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Sample records for underwent operative treatment

  1. HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

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    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Wowk, Pryscilla Fanini; Mattar, Sibelle Botogosque; Vargas, Rafael Gustavo; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; Bicalho, Maria da Graça

    2012-09-01

    The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART. Copyright © 2012. Published by Elsevier Inc.

  2. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment.

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    Cheng, Ching-Yu; Stevenson, Eleanor Lowndes; Yang, Cheng-Ta; Liou, Shwu-Ru

    2018-04-28

    To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Cross-sectional, correlational study. Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants' levels of fertility-related stress and fertility-related quality of life. Descriptive statistics, correlation, and regression analysis were used. Overall, participants reported low levels of fertility-related stress and fertility-related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility-related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility-related quality of life. In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility-related stress. Social support and family consultation might be offered to improve women's fertility-related quality of life. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  3. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis.

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    de Campos, José Ribas Milanez; Lembrança, Lucas; Fukuda, Juliana Maria; Kauffman, Paulo; Teivelis, Marcelo Passos; Puech-Leão, Pedro; Wolosker, Nelson

    2017-11-01

    Video thoracoscopic sympathectomy is the recommended surgical treatment for primary hyperhidrosis and has a high success rate. Despite this high success rate, some patients are unresponsive and eventually need a resympathectomy. Few studies have previously analysed exclusively the results of these resympathectomies in patients with primary hyperhidrosis. None of the studies have objectively evaluated the degree of response to surgery or the improvement in quality of life after resympathectomies. This is a retrospective study, evaluating 15 patients from an initial group of 2300 patients who underwent resympathectomy after failure of the primary surgical treatment. We evaluated sympathectomy levels of resection, technical difficulties, surgical complications preoperative quality of life, response to treatment and quality-of-life improvement 30 days after each surgery. Regarding gender, 11 (73.3%) patients were women. The average age was 23.2 with SD of 5.17 years, and the mean body mass index was 20.9 (SD 2.12). Ten patients had major complaints about their hands (66%) and 5 (33%) patients about their forearms. A high degree of response to sympathectomy occurred in 73% of patients. In 11 of these patients, the improvement in quality of life was considered high, 3 showed a mild improvement and 1 did not improve. No major complications occurred; the presence of adhesions was reported in 11 patients and pleural drainage was necessary in 4 patients. Resympathectomy is an effective procedure, and it improves the quality of life in patients with primary hyperhidrosis who failed after the first surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  4. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

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    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-01-01

    Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  5. HLA-G profile of infertile couples who underwent assisted reproduction treatment.

    Science.gov (United States)

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Nardi, Fabiola Silva; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; da Graça Bicalho, Maria

    2016-12-01

    HLA-G codes for a non-classical class I (Ib) protein which is mainly expressed in trophoblast cells. Many pieces of evidence pointed out its essential role conferring immunological tolerance to the fetus. Some HLA-G alleles have been linked to enhanced or reduced HLA-G protein levels expression, which have been associated with reproductive failure. In this study 33 couples undergoing ART (assisted reproduction treatment; n=66) and 120 couples who conceived naturally (controls; n=240) were enrolled in the study. Genotyping was performed by SBT and tagged an 1837bp at 5'URR as well as exons 2, 3 and4 of HLA-G. Alleles, genotypes and haplotypes were compared between infertile and control groups using Fisher Exact Test. The haplotype HLA-G ∗ 010101b/HLA-G ∗ 01:01:01 showed statistically significant higher frequency in control groups. The immunogenetics of infertility is complex and might be dependent on different genes involved in the establishment of a successful pregnancy. A better understanding of HLA-G alleles and haplotypes structure and how the genetic diversity at their regulatory sites could impact on their level of expression and build up the susceptibility or protection conditions may shed light on the comprehension of immunogenetics mechanisms acting at the fetus-maternal interface. Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  6. Management of antithrombotic therapy in patients with coronary artery disease or atrial fibrillation who underwent abdominal surgical operations.

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    Schizas, Dimitrios; Kariori, Maria; Boudoulas, Konstantinos Dean; Siasos, Gerasimos; Patelis, Nikolaos; Kalantzis, Charalampos; Carmen-Maria, Moldovan; Vavuranakis, Manolis

    2018-04-02

    Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations. For this purpose, incidence of major adverse cardiovascular events (MACE) and risk of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized controlled trials, observational studies, novel current reviews, and ESC and ACC/AHA guidelines on the subject. Antithrombotic use in daily clinical practice results to two different pathways: reduction of thromboembolic risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic events, however, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current guidelines can assist clinicians in making decisions for the treatment of patients that undergo abdominal surgical operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued. Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, patients with an intermediate risk for thromboembolism, management should be individualized according to patient

  7. Early prediction of treatment response by serum CRP levels in patients with advanced esophageal cancer who underwent definitive chemoradiotherapy

    International Nuclear Information System (INIS)

    Yoneda, Masayuki; Fujiwara, Hitoshi; Okamura, Shinichi

    2010-01-01

    Serum C reactive protein (CRP) has been shown to be associated with the progression of esophageal cancer. The purpose of this study was to examine the relationship between treatment response and serum CRP levels in time course during definitive chemoradiotherapy (CRT) in terms of early prediction of CRT response by serum CRP. The subjects of this study were 36 patients with cT3/cT4 esophageal squamous cell carcinoma who underwent definitive CRT in our hospital. Serum CRP levels during definitive CRT (pretreatment, 1W, 2W and 3W after CRT initiation) were compared between CR and non-CR group. In addition, partition model was constructed to discriminate CR with non-CR and the prediction accuracy was evaluated. The patients were consisted of 28 males and 8 females. At pretreatment diagnosis, tumors were categorized as T3 (n=21) and T4 (n=15). Thirty four patients received FP-based chemotherapy and 2 patients received docetaxel-based chemotherapy. Treatment responses were categorized as CR (n=8), partial response (PR) (n=14), no change (NC) (n=2) and progressive disease (PD) (n=12). Serum CRP levels at the time of 2W after CRT initiation (CRT2W) in CR group were low compared to those in non-CR group (p=0.071). The partition model was constructed based on CRP levels at CRT2W. The prediction accuracies to discriminate CR from non-CR by CRP ≤0.1 were 50%, 82%, and 75% in sensitivity, specificity and accuracy, respectively. Serum CRP is a useful biomarker for an early prediction of CRT response. (author)

  8. Functional Changes of Dendritic Cells in C6 Glioma-Bearing Rats That Underwent Combined Argon-Helium Cryotherapy and IL-12 Treatment.

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    Li, Ming; Cui, Yao; Li, Xiqing; Guo, Yanwu; Wang, Bin; Zhang, Jiadong; Xu, Jian; Han, Shuangyin; Shi, Xiwen

    2016-08-01

    The aim of this study was to explore changes in tumor tissues of glioma-bearing rats that underwent argon-helium cryoablation as well as changes in antitumor immunity before and after combined interleukin 12 treatment. Two hundred sixty Wistar rats were randomly divided into a blank control group, intravenous injection interleukin-12 group, cryotherapy group, and cryotherapy + intravenous injection group. C6 glioma cells proliferated in vitro were implanted subcutaneously on the backs of rats to establish C6 glioma-bearing animal models. Each group underwent the corresponding treatments, and morphological changes in tumor tissues were examined using hematoxylin-eosin staining. CD11c staining was examined using immunohistochemistry, and differences in dendritic cells and T-cell subsets before and after treatment were analyzed using flow cytometry. The control group showed no statistical changes in terms of tumor tissue morphology and cellular immunity, cryotherapy group, and cryotherapy + intravenous injection group, among which the count for the cryotherapy + intravenous injection group was significantly higher than those of all other groups. In the argon-helium cryotherapy group, tumor cells were damaged and dendritic cell markers were positive. The number of CD11c+ and CD86+ cells increased significantly after the operation as did the cytokine interferon-γ level (P < .01), suggesting a shift toward Th1-type immunity. Combined treatment of argon-helium cryoablation and interleukin 12 for gliomas not only effectively injured tumor tissues but also boosted immune function and increased antitumor ability. Therefore, this approach is a promising treatment measure for brain gliomas. © The Author(s) 2015.

  9. Analysis of 175 Cases Underwent Surgical Treatment in Our Hospital After Having Abdominal Wounding by Firearm in the War at Syria

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    Yusuf Yucel

    2016-04-01

    Full Text Available Aim: We aimed at analysing the patients, who underwent surgical treatment in our hospital after having abdominal wounding by firearm in the war at Syria, retrospectively. Material and Method: The files of Syrian patients, who applied to Emergency Service of Harran University Medical Faculty because of gunshot wounds and had operation after being hospitalized in General Surgery Clinic due to abdominal injuries between the years of 2011 and 2014, were analysed retrospectively. Results: 175 Syrian patients, who had abdominal injuries by firearms, underwent operation in our general surgery clinic. 99.4% (n=174 of the patients were male, and 0.6% (n=1 were female. Trauma-admission to hospital times of all cases were %u2265 6 hours. 62.8% (n=110 of the patients had isolated abdominal injuries, and 37.1% (n=65 had two or more system injuries. The frequency of more than one organ injuries in abdominal region was 44.5% (n=78 and the most frequent complication was wound infection (10%. Negative laparoscopy was 2.8% (n=5, support for intensive care was 38.2% (n=67, average duration of intensive care unit stay was 5.57 days and mortality was 9.7% (n=17. Discussion: In our study, it was seen that infectious morbidity and mortality increased for the patients, who applied to our hospital because of abdominal injuries by firearm, particularly the ones with gastrointestinal perforation, if trauma-admission to hospital times were %u2265 6 hours. And this shows us that the early intervention to injuries that perforate gastrointestinal tract was an important factor for decreasing morbidity and mortality.

  10. Basic Water Treatment Operation.

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    Ontario Ministry of the Environment, Toronto.

    This manual was developed for use at workshops designed to introduce the fundamentals of water treatment plant operations. The course consists of lecture-discussions and hands-on activities. Each of the fourteen lessons in this document has clearly stated behavioral objectives to tell the trainee what he should know or do after completing that…

  11. Clinical Outcome of a Prospective Case Series of Patients With Ketamine Cystitis Who Underwent Standardized Treatment Protocol.

    Science.gov (United States)

    Yee, Chi-hang; Lai, Pui-tak; Lee, Wai-man; Tam, Yuk-him; Ng, Chi-fai

    2015-08-01

    To assess the outcome of a prospective cohort of patients with ketamine-associated uropathy after standardized treatment. This is a prospective case series of patients with ketamine-related urologic problems. Management for the patients includes a 4-tier approach, namely anti-inflammatory or anti-cholinergic drugs, opioid analgesics or pregabalin, intravesical hyaluronic acid, and finally, surgical intervention including hydrodistension and augmentation cystoplasty. Outcome was assessed with functional bladder capacity, pelvic pain and urgency or frequency (PUF) symptom scale, and the EuroQol visual analog scale. Between December 2011 and June 2014, 463 patients presented with ketamine-associated uropathy. All were managed by the same standardized protocol. Among these patients, 319 patients came back for follow-up assessment. Overall mean follow-up duration was 10.7 ± 8.5 months. For those patients who received first-line treatment (290 patients), there was a significant improvement in PUF scores, the EuroQol visual analog scale, and functional bladder capacity. Both abstinence from ketamine usage and the amount of ketamine consumed were factors predicting the improvement of PUF scores. For those patients who required second-line oral therapy (62 patients), 42 patients (67.7%) reported improvement in symptoms. Eight patients have completed intravesical therapy. There was a significant improvement in voided volume for the patients after treatment. The study demonstrated the efficacy of managing ketamine-associated uropathy using a 4-tier approach. Both anti-inflammatory drugs and analgesics could effectively alleviate symptoms. Being abstinent from ketamine abuse and the amount of ketamine consumed have bearings on treatment response. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Long-term psychological distress, and styles of coping, in parents of children and adolescents who underwent invasive treatment for congenital cardiac disease

    NARCIS (Netherlands)

    Spijkerboer, Alinda W.; Helbing, Willem A.; Bogers, Ad J. J. C.; van Domburg, Ron T.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.

