 colonoscopy). Seventy-six patients had upper GI bleeding (Upper group) and 65 had lower GI bleeding (Lower group). Variables were compared between the groups using one-way analysis of variance. Logistic regression was performed to identify variables significantly associated with the diagnosis of upper vs lower GI bleeding. Receiver-operator characteristic (ROC) analysis was performed to determine the threshold value that could distinguish upper from lower GI bleeding. Hemoglobin (P = 0.023), total protein (P = 0.0002), and lactate dehydrogenase (P = 0.009) were significantly lower in the Upper group than in the Lower group. Blood urea nitrogen (BUN) was higher in the Upper group than in the Lower group (P = 0.0065). Logistic regression analysis revealed that BUN was most strongly associated with the diagnosis of upper vs lower GI bleeding. ROC analysis revealed a threshold BUN value of 21.0 mg/dL, with a specificity of 93.0%. The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/dL.

  19. The use of selective serotonin receptor inhibitors (SSRIs) is not associated with increased risk of endoscopy-refractory bleeding, rebleeding or mortality in peptic ulcer bleeding.

    Science.gov (United States)

    Laursen, S B; Leontiadis, G I; Stanley, A J; Hallas, J; Schaffalitzky de Muckadell, O B

    2017-08-01

    Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRIs is often temporarily withheld in patients with peptic ulcer bleeding. However, abrupt discontinuation of SSRIs is associated with development of withdrawal symptoms in one-third of patients. Further data are needed to clarify whether treatment with SSRIs is associated with poor outcomes, which would support temporary discontinuation of treatment. To identify if treatment with SSRIs is associated with increased risk of: (1) endoscopy-refractory bleeding, (2) rebleeding or (3) 30-day mortality due to peptic ulcer bleeding. A nationwide cohort study. Analyses were performed on prospectively collected data on consecutive patients admitted to hospital with peptic ulcer bleeding in Denmark in the period 2006-2014. Logistic regression analyses were used to investigate the association between treatment with SSRIs and outcome following adjustment for pre-defined confounders. Sensitivity and subgroup analyses were performed to evaluate the validity of the findings. A total of 14 343 patients were included. Following adjustment, treatment with SSRIs was not associated with increased risk of endoscopy-refractory bleeding (odds ratio [OR] [95% Confidence Interval (CI)]: 1.03 [0.79-1.33]), rebleeding (OR [95% CI]: 0.96 [0.83-1.11]) or 30-day mortality (OR [95% CI]: 1.01 [0.85-1.19]. These findings were supported by sensitivity and subgroup analyses. According to our data, treatment with SSRIs does not influence the risk of endoscopy-refractory bleeding, rebleeding or 30-day mortality in peptic ulcer bleeding. © 2017 John Wiley & Sons Ltd.

  20. Preventive Strategies against Bleeding due to Nonvitamin K Antagonist Oral Anticoagulants

    Directory of Open Access Journals (Sweden)

    Lessire Sarah

    2014-01-01

    Full Text Available Dabigatran etexilate (DE, rivaroxaban, and apixaban are nonvitamin K antagonist oral anticoagulants (NOACs that have been compared in clinical trials with existing anticoagulants (warfarin and enoxaparin in several indications for the prevention and treatment of thrombotic events. All NOACs presented bleeding events despite a careful selection and control of patients. Compared with warfarin, NOACs had a decreased risk of intracranial hemorrhage, and apixaban and DE (110 mg BID had a decreased risk of major bleeding from any site. Rivaroxaban and DE showed an increased risk of major gastrointestinal bleeding compared with warfarin. Developing strategies to minimize the risk of bleeding is essential, as major bleedings are reported in clinical practice and specific antidotes are currently not available. In this paper, the following preventive approaches are reviewed: improvement of appropriate prescription, identification of modifiable bleeding risk factors, tailoring NOAC’s dose, dealing with a missed dose as well as adhesion to switching, bridging and anesthetic procedures.