    2007-01-01

    To assess the level of psychological distress and styles of coping in both mothers and fathers of children who underwent invasive treatment for congenital cardiac disease at least 7 years and 6 months ago. The General Health Questionnaire and the Utrecht Coping List were completed by parents of

  13. Academic performance of students who underwent psychiatric treatment at the students’ mental health service of a Brazilian university

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    Cláudia Ribeiro Franulovic Campos

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students’ mental health service (SAPPE and to compare their academic performance with that of non-patient students. DESIGN AND SETTING: Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. METHODS: Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. RESULTS: 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1% and anxiety disorders/phobias (33.2% were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7% and bipolar disorder (1.9% were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025, but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. CONCLUSION: Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

  14. Academic performance of students who underwent psychiatric treatment at the students' mental health service of a Brazilian university.

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    Campos, Cláudia Ribeiro Franulovic; Oliveira, Maria Lilian Coelho; Mello, Tânia Maron Vichi Freire de; Dantas, Clarissa de Rosalmeida

    2017-01-01

    University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students' mental health service (SAPPE) and to compare their academic performance with that of non-patient students. Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC) and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1%) and anxiety disorders/phobias (33.2%) were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7%) and bipolar disorder (1.9%) were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025), but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

  15. Basic Sewage Treatment Operation.

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    Ontario Ministry of the Environment, Toronto.

    This manual was developed for use at workshops designed to introduce operators to the fundamentals of sewage plant operation. The course consists of lecture-discussions and hands-on activities. Each of the lessons has clearly stated behavioral objectives to tell the trainee what he should know or do after completing that topic. Areas covered in…

  16. Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro; Sugimura, Kazuro [Kobe University Graduate School of Medicine, Department of Radiology, Kobe, Hyogo (Japan); Yoshikawa, Takeshi; Ohno, Yoshiharu [Kobe University Graduate School of Medicine, Advanced Biomedical Imaging Research Center, Kobe, Hyogo (Japan); Kobe University Graduate School of Medicine, Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe, Hyogo (Japan); Negi, Noriyuki [Kobe University Hospital, Division of Radiology, Kobe, Hyogo (Japan); Inokawa, Hiroyasu; Sugihara, Naoki [Toshiba Medical Systems Corporation, Otawara, Tochigi (Japan)

    2017-07-15

    To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P < 0.0001). Liver and pancreas image qualities and visualizations of vasculature were significantly improved on CT with SEMAR (P < 0.0001) with substantial or almost perfect agreement (0.62 ≤ κ ≤ 0.83). SEMAR can improve image quality in abdominal CT in patients with small metal implants by reducing metallic artefacts. (orig.)

  17. Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm.

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    Sofue, Keitaro; Yoshikawa, Takeshi; Ohno, Yoshiharu; Negi, Noriyuki; Inokawa, Hiroyasu; Sugihara, Naoki; Sugimura, Kazuro

    2017-07-01

    To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P small metal implants by reducing metallic artefacts. • SEMAR algorithm significantly reduces metallic artefacts from small implants in abdominal CT. • SEMAR can improve image quality of the liver in dynamic CECT. • Confidence visualization of hepatic vascular anatomies can also be improved by SEMAR.

  18. Operative treatment of degenerative lumbar spine spondylolisthesis.

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    Kaftandziev, I; Trpeski, S; Filipce, V; Arsovski, O; Hasani, I; Nikolov, L; Kaev, A

    2015-01-01

    Management of degenerative lumbosacral spondylolisthesis with spinal stenosis is still controversial. Surgery is widely used, as well as non-surgical treatment. To evaluate the clinical results and functional outcome after operative treatment in Grade II and III lumbar spine spondylolisthesis. Twelve patients with symptoms and image-confirmed degenerative spondylolisthesis entered the study. Mean patient age was 57 years. Spondylolisthesis Grade II or III, segment L4-L5 or L5-S1 were evaluated. All patients underwent similar protocols. Operative treatment was decompressive laminectomy, posterior one segment fixation, and fusion with autologous bone grafting. Functional outcome measures were Visual Analog Scale (VAS, 10-point scale) and Oswestry Disability Index (ODI, 100-percent scale) after 6 and 12 months. Patient follow-up was 12 months. Preoperatively, 7 patients had severe disability according to ODI, 4 had moderate disability. VAS measured 6 and 7 points in 6 patients, lowest score of 4 points and the highest score of 9. After 6 months, ODI showed 5 patients had minimal and 7 had moderate disability; 2 patients had 0 points on the VAS, 2 had a score of 1, 4 had a score of 2, highest score of 4 points. Treatment outcome effects after 1 year were 9 patients with minimal disability, 3 with moderate; VAS - 2 patients with O points, 3 with 1 point, 4 with 2 points. Patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and functional outcome during a period of 1 year.

  19. Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery

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    H. Hakan Poyrazoğlu

    2016-04-01

    Full Text Available Background: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α playing an active role in this process. Aims: This research was to investigate the effects of preoperative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. Study Design: Controlled clinical study. Methods: This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF; at the 5th minute of cross-clamping (Per TNF; 2 hours after termination of cardiopulmonary bypass (Post TNF; and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF. Results: The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05. The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05. Conclusion: There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect

  20. NONOPERATIVE VERSUS OPERATIVE TREATMENT OF PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS

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    Jose Alfredo Corredor

    2016-03-01

    Full Text Available ABSTRACT Objective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS, Fischgrund criteria, Short Form-36 (SF-36 function score, and the modified Oswestry Disability Index (ODI. Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 - 72 for the nonoperative group and 36 months (range 6-80 for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000, leg VAS (mean 3 versus 6, p = 0.0015, SF-36 function score (mean 77 versus 35, p = 0.000, and ODI (mean 17 versus 46, p = 0.000. On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000. Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.

  1. Treatment of operational monitoring data

    International Nuclear Information System (INIS)

    Azevedo P, D. de; Marcondes T, J.

    1996-01-01

    From effective doses calculation models, published in norms and regulatory guides, the specific dose conversion factors for different installations are used on monitoring data. The monitoring data are achieved from many individual parameters and, in case there is no individual parameters, area monitoring data are used. With the objective of reducing occupational exposures, the results are evaluated in function of the pertinent norms. The measurements are analyzed also in function of the consistency of the data obtained from former similar operations. The results are saved as individual historical dose, in each worker annual dose of every work year. The other files are formed by determined operation individual doses, calculated per capita; dose rates are achieved from individual monitoring data and the averages of each operational function are calculated; dose rates are also obtained by area monitoring, and each workplace mean is calculated. These averages are compared with the correspondent annual dose equivalent limit fraction. The analysis of variance is applied to individuals dose rates and to workplace dose rates in order to verify statistical differences, the largest mean is compared to the remaining. The individual working time in a programmed operation is limited in order to avoid that the predicted dose equivalent of twelve months exceed the established annual limit. When this limit is predicted to be exceeded, the working time is re-programmed, with worker removing at the beginning of the operation or before the end of operation, keeping prevision below the limit. (authors). 7 refs

  2. Planning for the radwaste treatment facility operation

    International Nuclear Information System (INIS)

    Park, H.H.; Han, K.W.; Kim, J.H.

    1985-04-01

    In accordance with treatment of radioactive wastes from normal operation of PIEF and nuclear fuel fabrication facilities, institutions using RI, of spent fuel from nuclear power plants, the operation of RWTF is requested. Therefore the objective is to treat the radioactive wastes safely by the treatment techniques accmulated through research experiences of many years, to minimize the effect to environments and inhabitants, to establish the operation program to perform the facilities management effectively and reasonably. (Author)

  3. [Rehabilitation treatment of patients with operable gastric cancer].

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    Kulikov, E P; Lebedev, A M; Telegin, V N; Maksimova, T N

    1991-04-01

    Observations over 130 patients who underwent radical operation for gastric carcinoma showed that survival is higher among those who received rehabilitation measures and that post-gastroresection complications occurred in them 1.5-2 times less frequently than in the control group; 39.2% of patients who were given rehabilitation therapy and only 15.8% of patients in the control group resumed occupational activity. The authors worked out an optimal plan of restorative treatment according to the character and severity of the postresection complications.

  4. Water Treatment Technology - General Plant Operation.

    Science.gov (United States)

    Ross-Harrington, Melinda; Kincaid, G. David

    One of twelve water treatment technology units, this student manual on general plant operations provides instructional materials for seven competencies. (The twelve units are designed for a continuing education training course for public water supply operators.) The competencies focus on the following areas: water supply regulations, water plant…

  5. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  6. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  7. The incidence and risk factors of apnea in premature infants underwent general anesthesia for cryotherapy or laser photocoagulation for treatment of retinopathy of prematurity at Queen Sirikit National Institute of Child Health.

    Science.gov (United States)

    Attachoo, Anchalee; Horatanaruang, Duenpen; Chongarunngamsang, Wanida; Lauhsattana, Suda

    2014-06-01

    To determine the incidence and risk factors of postoperative apnea in premature infants who received general anesthesia for cryotherapy or laser photocoagulation for treatment of retinopathy of prematurity (ROP) at Queen Sirikit National Institute of Child Health. A retrospective cohort study was performed by reviewing medical records of premature infants with ROP who underwent general anesthesia for cryotherapy or laser photocoagulation during January 2008 and December 2010 at Queen Sirikit National Institute of Child Health. The incidence and risk factors of postoperative apnea were analyzed. Forty of 167 (24%) premature infants had apnea after general anesthesia for treatment of ROP. The risk factors were post-conceptual age and history of apnea. The risk of apnea in patients with post-conceptual age less than 35 weeks was 5.7 times higher than in patients with post-conceptual age more than 37 weeks (95% CI 1.59-20.45). Patients with a prior history of apnea had a 6.42 times greater risk of postoperative apnea compared to patients without a prior history of apnea (95% CI 2.01-20.50). No other serious complications were reported during the study period. The incidence of apnea after general anesthesia in infants with ROP treated with cryotherapy or laser photocoagulation was 24%. The risk factors of postoperative apnea were post-conceptual age less than 35 weeks and prior history of apnea. Patients with risk factors should be closely monitored.

  8. Operative Treatment of Cervical Spondylotic Myelopathy and Radiculopathy

    Science.gov (United States)

    Kaminsky, SB; Clark, CR; Traynelis, VC

    2004-01-01

    Background: The natural history of cervical spondylotic myelopathy is frequently one of slow, progressive neurological deterioration. The operative treatment for patients with moderate to severe involvement is decompression of the spinal cord. Laminectomy has been a traditional approach and laminoplasty has developed as an attractive alternative. The purpose of this study was to examine and compare the outcomes of these two procedures in similar groups of patients at a five year average follow-up. Methods: A consecutive series of twenty patients who underwent open-door laminoplasty for multi-level cervical spondylotic myelopathy or radiculopathy was compared to a similar group of 22 matched patients who underwent multi-level laminectomies. Patients were similar in age, gender, number of operative levels, and length of follow-up. At the latest examination, each patient underwent a comprehensive neurological evaluation. A modification of the Nurick classification was used to assess the degree of myelopathy. Radiographs at latest follow-up were assessed for instability, and measurements of the space-available-for-the-cord and Pavlov ratio were made at involved levels. Results: Myelopathy, as determined by our modified Nurick scale, improved from a preoperative average of 2.44 to 1.48 in laminoplasty patients and from an average of 3.09 to 2.50 in laminectomy patients. Pain improved 57 percent and 8 percent in laminoplasty and laminectomy groups, respectively. Subjective neck stiffness was not significantly different based on the numbers available, although laminoplasty patients demonstrated some loss of range of motion on examination. The only variable that predicted the postoperative degree of myelopathy in both groups was the preoperative degree of myelopathy. Conclusions: Laminectomy and laminoplasty patients demonstrated improvements in gait, strength, sensation, pain, and degree of myelopathy. Laminoplasty was associated with fewer late complications. Based on

  9. Sports Hernia: Diagnosis, Management and Operative Treatment

    Science.gov (United States)

    Emblom, Benton A.

    2017-01-01

    Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.

  10. Intra-operative radiation treatment of cancers

    International Nuclear Information System (INIS)

    Dubois, J.B.; Joyeux, H.; Solassol, C.; Pujol, H.

    1986-01-01

    Intra-operative radiation treatment (I.O.R.T.) is concerning the treatment either of an unresectable tumor or of tumor bed after complete excision of a primary tumor and its first draining lymph nodes. We describe X-ray and electrons techniques and we discuss the delivered doses according to experimental and clinical data. According to the residual disease (macroscopic or microscopic), to the healthy tissues in the target volume, and the histological type, single doses from 20 Gy to 40 Gy can be delivered. Our preliminary results are reported: 25 patients with resectable tumors of the cardia, the stomach and the pancreas, 5 patients with pelvic recurrences of colon and rectum carcinomas. Therapeutic results of the I.O.R.T. providing from the literature are discussed. The I.O.R.T. indications are defined as palliative (unresectable tumors) and curative (irradiation of tumor bed after complete excision of the tumor) [fr

  11. Operative treatment of severe forms of hypospadias.

    Science.gov (United States)

    Abramovic, V

    1981-10-01

    , as well as the safety of the method. There is practically no risk of loss of the valuable dorsal preputial skin. For these reasons, even in the event of complications, the final result is always reliable. The simple operative technique and uncomplicated postoperative care also make this method suitable for smaller medical centers. The first stage of the procedure--formation of the preputial tube--can, if necessary, be combined with elongation and chordectomy, thereby saving one operative stage. The good functional and aesthetic results achieved in 196 patients, with no severe postoperative complications and only 37 instances of fistula formation justify further application of this method for the treatment of severe forms of hypospadias.

  12. Operative treatment of radiation-induced fistulae

    International Nuclear Information System (INIS)

    Balslev, I.; Harling, H.

    1987-01-01

    Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05< p<0.10). Following establishment of defunctioning colostomy on account of rectovaginal fistulae in 25 patients, eight patients developed new fistulae, Significantly more patients with fistulae died of recurrence as compared with patients with other lesions (p<0.01). Defunctioning colostomy in the treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. (author)

  13. Operative treatment of radiation-induced fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Balslev, I.; Harling, H.

    1987-01-01

    Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. 11 refs.

  14. Control retrofit optimizes water treatment operation

    International Nuclear Information System (INIS)

    Ball, H.R.

    1992-01-01

    Mississippi Power's Plant Daniel has installed a state-of-the-art microprocessor-based monitoring and control system. According to Leeds and Northrup, manufacturers of the new control system, the system collects water chemistry data from on-line analyzers. In addition, it provides automatic control and monitoring of the plant's demineralizer and condensate polishers. A two-year study conducted by Plant Daniel determined the need for updating of the plant's water treatment instrumentation and control system. From this study Mississippi Power made the decision to purchase an integrated control system. This paper reports that operator stations and CRT displays are installed at three plant locations - the demineralizer control room, near the mixed bed polishers, and in the chemical laboratory. All of the stations communicate with one common database. The data base includes three functions of data acquisition, a PID loop control, and ladder logic (PLC) control. In addition to monitoring and controlling the water treatment plant, the system provides consistent control of the regeneration processes. This not only results in improved effluent water quality and longer service runs between regeneration, but also eliminates operator error

  15. OPERATIVE TREATMENT FOR DEGENERATIVE LUMBAR SPINAL STENOSIS

    Directory of Open Access Journals (Sweden)

    Samo K. Fokter

    2002-11-01

    Full Text Available Background. Degenerative lumbar spinal stenosis (DLSS is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement.Methods. Fifty-six patients (33 women, 23 men older than 50 years (mean 67 years, range 51 to 82 years and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS. The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5% with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion.Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA.Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.

  16. Surgical treatment of spinal ependymoma and post-operative radiotherapy

    International Nuclear Information System (INIS)

    Lee, T.T.; Gromelski, E.B.; Green, B.A.

    1998-01-01

    With the advances in microsurgical and monitoring techniques, spinal ependymomas are gross totally resected more frequently. The use of adjuvant radiotherapy has become questionable with gross total resection and its role for residual neoplasm need to be redefined. A retrospective analysis of a series of patients was carried out to investigate our clinical outcome and selected use of postoperative radiotherapy. Clinical materials and methods Between July 1990 and May 1995, nineteen patients [M : F = 12 : 7; age range: 21 to 71 years] with a spinal ependymoma were treated at University of Miami by the senior author. (BAG). Pre-operative MRI diagnosed the intraspinal tumor, and pathology reports demonstrated that each patient had a histologically confirmed ependymoma. At the time of diagnosis, the most common symptoms presented were pain (in 16 patients = 84.2%). The pattern of progression of clinical symptoms was directly related to the location of the tumor. Each patient had an MRI immediately after surgery, approximately 6 months post-operatively, and then annually. Results: All 19 patients underwent intradural microsurgical exploration with an attempted gross total resection (achieved in 16 patients = 79%) of the ependymoma through a posterior approach. Direct neural tissue stimulation halted further resection in 2 patients with questionable tumor margins. Radiation therapy was employed as a surgical adjunct in 3 patients (15.8%) because of possible residual tumor. All patients were followed up postoperatively for an average of 50.6 months (range 6 months to 6 years). All patients are surviving to date. Surgical resection of these tumors led to significant alleviation of pre-operative symptoms. There has been no radiographic evidence of tumor recurrence or growth in any patient to date. Conclusion: Surgical resection of spinal ependymoma leads to significant improvement of pre-operative symptom. Surgical removal alone, with an attempt to grossly resect the tumor

  17. Water/Wastewater Treatment Plant Operator Qualifications.

    Science.gov (United States)

    Water and Sewage Works, 1979

    1979-01-01

    This article summarizes in tabular form the U.S. and Canadian programs for classification of water and wastewater treatment plant personnel. Included are main characteristics of the programs, educational and experience requirements, and indications of requirement substitutions. (CS)

  18. Projection operator treatment of single particle resonances

    International Nuclear Information System (INIS)

    Lev, A.; Beres, W.P.

    1976-01-01

    A projection operator method is used to obtain the energy and width of a single particle resonance. The resonance energy is found without scanning. An example of the first g/sub 9/2/ neutron resonance in 40 Ca is given and compared with the traditional phase shift method. The results of both approaches are quite similar. 4 figures

  19. Effective operator treatment of the Lipkin model

    International Nuclear Information System (INIS)

    Abraham, K.J.; Vary, J.P.

    2004-01-01

    We analyze the Lipkin model in the strong coupling limit using effective operator techniques. We present both analytical and numerical results for low energy effective Hamiltonians. We investigate the reliability of various approximations used to simplify the nuclear many body problem, such as the cluster approximation. We demonstrate, in explicit examples, certain limits to the validity of the cluster approximation but caution that these limits may be particular to this model where the interactions are of unlimited range

  20. Estudo dos lipídios em jovens portadores de esquistossomose hepatoesplênica submetidos a tratamento cirúrgico A lipid study of schistosomotic young people underwent surgical treatment

    Directory of Open Access Journals (Sweden)

    Schirley Nóbrega da Silva

    2002-08-01

    group of the patients, which was similar to the control group. Similar results were observed with the fractions of ester and free cholesterol. There was a reduction on the concentration of plasmatic triglicerides, but without significance. The individual's phospholipids presented relative concentration, similar to the control group, but there was significant reduction (p<0,01 in the patient's phosphatidilethanolamine fraction, however, there was no significantly reduction of molar concentration of total plasmatic phospholipids, compared to the controls. In the erythrocyte membrane, the total cholesterol and. total phospholipids levels do not suffered significant alterations. Conclusion: The obtained data indicated a similarity of the lipids levels in the plasma and in the erythrocyte membrane of the patients submitted to the surgical treatment.

  1. Operative treatment of recurrent or complicated diverticulitis.

    Science.gov (United States)

    Dozois, Eric J

    2008-08-01

    Sigmoid diverticulosis remains a common disease in developed Western countries, and surgeons are frequently asked to manage diverticulitis and its complications. When to offer elective surgery to patients with uncomplicated, but recurrent, diverticulitis should be individualized, and practice recommendations by national societies continues to be debated. Complicated diverticulitis remains a surgically treated disease, and new technology such as colonic stents (for obstruction) and computed-tomography-guided percutaneous drainage (for abscess) have become bridging techniques to avoid two-stage operations in selected patients. Minimally invasive surgery for elective sigmoid resection has been shown to be safe and feasible and confers many patient-related short-term over traditional open surgery.