  1. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients

    DEFF Research Database (Denmark)

    Schulman, S; Angerås, U; Bergqvist, D

    2010-01-01

    subcommittee on Control of Anticoagulation, of the International Society on Thrombosis and Haemostasis has previously published a recommendation for a harmonized definition of major bleeding in non-surgical studies. That definition has been adopted by the European Medicines Agency and is currently used......The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its...... in several non-surgical trials. A preliminary proposal for a parallel definition for surgical studies was presented at the 54(th) Annual Meeting of the SSC in Vienna, July 2008. Based on those discussions and further consultations with European and North American surgeons with experience from clinical trials...

  2. Bayesian network modelling of upper gastrointestinal bleeding

    Science.gov (United States)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  3. A novel semi-quantitative method for measuring tissue bleeding.

    Science.gov (United States)

    Vukcevic, G; Volarevic, V; Raicevic, S; Tanaskovic, I; Milicic, B; Vulovic, T; Arsenijevic, S

    2014-03-01

    In this study, we describe a new semi-quantitative method for measuring the extent of bleeding in pathohistological tissue samples. To test our novel method, we recruited 120 female patients in their first trimester of pregnancy and divided them into three groups of 40. Group I was the control group, in which no dilation was applied. Group II was an experimental group, in which dilation was performed using classical mechanical dilators. Group III was also an experimental group, in which dilation was performed using a hydraulic dilator. Tissue samples were taken from the patients' cervical canals using a Novak's probe via energetic single-step curettage prior to any dilation in Group I and after dilation in Groups II and III. After the tissue samples were prepared, light microscopy was used to obtain microphotographs at 100x magnification. The surfaces affected by bleeding were measured in the microphotographs using the Autodesk AutoCAD 2009 program and its "polylines" function. The lines were used to mark the area around the entire sample (marked A) and to create "polyline" areas around each bleeding area on the sample (marked B). The percentage of the total area affected by bleeding was calculated using the formula: N = Bt x 100 / At where N is the percentage (%) of the tissue sample surface affected by bleeding, At (A total) is the sum of the surfaces of all of the tissue samples and Bt (B total) is the sum of all the surfaces affected by bleeding in all of the tissue samples. This novel semi-quantitative method utilizes the Autodesk AutoCAD 2009 program, which is simple to use and widely available, thereby offering a new, objective and precise approach to estimate the extent of bleeding in tissue samples.

  4. Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

    Directory of Open Access Journals (Sweden)

    V. V. Izbitsky

    2013-06-01

    Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

  5. Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies.

    Science.gov (United States)

    Shatzel, J J; Olson, S R; Tao, D L; McCarty, O J T; Danilov, A V; DeLoughery, T G

    2017-05-01

    Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase (Btk) that has proven to be an effective therapeutic agent for multiple B-cell-mediated lymphoproliferative disorders. Ibrutinib, however, carries an increased bleeding risk compared with standard chemotherapy. Bleeding events range from minor mucocutaneous bleeding to life-threatening hemorrhage, due in large part to the effects of ibrutinib on several distinct platelet signaling pathways. There is currently a minimal amount of data to guide clinicians regarding the use of ibrutinib in patients at high risk of bleeding or on anticoagulant or antiplatelet therapy. In addition, the potential cardiovascular protective effects of ibrutinib monotherapy in patients at risk of vascular disease are unknown. Patients should be cautioned against using non-steroidal anti-inflammatory drugs, fish oils, vitamin E and aspirin-containing products, and consider replacing ibrutinib with a different agent if dual antiplatelet therapy is indicated. Patients should not take vitamin K antagonists concurrently with ibrutinib; direct oral anticoagulants should be used if extended anticoagulation is strongly indicated. In this review, we describe the pathophysiology of ibrutinib-mediated bleeding and suggest risk reduction strategies for common clinical scenarios associated with ibrutinib. © 2017 International Society on Thrombosis and Haemostasis.

  6. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies.

    Science.gov (United States)

    Vaidya, S; Lakhey, M; Vaidya, S; Sharma, P K; Hirachand, S; Lama, S; KC, S

    2013-03-01

    Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.

  7. Evaluation and Management of Adolescents with Abnormal Uterine Bleeding.

    Science.gov (United States)

    Mullins, Tanya L Kowalczyk; Miller, Rachel J; Mullins, Eric S

    2015-09-01

    The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB. Copyright 2015, SLACK Incorporated.

  8. Clinical approach to obscure GI bleeding - Diagnostic testing and management

    Directory of Open Access Journals (Sweden)

    Prashanth Prabakaran

    2013-01-01

    Full Text Available Obscure gastrointestinal bleeding (OGIB can present as a diagnostic dilemma and management can be challenging. The search for causes of OGIB is usually centered on visualizing the small bowel, and in the past decade, the technology to visualize the entire small bowel has significantly advanced. Moreover, small bowel endoscopic imaging has replaced, in many instances, prior radiographic evaluation for obscure GI bleeding. These new modalities, such as small bowel capsule endoscopy (CE, balloon-assisted deep enteroscopy [double balloon enteroscopy (DBE and single balloon enteroscopy (SBE], and overtube-assisted deep enteroscopy (spiral enteroscopy, are paving the way toward more accurately identifying and treating patients with OGIB. We will review the diagnostic modalities available in evaluating a patient with OGIB and also propose the management based on clinical and endoscopic findings.

  9. Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

    Science.gov (United States)

    Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

    2016-04-01

    To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

  10. Knee arthroplasty and bleeding: when to remove drainages.

    Science.gov (United States)

    Ares, Oscar; Seijas, Roberto; Hernandez, Alberto; Castellet, Enric; Sallent, Andrea

    2013-02-01

    The aim of this study is an attempt to clarify the productive time of drainages as we find that the use of drains in knee arthroplasty is controversial, and there is no consensus regarding their length-time maintenance. We analysed the survival curve of bleeding within three surgical techniques for knee arthroplasty and the effect of two variables on survival curve. One hundred and eighty-eight out of 234 knees were included in the study, and patients were divided into three groups according to the surgical technique: conventional total knee arthroplasty (TKA), subvastus TKA and unicompartmental knee arthroplasty. Variables of study were type of surgery, number and placement of drains. Mean of survival curve for postoperative bleeding time was 16 h (95 % CI: 15.4; 16.6). The risk for longer bleeding increased 1.38-fold with each additional drain used (95 % CI 1.1; 1.8). According to the present study, drains can be safely removed at around 17 h postoperative. Bleeding time reduces as less drains are applied. Therapeutic study, Level III.

  11. Interventions for treating acute bleeding episodes in people with acquired hemophilia A.

    Science.gov (United States)

    Zeng, Yan; Zhou, Ruiqing; Duan, Xin; Long, Dan; Yang, Songtao

    2014-08-28

    Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies to coagulation factor VIII (FVIII). In most cases, bleeding episodes are spontaneous and severe at presentation. The optimal hemostatic therapy is controversial. To determine the efficacy of hemostatic therapies for acute bleeds in people with acquired hemophilia A; and to compare different forms of therapy for these bleeds. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 4) and MEDLINE (Ovid) (1948 to 30 April 2014). We searched the conference proceedings of the: American Society of Hematology; European Hematology Association; International Society on Thrombosis and Haemostasis (ISTH); and the European Association for Haemophilia and Allied Disorders (EAHAD) (from 2000 to 30 April 2014). In addition to this we searched clinical trials registers. All randomised controlled trials and quasi-randomised trials of hemostatic therapies for people with acquired hemophilia A, with no restrictions on gender, age or ethnicity. No trials matching the selection criteria were eligible for inclusion. No trials matching the selection criteria were eligible for inclusion. No randomised clinical trials of hemostatic therapies for acquired hemophilia A were found. Thus, we are not able to draw any conclusions or make any recommendations on the optimal hemostatic therapies for acquired hemophilia A based on the highest quality of evidence. GIven that carrying out randomized controlled trials in this field is a complex task, the authors suggest that, while planning randomised controlled trials in which patients can be enrolled, clinicians treating the disease continue to base their choices on alternative, lower quality sources of evidence, which hopefully, in the future, will also be appraised and incorporated in a Cochrane Review.