  2. Operative treatment for calcaneal fracture with plate

    International Nuclear Information System (INIS)

    Osako, Hirofumi; Imabayashi, Masaaki; Horikawa, Ryoji; Yazaki, Yuichiro; Fukuyama, Katsuro; Imabayashi, Masanori; Morimoto, Norio

    2008-01-01

    We treated calcaneal fractures by means of lateral approach using a calcaneal plate, and evaluated the clinical results. The mean age at the time of surgery was 60.1 (range: 36 to 78). The mean duration of follow-up was 3.4 years. Eleven feet were treated with the ACE calcaneal plate, and two feet were treated with the Rabbit plate. The clinical result evaluation according to the Maxfield criteria was as follows: excellent in nine feet; very good in two feet; poor in one foot. Pre-and postoperative changes in radiographic findings were studied. The improvement of the Boehler angle, width index, and intra-articular displacement was reflected in the clinical result. This method is considered to be an effective treatment for intra-articular calcaneal fractures. (author)

  3. Operation technology of air treatment system in nuclear facilities

    CERN Document Server

    Chun, Y B; Hwong, Y H; Lee, H K; Min, D K; Park, K J; Uom, S H; Yang, S Y

    2001-01-01

    Effective operation techniques were reviewed on the air treatment system to protect the personnel in nuclear facilities from the contamination of radio-active particles and to keep the environment clear. Nuclear air treatment system consisted of the ventilation and filtering system was characterized by some test. Measurement of air velocity of blowing/exhaust fan in the ventilation system, leak tests of HEPA filters in the filtering, and measurement of pressure difference between the areas defined by radiation level were conducted. The results acquired form the measurements were reflected directly for the operation of air treatment. In the abnormal state of virus parts of devices composted of the system, the repairing method, maintenance and performance test were also employed in operating effectively the air treatment system. These measuring results and techniques can be available to the operation of air treatment system of PIEF as well as the other nuclear facilities in KAERI.

  4. Operative treatment of the displaced intraarticular fractures of the calcaneus

    Directory of Open Access Journals (Sweden)

    Popović Zoran

    2003-01-01

    Full Text Available Most calcaneal fractures occur in male industrial workers, having significant economic repercussions. Although current operative treatment has improved the outcome of the treatment in many patients, there is still no consensus on the classification, treatment, operative technique, or postoperative management. Computed tomographic scanning has improved our understanding of these fractures substantially, and has allowed the consistent analysis of the results of the treatment. The focus of current treatment is on the operative methods, internal fixation by leg-screw and plate through the lateral Kocher approach. Between April 1998 and July 2002, we treated operatively 6 displaced intraarticular fractures of the calcaneus. A lateral Kocher incision, leg-screw, and plate fixation were used. Neither infection, nor nonunion, or malunion occurred. All the patients presently have painless foot, use normal footwear, and are capable of normal activities.

  5. Sustainable operation of a biological wastewater treatment plant

    Science.gov (United States)

    Trikoilidou, E.; Samiotis, G.; Bellos, D.; Amanatidou, E.

    2016-11-01

    The sustainable operation of a biological wastewater treatment plant is significantly linked to its removal efficiency, cost of sludge management, energy consumption and monitoring cost. The biological treatment offers high organic removal efficiency, it also entails significant sludge production, which contains active (live) and inactive (dead) microorganisms and must be treated prior to final disposal, in order to prevent adverse impact on public health and environment. The efficiency of the activated sludge treatment process is correlated to an efficient solid-liquid separation, which is strongly depended on the biomass settling properties. The most commonly encountered settling problems in a wastewater treatment plant, which are usually associated with operating conditions and specific microorganisms growth, are sludge bulking, floating sludge, pin point flocs and straggler flocs. Sustainable management of sludge and less energy consumption are the two principal aspects that determine the operational cost of wastewater treatment plants. Sludge treatment and management accumulate more than 50% of the operating cost. Aerobic wastewater treatment plants have high energy requirements for covering the needs of aeration and recirculations. In order to ensure wastewater treatment plants’ effective operation, a large number of physicochemical parameters have to be monitored, thus further increasing the operational cost. As the operational parameters are linked to microbial population, a practical way of wastewater treatment plants’ controlling is the microscopic examination of sludge, which is proved to be an important tool for evaluating plants’ performance and assessing possible problems and symptoms. This study presents a biological wastewater treatment plant with almost zero biomass production, less energy consumption and a practical way for operation control through microbial manipulation and microscopic examination.

  6. [Operative treatment of central talar fractures].

    Science.gov (United States)

    Rammelt, S; Winkler, J; Zwipp, H

    2013-12-01

    Anatomic reduction of talar neck and body fractures with axial realignment and restoration of the articular surfaces of the talus. Displaced talar neck and body fractures. High perioperative risk, soft tissue infection, neurogenic osteoarthropathy. Reduction of the axial alignment of the talus and its joints via bilateral approaches according to the preoperative CT-based planning. A medial malleolar osteotomy may be necessary to approach the talar dome. The blood supply via the deltoid ligament and the sinus tarsi has to be respected. Manipulation of the main fragments with K-wires introduced temporarily; a mini-distractor is helpful in restoring the length. Internal fixation is tailored to the individual fracture pattern, including conventional and headless screws, bioresorbable pins, lost K-wires, and/or minifragment plates. Joint transfixation for 6 weeks to ensure ligamentous healing if instability persists after internal fixation. With severe soft tissue damage, temporary tibiometatarsal external fixation is applied until soft tissue consolidation. Range of motion exercises of the ankle and subtalar joints starting postoperative day 2 except for cases with joint transfixation. Partial weight bearing of 20 kg for 10-12 weeks. Use of a cast or walker for 6 weeks followed by intensive active and passive range of motion exercises of the ankle and subtalar joints. Over 8 years 79 fractures of the talar neck and body were treated. In all, 43 patients with 45 talar neck (n = 30) and body (n = 15) fractures were re-examined clinically and radiologically (mean follow-up 3 years). Definite treatment consisted of open reduction and screw fixation of the talus in 41 cases and small plate fixation in 2 cases supplemented by temporary external fixation for 1-3 weeks in 12 cases. At follow-up, the Maryland Foot Score averaged 86.1 and the AOFAS Ankle/Hindfoot Score averaged 78.9. The Hawkins classification was of prognostic value in talar neck fractures. The functional

  7. Operation and effluent quality of a small rural wastewater treatment ...

    African Journals Online (AJOL)

    The objective of this study was to evaluate the impact of effluent and sludge discharges of an abattoir wastewater treatment plant (WWTP) on the operation of a municipal aerated pond WWTP. Experiments were carried out in Cervera WWTP, located in northeastern Spain, which comprises four ponds operating in series.

  8. Improved Outcome of Fracture Treatment by Early Operative ...

    African Journals Online (AJOL)

    Two years, 1997 and 1998 were analysed for age, sex, type of treatment and quality of outcome. A total of 247 admissions into orthopaedic wards were made in 1997 leading to 79 major operations, 20 of which were operative reduction of fractures (25.3 %). In 1998, 239 patients were admitted out of which 174 major ...

  9. early experience of operative treatment of pelvic and acetabular

    African Journals Online (AJOL)

    Objective: To review early post-operative results of pelvic and acetabular fracture intern al fixation. Design: ... 600 needing operative treatment annually. ... Infection was controlled with debridement and antibiotics. All the patients in the study returned to their work except one who has yet to do so 5 months after his injury.

  10. Operation of Wastewater Treatment Plants, Manual of Practice No. 11.

    Science.gov (United States)

    Albertson, Orrie E.; And Others

    This book is intended to be a reference or textbook on the operation of wastewater treatment plants. The book contains thirty-one chapters and three appendices and includes the description, requirements, and latest techniques of conventional unit process operation, as well as the symptoms and corrective measures regarding process problems. Process…

  11. [Effect of modified Badenoch operation on the treatment of posterior urethral stricture].

    Science.gov (United States)

    Wang, Ping-xian; Zhang, Gen-pu; Huang, Chi-bing; Fan, Ming-qi; Feng, Jia-yu; Xiao, Ya

    2012-02-01

    To determine the effects of modified pull-through operation (Badenoch operation) on the treatment of posterior urethral stricture. From September 2001 to December 2010 traditional pull-through operation was Modified for two times in our center. A total of 129 patients with posttraumatic posterior urethral stricture resulting from pelvic fracture injury underwent the modified urethral pull-through operation. Stricture length was 1.5 to 5.3 cm (mean 2.9 cm). Of the patients 43 had undergone at least 1 previous failed management for stricture. In phase 1 (from September 2001 to January 2008), the improving items include: (1) The distal urethral end was stitched and tied to the catheter. (2) As catheter was inserted into bladder and 20 ml water was injected into catheter balloon, the distal urethral end was fixed in the proximal urethra and an overlaying of 1.5 cm was formed between the two ends. (3) Three weeks later, it was tried to insert the catheter to bladder. After the urethral stump necrosis and the catheter separating from the urethra, the catheter was removed. In phase 2 (from February 2008 to December 2010), based on the above, irrigating catheter was used. After the surgery, urethra was irrigated with 0.02% furacillin solution through the catheter 3 times a day. All patients were followed up for at least 6 months. If patients had no conscious dysuria and maximum urinary flow rate (Qmax) > 15 ml/s, the treatment was considered successful. All complications were recorded. In phase 1, the 96 patients (101 times) underwent the procedure. The treatment was successful in 88 patients (success rate 92%). Within 1 to 13 days after removal of the catheter, urethral stricture was recurred in 8 patients. They had to undergo cystostomy once more for 3 to 11 months before reoperation (the 3 patients' reoperation was in phase 2). The 8 cases were treated successfully. In phase 2, 33 patients (total 36 times) underwent the procedure. One patient was failed (success rate 97

  12. Principles of Design And Operations Of Wastewater Treatment Pond Systems For Plant Operators, Engineers, And Managers

    Science.gov (United States)

    Wastewater pond systems provide reliable, low cost, and relatively low maintenance treatment for municipal and industrial discharges. However, they do have certain design, operations, and maintenance requirements. While the basic models have not changed in the 30-odd years sinc...

  13. Humeral shaft fractures: Retrospective results of non-operative and operative treatment of 186 patients

    NARCIS (Netherlands)

    K.C. Mahabier (Kiran); L.M.M. Vogels (Lucas); B.J. Punt (Bas); G.R. Roukema (Gert); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2013-01-01

    textabstractBackground: Humeral shaft fractures account for 1-3% of all fractures and 20% of the fractures involving the humerus. The aim of the current study was to compare the outcome after operative and non-operative treatment of humeral shaft fractures, by comparing the time to radiological

  14. [Operative treatment of degenerative diseases of the lumbar spine].

    Science.gov (United States)

    Czabanka, M; Thomé, C; Ringel, F; Meyer, B; Eicker, S-O; Rohde, V; Stoffel, M; Vajkoczy, P

    2018-04-20

    Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.

  15. Results of operative treatment for recalcitrant retrocalcaneal bursitis and midportion Achilles tendinopathy in athletes.

    Science.gov (United States)

    Lohrer, Heinz; Nauck, Tanja

    2014-08-01

    The results of operative treatment for recalcitrant midportion Achilles tendinopathy and recalcitrant retrocalcaneal bursitis were evaluated using the patient administered, disease specific, and validated VISA-A-G questionnaire. A cohort of 89 patients was prospectively followed. These patients underwent operations for sport induced midportion Achilles tendinopathy (39 procedures) or retrocalcaneal bursitis (55 procedures). Depending on the individual intraoperative findings the patients of either disease were treated with two respective operative modifications (tendon repair or no tendon repair). Preoperative and follow-up status (3, 6, and 12 months) were investigated using the VISA-A-G questionnaire. Preoperatively, the four groups scored from 37.0 ± 17.6 to 45.9 ± 15.2 (p = 0.376-0.993) on the VISA-A-G questionnaire. Six and 12 months postoperatively, the VISA-A-G scores improved significantly (p bursitis and midportion Achilles tendinopathy responded equally well to operative treatment. When repaired, additional tendon lesions did not influence this result. We demand to differentiate not only between midportion Achilles tendinopathy and retrocalcaneal bursitis but also to identify additional Achilles tendon lesions to specifically address these lesions during operative procedures.