  12. Transvaginal Ultrasound for the Diagnosis of Abnormal Uterine Bleeding.

    Science.gov (United States)

    Wheeler, Karen C; Goldstein, Steven R

    2017-03-01

    Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. In this article we discuss specific ultrasound findings and technical considerations useful in the diagnosis of abnormal uterine bleeding.

  13. Clival chordoma manifesting as nasal bleeding. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma [University of Fukui, Department of Neurosurgery, Fukui (Japan); Nakajima, Hirofumi [Tsuruga Municipal Hospital, Department of Neurosurgery, Fukui (Japan)

    2005-05-01

    Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

  14. Clival chordoma manifesting as nasal bleeding. A case report

    International Nuclear Information System (INIS)

    Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma; Nakajima, Hirofumi

    2005-01-01

    Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

  15. Bleeding complications in BCR-ABL negative myeloproliferative neoplasms: prevalence, type, and risk factors in a single-center cohort.

    Science.gov (United States)

    Kander, Elizabeth M; Raza, Sania; Zhou, Zheng; Gao, Juehua; Zakarija, Anaadriana; McMahon, Brandon J; Stein, Brady L

    2015-11-01

    The BCR-ABL1-negative myeloproliferative neoplasms (MPN) share an increased risk of thrombotic and hemorrhagic complications. Risk factors for hemorrhage are less well defined than those for thrombosis. Because patients with CALR mutations have higher platelet counts compared to JAK2 V617F-mutated patients, bleeding rates may be increased in this group. Our aim was to retrospectively evaluate whether acquired von Willebrand disease (AvWD), thrombocytosis, mutational status, or treatment history are associated with bleeding in a cohort of MPN patients. Using an electronic database, MPN patients seen between 2005 and 2013 were retrospectively identified using ICD-9 codes and billing records. A bleeding event was defined as one that was identified in the medical record and graded based on the Common Terminology Criteria for Adverse Event (CTCAE) version 4.0. Among 351 MPN patients, 15.6 % experienced 64 bleeding event types. There was no association of bleeding with mutational status, gender, MPN subtype, aspirin use, prior thrombosis, or platelet count at presentation. There was an association between bleeding and older age at diagnosis. aVWD was identified in six patients. In this single-center retrospective study, bleeding events were identified in 15 % of patients, and associated with older age at diagnosis. aVWD was rarely tested for in this cohort.

  16. Outcome of the Pediatric Patients with Portal Cavernoma: The Retrospective Study for 10 Years Focusing on Recurrent Variceal Bleeding

    Directory of Open Access Journals (Sweden)

    Hongjie Guo

    2016-01-01

    Full Text Available Background. Portal cavernoma (PC is the most critical condition with risk or variceal hemorrhage in pediatric patients. We retrospectively investigated the patients with PC focusing on the predictors for recurrent variceal bleeding. Methods. Between July 2003 and June 2013, we retrospectively enrolled all consecutive patients admitted to our department with a diagnosis of PC without abdominal malignancy or liver cirrhosis. The primary endpoint of this observational study was recurrent variceal bleeding. Independent predictors of recurrent variceal bleeding were identified using the logistic regression model. Results. A total of 157 patients were enrolled in the study. During the follow-up period, 24 patients exhibited onset of recurrent variceal bleeding. Acute variceal bleeding was subjected to conservative symptomatic treatment and emergency endoscopic sclerotherapy. Surgical procedure selection was based on the severity of vascular dilation and collateral circulation. Multivariate logistic regression analysis demonstrated that the presence of ascites, collateral circulation, and portal venous pressure were independent prognostic factors of recurrent variceal bleeding for patients with portal cavernoma. Conclusions. The presence of ascites, collateral circulation, and portal venous pressure evaluation are important and could predict the postsurgical recurrent variceal bleeding in patients with portal cavernoma.

  17. Late rectal bleeding after 3D-CRT for prostate cancer: development of a neural-network-based predictive model

    Science.gov (United States)

    Tomatis, S.; Rancati, T.; Fiorino, C.; Vavassori, V.; Fellin, G.; Cagna, E.; Mauro, F. A.; Girelli, G.; Monti, A.; Baccolini, M.; Naldi, G.; Bianchi, C.; Menegotti, L.; Pasquino, M.; Stasi, M.; Valdagni, R.

    2012-03-01

    ANNs are superior to those achieved with LR when predicting late radiotherapy-related rectal bleeding. The future introduction of patient-related personal characteristics, such as gene expression profiles, might improve the predictive power of statistical classifiers. More refined morphological aspects of the dose distribution, such as dose surface mapping, might also enhance the overall performance of ANN-based predictive models.

  18. Hepatitis A and B immunization for individuals with inherited bleeding disorders.

    Science.gov (United States)

    Steele, M; Cochrane, A; Wakefield, C; Stain, A-M; Ling, S; Blanchette, V; Gold, R; Ford-Jones, L

    2009-03-01

    Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics.

  19. A STUDY ON UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Salla Surya Prakasa Rao

    2016-10-01

    Full Text Available BACKGROUND Vomiting of blood almost always proximal to the ligament of Treitz is the upper gastrointestinal haemorrhage. The incidence of acute upper gastrointestinal haemorrhage has been estimated to be 50-100 per 1,00,000 person per year, with an annual hospitalization rate of approximately 100 per 1, 00,000 hospital admission. This study is to find out the prevalence of nature of lesion on Upper Gastrointestinal Endoscopy in patients admitted for Gastrointestinal bleeding. (UGI Bleed. MATERIALS AND METHODS Place of Study- Department of General Medicine, Andhra Medical College, Visakhapatnam, India. Type of Study- Prospective study. Period of Study- July 2015 to August 2016. RESULTS The Results Study on Endoscopic Findings in Upper Gastro Intestinal Bleed are 1. The peptic ulcer disease was the most common lesion found on endoscopy with prevalence of 54%. 2. Varices contributes second common lesion, next to peptic ulcer disease in UGI bleed with prevalence of 16%. 3. Minor UGI bleed was the commonest presentation. Majority of lesions (60% presented with minor UGI bleed, 28% lesions presented as moderate UGI bleed. Only 8% presented as major UGI bleed. 4. Varices account for the most common cause for major UGI bleed contributing 50%. 5. Gastric ulcer was commonest lesions accounting for 37 cases (37% among 72 cases having single acid peptic lesions on endoscopy. The second most common is duodenal ulcer (31%. 6. Multiple lesions were found in 10% of cases. Peptic ulcer lesions were found in 20% of total number of varices cases. CONCLUSION Peptic ulcer disease was found to be most common lesion causing UGI bleed, with most common presentation as minor UGI bleed and variceal bleed being most common cause of major UGI bleed.

  20. Bleeding complications during anticoagulant treatment in patients with cancer

    NARCIS (Netherlands)

    Kamphuisen, Pieter W.; Beyer-Westendorf, Jan

    Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or

  1. Using narrow-band imaging with conventional hysteroscopy increases the detection of chronic endometritis in abnormal uterine bleeding and postmenopausal bleeding.