  16. Treatment of Childhood Diarrhoea by Operators of Drug Stores in ...

    African Journals Online (AJOL)

    The treatment of childhood diarrhoea by 392 operators/attendants of drug stores in Benin City was evaluated using a semi structured questionnaire. About 72.6% of the study population dispensed drugs for childhood diarrhoea. The study also showed that the use of drugs in treating diarrhoea in children was significantly ...

  17. Blood Loss And Transfusion Need During Operative Treatment Of ...

    African Journals Online (AJOL)

    OBJECTIVE: To determine the incidence of excessive blood loss and transfusion needs during operative treatment of long bone fractures and identify risk factors for excessive blood loss. METHODS: A prospective study of fifty-nine patients was conducted, with excessive blood loss defined as blood loss in excess of 10% of ...

  18. An Analysis of the Waste Water Treatment Operator Occupation.

    Science.gov (United States)

    Clark, Anthony B.; And Others

    The occupational analysis contains a brief job description for the waste water treatment occupations of operator and maintenance mechanic and 13 detailed task statements which specify job duties (tools, equipment, materials, objects acted upon, performance knowledge, safety considerations/hazards, decisions, cues, and errors) and learning skills…

  19. Improving palliative treatment of patients with non-operable cancer ...

    African Journals Online (AJOL)

    Improving palliative treatment of patients with non-operable cancer of the oesophagus: training doctors and nurses in the use of self-expanding metal stents (SEMS) in Malawi. ... Nationwide only three hospitals are able to perform oesophagectomies, and there is no radiotherapy- or chemotherapy available. Owing to late ...

  20. The usefulness of biliopancreatic diversion/Scopinaro operation in treatment of patients with Prader-Willi syndrome.

    Science.gov (United States)

    Michalik, Maciej; Frask, Agata; Lech, Pawel; Zdrojewski, Michal; Doboszynska, Anna

    2015-07-01

    Prader-Willi syndrome (PWS) is the most common form of obesity with a genetic basis. The short expected survival time due to numerous accompanying diseases and their complications is the reason for research on the maximally efficient method of treatment of obesity in this syndrome. Undertaken attempts of conservative treatment, for example with somatostatin, are ineffective. It seems that the only effective treatment of obesity in this syndrome may be surgical. In this article we present 2 cases of patients with PWS who underwent surgery consisting of biliopancreatic diversion (BPD)/Scopinaro procedure. The BPD/Scopinaro operation in selected cases of disciplined patients with a co-operative family, which we find of key importance, can be considered as one option of treatment of this syndrome in patients with prior neglect of conservative treatment.

  1. [Late complications and treatment options of aortic coarctation operated in childhood].

    Science.gov (United States)

    Dzsinich, Csaba; Vaszily, Miklós; Vallus, Gábor; Dzsinich, Máté; Berek, Péter; Barta, László; Darabos, Gábor; Nyiri, Gabriella; Nagy, Gabriella; Pataki, Tibor; Szentpétery, László

    2014-07-27

    The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood.

  2. OPERATION OF THE HOUSEHOLD SEWAGE TREATMENT PLANTS IN POLAND

    Directory of Open Access Journals (Sweden)

    Marcelina Pryszcz

    2015-01-01

    Full Text Available In many rural communities the building of sewage collection and treatment system is still current and important problem of water and wastewater management. Besides the collection of sewage in the septic tank, the solution for wastewater treatment from individual buildings without access to sewerage system is the construction of household sewage treatment plants. Construction of household sewage treatment plant poses a number of challenges for municipalities and potential investors. The existing plants should be analyzed, so that in the future the selected systems would be characterized by high performance, simple operation and reliable exploitation. In the paper, the assessment of selection criteria of adopted technical solution and the functioning of household sewage treatment plants is carried out.

  3. Application of Intelligent System for Water Treatment Plant Operation

    Directory of Open Access Journals (Sweden)

    A Mirsepassi

    2004-10-01

    Full Text Available The water industry is facing increased pressure to produce higher quality treated water at a lower cost. The efficiency of a treatment process closely is related to the operation of the plant. To improve the operating performance, an Artificial Neural Network (ANN paradigm has been applied to a water treatment plant. An ANN which is able to learn the non-linear performance relationships of historical data of a plant has been proved to be capable of providing operational guidance for plant operators. A back-propagation network is used to determine the alum and polymer dosages. The results showed that the ANN model was most promising. The correlation coefficients (r between the actual and predicted values for the alum and polymer dosages were both 0.97 and the average absolute percentage errors were 4.09% and 8.76% for the alum and polymer dosages, respectively. The application of the ANN model was illustrated using data from Wyong Shire Council’s Mardi Water Treatment Plant on the Central Coast of NSW.

  4. The effects of physicochemical wastewater treatment operations on forward osmosis

    OpenAIRE

    Hey, Tobias; Bajraktari, Niada; Vogel, Jörg; Hélix-Nielsen, Claus; La Cour Jansen, Jes; Jönsson, Karin

    2016-01-01

    Raw municipal wastewater from a full-scale wastewater treatment plant was physicochemically pretreated in a large pilot-scale system comprising coagulation, flocculation, microsieve and microfiltration operated in various configurations. The produced microsieve filtrates and microfiltration permeates were then concentrated using forward osmosis (FO). Aquaporin Inside(TM) FO membranes were used for both the microsieve filtrate and microfiltration permeates, and Hydration Technologies Inc.-thin...

  5. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  6. The non-operative resin treatment of proximal caries lesions.

    Science.gov (United States)

    Ekstrand, Kim; Martignon, Stefania; Bakhshandeh, Azam; Ricketts, David N J

    2012-11-01

    Epidemiological data show that the prevalence of caries on proximal surfaces in need of operative treatment is very high around the world, both in the primary and the permanent dentition. This article presents two new treatment methods: proximal sealing and proximal infiltration. The indications are progressing proximal caries lesions, radiographically with a depth around the enamel-dentine junction. A small number of studies regarding the effect of sealing and infiltration on proximal caries versus the use of fluoride varnish, placebo treatment and flossing instructions have been carried out. About half of the studies disclose a not significant difference between test and control treatment. In the other half, the therapeutic effect is significant and corresponds to about 30% reduction in lesion progression. However, longitudinal studies of longer duration are lacking. Proximal sealing and proximal infiltration may have a place in the treatment of non-cavitated proximal lesions. Proximal caries is a problem in both primary and permanent dentitions. Proximal sealants or lesion infiltration are possible treatments.

  7. Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment.

    Science.gov (United States)

    Lempainen, Lasse; Kosola, Jussi; Pruna, Ricard; Puigdellivol, Jordi; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

    2018-02-01

    As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings. To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes. Case series; Level of evidence, 4. Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored. Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up. Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures.

  8. Operative treatment of metacarpal and phalangeal fractures in athletes: early return to play.

    Science.gov (United States)

    Kodama, Narihito; Takemura, Yoshinori; Ueba, Hiroaki; Imai, Shinji; Matsusue, Yoshitaka

    2014-09-01

    Evaluating the outcomes of operative treatment for metacarpal and phalangeal fractures in athletes returning early to play and discussing the more effective methods that permit rapid early return to athletic activity. We retrospectively identified a total of 105 metacarpal or phalangeal fractures in 105 athletes with conservative or operative treatment in our department. Of these, 20 athletes required an early return to sport because of a pending important game in their competition within 1 month after injury. Therefore, they underwent surgical treatment with open reduction and internal fixation of metacarpal or phalangeal fractures in an attempt to achieve an early return to their chosen sport at their usual competitive level. The patients included 6 rugby football players, 2 soccer goalkeepers, 3 American football players, 3 handball players, 2 baseball players and 4 who participated in other sports. The clinical records of preoperative and postoperative radiographs were available for all patients, and clinical outcome was evaluated by total active motion (TAM). The patients were followed up for a mean of 27 (24-43) months. At the latest follow-up examination, bone union was obtained in all cases. In cases with metacarpal and phalangeal fractures, the average TAM was 263° (range 240°-270°). We consider that an early comeback to training and competition can be permitted exclusively for patients with metacarpal and phalangeal fractures. It is important for the attending physician to administer such treatment after obtaining informed consent and develop a trusting relationship with the patient and other related individuals while paying attention to their hope of quick recovery.

  9. Electric pulse treatment of rim wheel metal after operation

    Directory of Open Access Journals (Sweden)

    L.I.Vakulenko

    2013-02-01

    Full Text Available Introduction. Load increase on the wheel pair ax requires the use of railway wheels with the advanced complex of properties. Except strength properties, the properties of metal resistance to defect nucleation on the wheel thread are of high importance. The above mentioned properties increase is possible by using different technological decisions: alloying and heat strengthening. Purpose. The purpose is an attempt to estimate the softening degree of the wheel thread metal using the electric pulse treatment. Methodology. Electric pulse treatment (ET was carried out on the special plant in the conditions of JSC DS (Nikolayev city. As the property of metal strength the Vickers hardness number is used. The microstructure research was carried out using the light microscope. The material for research is the carbon steel of the rim fragment of railway wheel №181732, withdrawn after operation, containing 0,55%С, 0,74%Mn, 0,33%Si, 0,009%P, 0,01%S, 0,06% Ni, 0,1%Cr, 0,08%Cu. Findings. Exposing the rim fragment to electric pulse treatment (ET, the qualitative changes of internal structure of the wheel rim metal corresponded to the experimentally observed geometrical dimensions change of the specimen, depending on the cycles number. As a result of the treatment the reduction of cold strained metal hardness is observed. It was found out 20 % softening on the wheel thread for the І rim area the, for the ІІ rim area the 8% softening and for the ІІІ 11% softening in relation to the initial state. Originality. As a result of electric pulse treatment, the change of the specimen geometrical dimensions is observed. Depending on the number of cycles it causes softening effect. It is proved that the observed softening value during ET is qualitatively connected with the cold strain level on the rail wheel thread. Practical value. As a result of metal cold work on the wheel thread its resistance to the defect nucleation is being reduced. The resulted data can

  10. A Case of Type 2 Amiodarone-Induced Thyrotoxicosis That Underwent Total Thyroidectomy under High-Dose Steroid Administration

    Directory of Open Access Journals (Sweden)

    Koshi Hashimoto

    2015-01-01

    Full Text Available Amiodarone is used commonly and effectively in the treatment of arrhythmia; however, it may cause thyrotoxicosis categorized into two types: iodine-induced hyperthyroidism (type 1 amiodarone-induced thyrotoxicosis (AIT and destructive thyroiditis (type 2 AIT. We experienced a case of type 2 AIT, in which high-dose steroid was administered intravenously, and we finally decided to perform total thyroidectomy, resulting in a complete cure of the AIT. Even though steroid had been administered to the patient (maximum 80 mg of prednisolone, the operation was performed safely and no acute adrenal crisis as steroid withdrawal syndrome was found after the operation. Few cases of type 2 AIT that underwent total thyroidectomy with high-dose steroid administration have been reported. The current case suggests that total thyroidectomy should be taken into consideration for patients with AIT who cannot be controlled by medical treatment and even in those under high-dose steroid administration.

  11. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

    Directory of Open Access Journals (Sweden)

    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  12. A case that underwent bilateral video-assisted thoracoscopic ...

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  13. Operational Performance of an AnaerobicAnoxic-Aerobic Treatment System

    Directory of Open Access Journals (Sweden)

    Andre Luis Calado Araujo

    2017-12-01

    Full Text Available An anaerobic (UASB – hybrid aerobic (suspended and attached growth activated sludge wastewater treatment system was evaluated on the removal of organic matter, solids and nitrogen following its pre-operational phase. Analysis were made weekly based on composite samples, prepared by grab samples taken every four hours, during 24-hour cycle, weighted by flow rate, on each monitoring point (raw sewage, UASB, anoxic chamber, aerobic reactors, return sludge from secondary decanters and final effluent. The plant presented an average flow rate of 908 m3/h with peaks from 10 to 14 h. BOD was removed by 86 % (310 to 41 mg/L being the highest parcel accounted by UASB reactors (70 % and removal of total suspended solids reached 63 % (190 to 94 mg/L. Mean removals of TKN (71 % and Ammonium (77 % were above the value predicted by design and, probably the nitrification-denitrification process was not the dominant route.

  14. Effects of Surgical Assistant's Level of Resident Training on Surgical Treatment of Intermittent Exotropia: Operation Time and Surgical Outcomes.

    Science.gov (United States)

    Kim, Moo Hyun; Chung, Hyunuk; Kim, Won Jae; Kim, Myung Mi

    2018-02-01

    To evaluate the effects of the surgical assistant's level of resident training on operation time and surgical outcome in the surgical treatment of intermittent exotropia. This study included 456 patients with intermittent exotropia who underwent lateral rectus recession and medial rectus resection and were followed up for 24 months after surgery. The patients were divided into two groups according to the surgical assistant's level of resident training: group F (surgery assisted by a first-year resident [n = 198]) and group S (surgery assisted by a second-, third-, or fourth-year resident [n = 258]). The operation time and surgical outcomes (postoperative exodeviation and the number of patients who underwent a second operation) were compared between the two groups. The average operation times in groups F and S were 36.54 ± 7.4 and 37.34 ± 9.94 minutes, respectively (p = 0.33). Immediate postoperative exodeviation was higher in group F (0.79 ± 3.82 prism diopters) than in group S (0.38 ± 3.75 prism diopters). However, repeated-measures analysis of variance revealed no significant difference in exodeviation between the two groups during the 24-month follow-up period (p = 0.45). A second operation was performed in 29.3% (58 / 198) of the patients in group F, and in 32.2% (83 / 258) of those in group S (p = 0.51). No significant difference in operation time was observed when we compared the effects of the level of resident training in the surgical treatment of intermittent exotropia. Although the immediate postoperative exodeviation was higher in patients who had undergone surgery assisted by a first-year resident, the surgical outcome during the 24-month follow-up was not significantly different.

  15. The effects of physicochemical wastewater treatment operations on forward osmosis.

    Science.gov (United States)

    Hey, Tobias; Bajraktari, Niada; Vogel, Jörg; Hélix Nielsen, Claus; la Cour Jansen, Jes; Jönsson, Karin

    2017-09-01

    Raw municipal wastewater from a full-scale wastewater treatment plant was physicochemically pretreated in a large pilot-scale system comprising coagulation, flocculation, microsieve and microfiltration operated in various configurations. The produced microsieve filtrates and microfiltration permeates were then concentrated using forward osmosis (FO). Aquaporin Inside TM FO membranes were used for both the microsieve filtrate and microfiltration permeates, and Hydration Technologies Inc.-thin-film composite membranes for the microfiltration permeate using only NaCl as the draw solution. The FO performance was evaluated in terms of the water flux, water flux decline and solute rejections of biochemical oxygen demand, and total and soluble phosphorus. The obtained results were compared with the results of FO after only mechanical pretreatment. The FO permeates satisfied the Swedish discharge demands for small and medium-sized wastewater treatment plants. The study demonstrates that physicochemical pretreatment can improve the FO water flux by up to 20%. In contrast, the solute rejection decreases significantly compared to the FO-treated wastewater with mechanical pretreatment.

  16. Seabrook, N.H. Wastewater Treatment Plant Chief Operator Recognized for Outstanding Service

    Science.gov (United States)

    Dustin Price, a resident of Berwick Maine and the Chief Operator of the Seabrook, N.H. Wastewater Treatment Plant, was honored by EPA with a 2016 Regional Wastewater Treatment Plant Operator of the Year Excellence Award.

  17. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  18. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  19. Operation technology of the ventilation system of the radioactive waste treatment facility(II) - Design and operation note

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K. M.; Lee, B. C.; Bae, S. M. [Korea Atomic Energy Research Institute, Taejon (Korea)

    1999-12-01

    As the radioactive waste treatment work, such as compaction and/or solidification of wastes, are done directly by the workers in the Radioactive Waste Treatment Facility, the reasonable design and operation of the ventilation system is essential. In this report, the design criteria and specification of the ventilation equipment, system operation method are described for the effective design and operation of ventilation system in the radioactive waste treatment facility. And the anti-vibration work which was done in the Radioactive Waste Treatment Facility in KAERI to reduce the effect of vibration due to the continuous operation of big rotational equipment, the intake fans and the exhaust fans, are described in the report. 11 refs., 10 figs., 12 tabs. (Author)

  20. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial.

    Science.gov (United States)

    Griffin, Damian; Parsons, Nick; Shaw, Ewart; Kulikov, Yuri; Hutchinson, Charles; Thorogood, Margaret; Lamb, Sarah E

    2014-07-24

    To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures. Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial). 22 tertiary referral hospitals, United Kingdom. 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat. 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference -7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8). Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541. © Griffin et al 2014.

  1. HUMeral Shaft Fractures: MEasuring Recovery after Operative versus Non-operative Treatment (HUMMER): A multicenter comparative observational study

    NARCIS (Netherlands)

    K.C. Mahabier (Kiran); E.M.M. van Lieshout (Esther); H.W. Bolhuis (Hugo); P.K. Bos (Koen); M.W.G.A. Bronkhorst (Maarten); M.M.M. Bruijninckx (Milko); J. de Haan (Jeroen); W. Deenik (Wendy); B.J. Dwars (Boudewijn); M.G. Eversdijk (Martin); J.C. Goslings (Carel); R. Haverlag (Robert); M.J. Heetveld (Martin); A.J.H. Kerver (Albert J.H.); K.A. Kolkman (Karel); K. Leenhouts (Kees); S.A.G. Meylaerts (Sven); H. Poeze; R.W. Poolman (Rudolf); B.J. Punt (Bas); W.H. Roerdink (Herbert); G.R. Roukema (Gert); J.B. Sintenie (Jan Bernard); N.M.R. Soesman (Nicolaj); A.F.K. Tanka (Andras); E.J.T. ten Holder (Edgar); M. van der Elst (Maarten); F.H.W.M. van der Heijden (Frank); F.M. van der Linden (Frits); P. van der Zwaal (Peer); J.P. van Dijk (Johannes); H.P.W. van Jonbergen; E.J.M.M. Verleisdonk (Egbert); J.P.A.M. Vroemen (Jos); M. Waleboer (Marco); P. Wittich (Philippe); W.P. Zuidema (Wietse); S. Polinder (Suzanne); M.H.J. Verhofstad (Michiel); D. den Hartog (Dennis); R. Onstenk (Ron)

    2014-01-01

    textabstractBackground: Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an

  2. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  3. Operation and Maintenance Manual for the Central Facilities Area Sewage Treatment Plant

    Energy Technology Data Exchange (ETDEWEB)

    Norm Stanley

    2011-02-01

    This Operation and Maintenance Manual lists operator and management responsibilities, permit standards, general operating procedures, maintenance requirements and monitoring methods for the Sewage Treatment Plant at the Central Facilities Area at the Idaho National Laboratory. The manual is required by the Municipal Wastewater Reuse Permit (LA-000141-03) the sewage treatment plant.

  4. Water Treatment Plant Operation. Volume II. A Field Study Training Program.

    Science.gov (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  5. Water Treatment Plant Operation. Volume I. A Field Study Training Program.

    Science.gov (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  6. Water Treatment Plant Operation Volume 2. A Field Study Training Program. Revised.

    Science.gov (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  7. Operation of Wastewater Treatment Plants. Volume 1. A Field Study Training Program. Third Edition. Revised.

    Science.gov (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The purpose of this wastewater treatment field study training program is to: (1) develop new qualified wastewater treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  8. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  9. Frequency of Helicobacter pylori in patients underwent endoscopy

    Directory of Open Access Journals (Sweden)

    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  10. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  11. Hydraulic modelling of drinking water treatment plant operations

    NARCIS (Netherlands)

    Worm, G.I.M.; Mesman, G.A.M.; Van Schagen, K.M.; Borger, K.J.; Rietveld, L.C.

    2009-01-01

    The flow through a unit of a drinking water treatment plant is one of the most important parameters in terms of a unit's effectiveness. In the present paper, a new EPAnet library is presented with the typical hydraulic elements for drinking water treatment processes well abstraction, rapid sand

  12. Hydraulic modelling of drinking water treatment plant operations

    Directory of Open Access Journals (Sweden)

    L. C. Rietveld

    2009-06-01

    Full Text Available The flow through a unit of a drinking water treatment plant is one of the most important parameters in terms of a unit's effectiveness. In the present paper, a new EPAnet library is presented with the typical hydraulic elements for drinking water treatment processes well abstraction, rapid sand filtration and cascade and tower aeration. Using this treatment step library, a hydraulic model was set up, calibrated and validated for the drinking water treatment plant Harderbroek. With the actual valve position and pump speeds, the flows were calculated through the several treatment steps. A case shows the use of the model to calculate the new setpoints for the current frequency converters of the effluent pumps during a filter backwash.

  13. The importance of the operating sequence: a multidisciplinary treatment approach.

    Science.gov (United States)

    Palazzo, Michele; Massai, Lorenzo

    2007-09-01

    Dental professionals will, from time to time, be presented with a patient who requires substantial treatment to correct trauma, caries damage, or severely compromised teeth. Such cases often require a multidisciplinary approach, which may include emergency endodontic, or periodontal pretreatment to obtain a morphological, functional, and aesthetic rehabilitation, while maintaining the residual dental and periodontal structures. This article will discuss a process to correctly develop the most appropriate treatment plan and how best to sequence treatment in cases requiring a multidisciplinary approach. This article will demonstrate how the formulation of a correct multidisciplinary treatment plan can provide the basis for predictable clinical success. Upon reading this article, the reader should: 1) Understand the importance of and learn how to determine the sequence for a multidisciplinary treatment plan. 2) Become familiar with the value of a correct dental-periodontal relationship.