    Science.gov (United States)

    Ozturk, Mustafa; Ulubay, Mustafa; Alanbay, Ibrahim; Keskin, Uğur; Karasahin, Emre; Yenen, Müfit Cemal

    2016-01-01

    A preliminary study was designed to evaluate whether a narrow-band imaging (NBI) endoscopic light source could detect chronic endometritis that was not identifiable with a white light hysteroscope. A total of 86 patients with endometrial pathology (71 abnormal uterine bleeding and 15 postmenopausal bleeding) were examined by NBI endoscopy and white light hysteroscopy between February 2010 and February 2011. The surgeon initially observed the uterine cavity using white light hysteroscopy and made a diagnostic impression, which was recorded. Subsequently, after pressing a button on the telescope, NBI was used to reevaluate the endometrial mucosa. The median age of the patients was 40 years (range: 30-60 years). Endometritis was diagnosed histologically. Six cases of abnormal uterine bleeding (6/71, 8.4%, 95% confidence interval [CI] 0.03-0.17) and one case of postmenopausal bleeding (1/15, 6%, 95%CI 0.01-0.29) were only diagnosed with chronic endometritis by NBI (7/86, 8.1%, 95%CI 0.04-0.15). Capillary patterns of the endometrium can be observed by NBI and this method can be used to assess chronic endometritis. © 2015 Japan Society of Obstetrics and Gynecology.

  2. Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report.

    Science.gov (United States)

    Mohd Rizal, M Y; Kosai, N R; Sutton, P A; Rozman, Z; Razman, J; Harunarashid, H; Das, S

    2013-01-01

    Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.

  3. Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI).

    Science.gov (United States)

    Stępińska, Janina; Czerwińska, Katarzyna; Witkowski, Adam; Dąbrowski, Maciej; Chmielak, Zbigniew; Kuśmierski, Krzysztof; Hryniewiecki, Tomasz; Demkow, Marcin

    2013-01-01

    The risk of bleedings in transcatheter aortic valve implantation (TAVI) patients increases due to age and concomitant diseases. The aim of the study was to assess the risk of bleedings, their influence on early prognosis of TAVI patients and utility of the TIMI and GUSTO scales in the evaluation of bleeding and in prediction of blood transfusion. This was a single center study of in-hospital bleedings in 56 consecutive TAVI patients. Bleedings were classified according to the GUSTO and TIMI scales. HASBLED's scale risk factors, diabetes mellitus, female sex, the route of bioprosthesis implantation and inhospital antithrombotic treatment were analyzed. Statistical analysis consisted of c2, Fisher's exact, Wilcoxon tests and logistic regression analysis. Serious bleedings occurred in 35 (62.5%) patients. There was no significant correlation with HASBLED score. History of anemia was a significant predictor of bleeding in GUSTO (p = 0.0013) and TIMI (p = 0.048) scales. No bleedings in patients receiving vitamin K antagonists (VKA) pre- and VKA plus clopidogrel post intervention were observed. Patients with bleedings according to the GUSTO scale more often required blood tranfusion than in TIMI scale (p = 0.03). History of anemia is the strongest predictor of serious bleedings. VKA before and VKA with clopidogrel after TAVI are safer than dual antiplatelet or triple therapy. The TIMI and GUSTO scales can adequately classify bleeding after TAVI, however the GUSTO better predicts transfusions.

  4. Selective CT mesentericography in the diagnostics of obscure overt intestinal bleeding: preliminary results

    International Nuclear Information System (INIS)

    Schuermann, K.; Buecker, A.; Tacke, J.; Schmitz-Rode, T.; Guenther, R.W.; Jansen, M.

    2002-01-01

    Aim: To evaluate intra-arterial CT mesentericography (CTM) in the diagnostics of severe obscure overt intestinal bleeding in comparison with conventional mesentericography (MG) and surgery. Methods: In 8 patients (23 - 82 years, mean 59 years), CTM was performed via the catheter left in the superior mesenteric art