  14. Endovascular treatment of aneurisms: Pre, intra and post operative management

    Energy Technology Data Exchange (ETDEWEB)

    Bracard, S., E-mail: s.bracard@chu-nancy.fr [Université de Lorraine (France); INSERM U 947 (France); Department of Diagnostic and Interventional Neuroradiology. CHU Nancy cedex (France); Barbier, C., E-mail: c.barbier@chu-nancy.fr [Department of Diagnostic and Interventional Neuroradiology. CHU Nancy, Batiment Jean Lepoire. Hopital Central, CHU Nancy, 54035 Nancy cedex (France); Derelle, A.L., E-mail: al.derelle@chu-nancy.fr [Department of Diagnostic and Interventional Neuroradiology. CHU Nancy, Batiment Jean Lepoire. Hopital Central, CHU Nancy, 54035 Nancy cedex (France); Anxionnat, R., E-mail: r.anxionnat@chu-nancy.fr [Université de Lorraine (France); INSERM U 947 (France); Department of Diagnostic and Interventional Neuroradiology. CHU Nancy cedex (France)

    2013-10-01

    The most frequent risk in endovascular aneurysm treatment is thromboembolic complications. Thus adjuvant pharmaceuticals are largely focused on preventing and treating these latter. Additionally symptomatic treatment of subarachnoid hemorrhage (SAH) and treatments to avoid vasospasm will enter into play in cases of ruptured aneurisms. Consensus exists in the literature neither for the necessity of heparin or antiplatelets nor for the doses to be administered. The principles and rationale of the use of these medications are reviewed with a discussion of protocols according with clinical situations and technical choices.

  15. [Operative treatment of congenital upward displacement of the shoulder blade].

    Science.gov (United States)

    Wirth, C J; Jäger, M

    1984-01-01

    In congenital elevation of the scapula the scapulothoracic movements and the patient's cosmetical appearance are affected. The aim of a number of operative procedures is the improvement or removal of this conditions. Between 1958 and 1978 15 patients with congenital elevation of the scapula were operatively treated by resection of the supraspinous portion of the scapula with or without relocating the scapula in a more caudal position, or in the method of König. 5 cases had a Grade-3 deformity, 9 cases a Grade-2 deformity and one case a Grade-1 deformity, measured in the technique of Rigault. By resection of the supraspinous portion of the scapula with mobilization of the scapula (6 cases) a mean caudalization of 2.7 cm. and a mean improvement in shoulder abduction of 32 degrees could be achieved. The procedure of König resulted in a mean scapular caudalization of 2.9 cm. and a mean improvement in shoulder abduction of 26 degrees. No important difference in the endresult could be found between the two operative procedures because of nearly the same pre-operative grading distribution of deformity. Only the partially unsightly surgical scars were dissatisfying.

  16. The Patterns Of Surgical Thyroid Diseases And Operative Treatment ...

    African Journals Online (AJOL)

    Girmaye T. M.D. Assistant professor of surgery,. Mensur 0. M.D. Assistant professor of surgery,. Sentayehu T. M.D. General practitioner,. Sissay B. M.D. Assistant professor of surgery,. Department of surgery, Gondar College .... We would like to acknowledge all surgeons, physicians, interns, nurses and the operation theatre ...

  17. The patterns of surgical thyroid diseases and operative treatment in ...

    African Journals Online (AJOL)

    Background: Goitre is defiied as enlargement of the thyroid gland that normally weighs 25-30g. Methods: This was a retrospective review aimed at determining the incidence, pattern, pathology, ostoperative complications of 137 cases of goitre operated at the Gondar College of Medical sciences, Ethiopia, over a period of ...

  18. Indication for Operative Treatment of Angiomata of the Brain

    Directory of Open Access Journals (Sweden)

    N. O. Ameli

    1964-01-01

    Full Text Available Many patients with known angiomata of the brain lead a useful life, and unless it is proved that their life is threatened. or their capacity for work progressively diminishing, do not need removal of the angiomata. In the course of removal of an intracranial hematoma the angioma should be removed if identified. At such a time the removal is easy as the vessels are collapsed. When there is a definite indication for operation, the size ano position of the angioma should not deter the surgeon. Besides and adequate surgical technique, one should utilise all the modern facilities, e.g, hypothermia, hypotension, rapid transfusion and temporary occlusion of main arteries. With proper care the results of operation are gratifying.

  19. Effect of operative treatment on psychosocial problems of men with gynaecomastia.

    Science.gov (United States)

    Kasielska, Anna; Antoszewski, Bogusław

    2011-11-01

    Gynaecomastia is defined as a hyperplasia of the breast tissue in men, bilateral or unilateral, usually not associated with the presence of malignant lesions.The aim of the study was to explore the psychosocial problems of men with gynecomastia and the effect of operative breast reduction on these problems.Material and methods. The survey was conducted in a group of 47 men who were treated surgically for gynaecomastia in the Department of Plastic, Reconstructive and Aesthetic Surgery. The mean age of the respondents was 25.6±3.5 years. For survey purposes, a questionnaire was developed with questions about the age of onset of gynaecomastia, coexisting disorders and medicines taken and also various aspects of the psychosocial life of the respondents. The questionnaire was completed by patients before surgery and at minimum 6 months after surgery.Results. The findings showed that in almost all patients gynaecomastia had caused emotional discomfort and limitation of everyday activity. In many patients, enlarged breasts caused difficulties in entering into social relationships. More than a half of the surveyed men admitted that their problems were ridiculed by others and they felt isolated. A comparison of the respondents' answers before and after the surgery showed statistically significant differences in all of the analysed questionnaire items.Conclusions. Gynaecomastia causes considerable emotional discomfort and limitation of everyday activity in young men, and that is why it constitutes a psychosocial problem. Surgical treatment of gynaecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in the men who underwent this intervention.

  20. Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment

    OpenAIRE

    Estrela, Carlos; Pécora, Jesus Djalma; Estrela, Cyntia R.A.; Guedes, Orlando A.; Silva, Brunno S.F.; Soares, Carlos José; Sousa-Neto, Manoel Damião

    2017-01-01

    Abstract Operative procedural errors must be well analyzed in order to avoid influence negatively the root canal treatment (RCT) prognosis. The successful RCT prevents tooth loss and avoids pain and apical periodontitis. This review aimed to categorize common operative procedure errors and clinical factors associated with RCT. Based on this, will be approached common errors of procedures within the clinical operative sequence: endodontic treatment planning, pulp and periapical disease diagnos...

  1. Post-operative duodenal fistula: percutaneous treatment and review

    Directory of Open Access Journals (Sweden)

    D.Huerta

    2015-04-01

    Full Text Available Duodenal fistula is a complex condition, relatively frequent presentation, being in most cases of postoperative origin. Among the latter, 6% to 11% are secondary to surgical treatment of perforated duodenal ulcer, and more unusual, as a complication of cholecystectomy. Two cases treated percutaneous at the Polyclinic Bank city of Buenos Aires are presented. The first, a female patient with a duodenal fistula as a postoperative complication of a perforated duodenal ulcer and the second one patient male with the same pathology but as a complication of cholecystectomy. Percutaneous treatment of this disease has been reported sporadically without having proven its usefulness. Once diagnosed the same Fistulography and obliteration were performed percutaneously achieving complete remission of the disease.

  2. Sternal fractures: "Operative treatment" should be kept in mind

    OpenAIRE

    Banu Yoldas; Hidir Esme; Mustafa Calik

    2012-01-01

    Isolated sternal fracture is a benign condition which generally heals with conservative treatment. But sometimes surgical intervention is necessary due to pain, other organ injury and union problems. There are several ways for repair; however, the best method is not yet defined. In this report, we presented two cases who were treated surgically for different indications with different suture materials. When anatomically correction can be achieved, using suture materials is a safe and effectiv...

  3. Heavy oil processing impacts refinery and effluent treatment operations

    Energy Technology Data Exchange (ETDEWEB)

    Thornthwaite, P. [Nalco Champion, Northwich, Cheshire (United Kingdom)

    2013-11-01

    Heavy oils are becoming more common in Europe. The processing of heavier (opportunity or challenge) crudes, although financially attractive, introduce additional challenges to the refiner. These challenges are similar whether they come from imported crudes or in the future possibly from shale oils (tight oils). Without a strategy for understanding and mitigating the processing issues associated with these crudes, the profit potential may be eroded by decreased equipment reliability and run length. This paper focuses on the impacts at the desalter and how to manage them effectively while reducing the risks to downstream processes. Desalters have to deal with an increased viscosity, density (lower API gravity), higher solids loading, potential conductivity issues, and asphaltene stability concerns. All these factors can lead to operational problems impacting downstream of the desalter, both on the process and the water side. The other area of focus is the effluent from the desalter which can significantly impact waste water operations. This can take the form of increased oil under-carry, solids and other contaminants originating from the crudes. Nalco Champion has experience in working with these challenging crudes, not only, Azeri, Urals and African crudes, but also the Canadian oil sands, US Shale oil, heavy South American crudes and crudes containing metal naphthenates. Best practices will be shared and an outlook on the effects of Shale oil will be given. (orig.)

  4. Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

    Science.gov (United States)

    Ketola, Saara; Lehtinen, Janne; Rousi, Timo; Nissinen, Maunu; Huhtala, Heini; Arnala, Ilkka

    2015-01-01

    Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation. In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure. Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation. The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.

  5. Recurrence After Operative Treatment of Adhesive Small-Bowel Obstruction

    DEFF Research Database (Denmark)

    Lorentzen, Lea; Øines, Mari N; Oma, Erling

    2018-01-01

    BACKGROUND: Postoperative adhesions are a common cause of small-bowel obstruction, and up to 53% of patients operated on for adhesive small-bowel obstruction (ASBO) experience recurrence. The primary aim of this study was to identify predictors for recurrence of ASBO. METHODS: We reviewed medical......: In total, 478 patients were included in the study. Of these, 58 (12.1%) patients experienced recurrence of ASBO during median 2.2 years follow-up. Female gender (hazard ratio [HR] 2.00, P = 0.023), multiple/matted adhesions (HR 1.72, P = 0.046), and fascial dehiscence (HR 3.26, P = 0.009) were associated...... with an increased risk were female gender, multiple/matted adhesions, and fascial dehiscence....

  6. Comparison of Operant Behavioral and Cognitive-Behavioral Group Treatment for Chronic Low Back Pain.

    Science.gov (United States)

    Turner, Judith A.; Clancy, Steve

    1988-01-01

    Assigned chronic low back pain patients to operant behavioral (OB) treatment, cognitive-behavioral (CB) treatment, or waiting-list (WL) condition. Both treatments resulted in decreased physical and psychosocial disability. OB patients' greater improvement leveled off at followup; CB patients continued to improve over the 12 months following…

  7. Operation, Maintenance and Management of Wastewater Treatment Facilities: A Bibliography of Technical Documents.

    Science.gov (United States)

    Himes, Dottie

    This is an annotated bibliography of wastewater treatment manuals. Fourteen manuals are abstracted including: (1) A Planned Maintenance Management System for Municipal Wastewater Treatment Plants; (2) Anaerobic Sludge Digestion, Operations Manual; (3) Emergency Planning for Municipal Wastewater Treatment Facilities; (4) Estimating Laboratory Needs…

  8. Exploring the Limits and Utility of Operant Conditioning in the Treatment of Drug Addiction

    Science.gov (United States)

    Silverman, Kenneth

    2004-01-01

    This article describes a research program to develop an operant treatment for cocaine addiction in low-income, treatment-resistant methadone patients. The treatment's central feature is an abstinence reinforcement contingency in which patients earn monetary reinforcement for providing cocaine-free urine samples. Success and failure of this…

  9. Treatment of pit water from uranium mining operation

    International Nuclear Information System (INIS)

    Mouton, A.; Lafforgue, P.; Lyaudet, G.

    1984-01-01

    The pit water from uranium mines is normally treated to eliminate the soluble radium and suspended solids. The radium is precipitated together with the barium sulphate. The latter results from the reaction of barium chloride with an excess of sulphate ions. The suspended solids are flocculated by aluminium salts (chloride, polychloride). If necessary, synthetic flocculants are also used. Certain grades of pit water contain, sometimes incidentally, a few milligrams of uranium per litre. These quantities always remain too low for any direct recovery (treatment by ion exchange resins). By applying certain measures, the preceding processes can also be used to eliminate uranium. The latter is carried away by aluminium hydroxide in a very narrow zone of pH (6 to 7,4) which corresponds to the minimum solubility of the hydroxide. Depending on the characteristic of the water (pH, salinity), use is made either of aluminium sulphate or of sodium aluminate, with an addition of a base in extreme cases. This article gives various examples of applications in the Haute-Vienne, Chardon in Vendee, the Commanderie mine in Vendee, at Cerilly in Allier and at Lodeve in Herault [fr

  10. Displaced Tibial Shaft Fractures With Intact Fibula in Children: Nonoperative Management Versus Operative Treatment With Elastic Stable Intramedullary Nailing.

    Science.gov (United States)

    Canavese, Federico; Botnari, Alexei; Andreacchio, Antonio; Marengo, Lorenza; Samba, Antoine; Dimeglio, Alain; Pereira, Bruno; Mansour, Mounira; Rousset, Marie

    2016-01-01

    The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibial shaft fractures with intact fibula in children after nonoperative management and operative treatment by elastic stable intramedullary nailing. A study was performed on 80 consecutive children, 56 males, 24 females from 2 Institutions, with displaced and closed tibial shaft fracture with intact fibula. All patients underwent regular clinical and radiographic follow-up visits for at least 2 years after injury. In total, 26 patients (group A-Institution I) were treated surgically by elastic stable intramedullary nailing and 54 patients (18 patients from group B-Institution I and 36 patients from group C-Institution II) were treated nonoperatively with closed reduction and casting. groups A, B, and C did not significantly differ on sex (P=0.37), side (P=0.54), and fracture site (P=0.14).Valgus deformity was significantly controlled in group A patients only (P=0.001); during follow-up in group B patients (P=0.017), and showed no significant change between pretreatment images and last follow-up in group C patients (P=0.71). Procurvatum deformity was significantly controlled in group A patients only (P=0.001); it showed no significant improvement after conservative treatment in group B (P=0.73) and C patients (P=0.8). Recurvatum was significantly improved in group A (Pfracture of tibial diaphysis without associated fibula fracture.On the basis of the findings reported here, it is not contraindicated to operate skeletally immature patients with displaced fracture of tibial diaphysis without associated fibula fracture. However, results were essentially the same and either method is a satisfactory choice for pediatric tibia shaft fractures with an intact fibula. In particular, we found that conservative treatment was as efficacious as surgical treatment apart from the length of time for immobilization. Level III.

  11. Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility

    NARCIS (Netherlands)

    Bosteels, Jan; Weyers, Steven; Kasius, Jenneke; Broekmans, Frank J.; Mol, Ben Willem J.; D'Hooghe, Thomas M.

    2015-01-01

    Background Limited observational evidence suggests potential benefit for subfertile women undergoing operative hysteroscopy with several anti-adhesion therapies (e. g. insertion of an intrauterine device (IUD) or balloon, hormonal treatment, barrier gels or human amniotic membrane grafting) to

  12. Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility

    NARCIS (Netherlands)

    Bosteels, Jan; Weyers, Steven; D'Hooghe, Thomas M.; Torrance, Helen; Broekmans, Frank J.; Chua, Su Jen; Mol, Ben Willem J.

    2017-01-01

    Background: Observational evidence suggests a potential benefit with several anti-adhesion therapies in women undergoing operative hysteroscopy (e.g. insertion of an intrauterine device or balloon, hormonal treatment, barrier gels or human amniotic membrane grafting) for decreasing intrauterine

  13. A Manual of Simplified Laboratory Methods for Operators of Wastewater Treatment Facilities.

    Science.gov (United States)

    Westerhold, Arnold F., Ed.; Bennett, Ernest C., Ed.

    This manual is designed to provide the small wastewater treatment plant operator, as well as the new or inexperienced operator, with simplified methods for laboratory analysis of water and wastewater. It is emphasized that this manual is not a replacement for standard methods but a guide for plants with insufficient equipment to perform analyses…

  14. Pilot Randomized Controlled Trial of Laparoscopic Cholecystectomy vs Active Non-operative Therapy for the Treatment of Biliary Dyskinesia

    Science.gov (United States)

    Richmond, Bryan K; Grodman, Caresse; Walker, Jerri; Dean, Scott; Tiley, Edward H; Hamrick, Roland E; Statler, Kristen; Emmett, Mary

    2016-01-01

    Introduction Despite widespread adoption by the surgical community, high-quality prospective data supporting the practice of laparoscopic cholecystectomy (LC) for the treatment of biliary dyskinesia (BD) is lacking. Methods Adult patients meeting criteria for diagnosis of BD (Rome III symptoms, normal ultrasound, gallbladder ejection fraction<38%) were randomized to either LC or a trial of non-operative (NO) therapy with a low-dose neuromodulator (amitriptyline 25mg/day). Patients in the NO arm were allowed to cross over to the surgical arm and remain in the study for any reason. Besides collection of basic demographics and medical/surgical history, patients were administered a standardized quality of life (QOL) assessment (SF-8) and a symptom-specific questionnaire (Rome III criteria) at enrollment and monthly through the study to assess the effect of treatment on biliary symptoms and overall QOL. Results Thirty patients were enrolled over 12 months (15LC, 15NO). In the LC group, 13 underwent LC, 1 refused surgery, 1 withdrew. In the NO group, 14 crossed over to the LC group (of which 13 had LC), yielding 26 patients who underwent LC. SF-8 physical scores (PCS-8) were significantly improved at both the first and last follow-up visits (p<0.0001, p=0.0003 respectively). SF-8 mental scores (MCS-8) were also significantly improved at both the first and last follow-up visits (p=0.0187, p=0.0017 respectively). With median follow-up of 12 months [range 3–14], all 26 reported relief of pain. Conclusions This pilot study raises doubts regarding the feasibility of a randomized trial, presumably due to both clinician and patient bias toward LC and the lack of “gold-standard” non-operative treatments. However, these prospective data indicate that, with careful patient selection (standardized symptom criteria/imaging methodology), LC results in pain relief and significant improvement in QOL in BD patients. Further prospective study of these findings is warranted. PMID

  15. Development of a Water Treatment Plant Operation Manual Using an Algorithmic Approach.

    Science.gov (United States)

    Counts, Cary A.

    This document describes the steps to be followed in the development of a prescription manual for training of water treatment plant operators. Suggestions on how to prepare both flow and narrative prescriptions are provided for a variety of water treatment systems, including: raw water, flocculation, rapid sand filter, caustic soda feed, alum feed,…

  16. A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Halit Diri

    2014-01-01

    Full Text Available Cushing’s syndrome (CS may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH- independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

  17. An evaluation of quality of life in women with endometriosis who underwent primary surgery: a 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia.

    Science.gov (United States)

    M F, Ahmad; Narwani, Hussin; Shuhaila, Ahmad

    2017-10-01

    Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p <.001) were observed. The Self Rate Assessment was improved; 6.66-4.68 post-operatively (p < .05). In EQ-5 D Index, the anxiety and activities outcomes showed a significant worsening post-intervention. There was no correlation between the stage of disease and endometrial pain; (p = .289), method of intervention (p = .290) and usage of post-operative hormonal therapy (p = .632). This study concluded that surgical treatment improved the QoL with added hormonal therapy post-intervention, despite not reaching statistical significance, showed a promising result. Impact statement Surgical intervention does improve the QoL for women with endometriosis however post interventional hormonal therapy is remain inconclusive.

  18. [Patients with astigmatism who underwent cataract surgery by phacoemulsification: toric IOL x asferic IOL?].

    Science.gov (United States)

    Torres Netto, Emilio de Almeida; Gulin, Marina Carvalho; Zapparoli, Marcio; Moreira, Hamilton

    2013-01-01

    Compare the visual acuity of patients who underwent cataract surgery by phacoemulsification with IOL AcrySof(®) toric implantation versus AcrySof(®) IQ and evaluate the reduction of cylindrical diopters (CD) in the postoperative period. Analytical and retrospective study of 149 eyes with 1 or more diopters of regular symmetrical keratometric astigmatism, which underwent cataract surgery by phacoemulsification. The eyes were divided into two groups: the toric group with 85 eyes and the non-toric group with 64 eyes. In the pre-operative phase, topographic data and refraction of each eye to be operated were assessed. In the postoperative phase, refraction and visual acuity with and without correction were measured. The preoperative topographic astigmatism ranged from 1.00 to 5.6 DC in both groups. Average reduction of 1.37 CD (p<0.001) and 0.16 CD (p=0.057) was obtained for the toric and non-toric group when compared to the refractive astigmatism, respectively. Considering visual acuity without correction (NCVA), the toric group presented 44 eyes (51.7%) with NCVA of 0 logMAR (20/20) or 0.1 logMAR (20/25) and the toric group presented 7 eyes (10.93%) with these same NCVA values. The results show that patients with a significant keratometric astigmatism presented visual benefits with the toric IOL implantation. The reduction of the use of optical aids may be obtained provided aberrations of the human eye are corrected more accurately. Currently, phacoemulsification surgery has been used not only for functional improvement, but also as a refraction procedure.

  19. Guidelines for the design and operation of makeup water treatment systems

    International Nuclear Information System (INIS)

    Lee, Y.H.; Planek, M.A.; Sopocy, D.M.; Tomaga, C.M.; Abrams, I.M.; Anderson, C.C.; Balazs, M.K.; Houskava, J.; Williams, R.

    1989-06-01

    These guidelines present the industry with a standardized program to ensure the optimum design and operation of their individual makeup water treatment systems. These guidelines present, in a non-technical and non-proprietary format, the makeup water treatment system design and operating topics that are discussed in detail in Volumes 1 and 2 of NP-6377-SL. The individual guidelines contained in Volumes 1 and 2 are presented as separate imperative statements, followed by a technical justification discussion, which provides further explanations. In addition and when applicable, the guidelines relate pertinent operational in regard to monitoring parameters for operation, alternative actions, troubleshooting, management responsibilities and shutdown practices. Design considerations are also addressed, when applicable, in regard to equipment cost and advantages and disadvantages for the design recommendations. Appendices provide background information for performance criteria, component description, economic evaluation procedures and definitions. 4 refs

  20. Operating cost guidelines for benchmarking DOE thermal treatment systems for low-level mixed waste

    International Nuclear Information System (INIS)

    Salmon, R.; Loghry, S.L.; Hermes, W.H.

    1994-11-01

    This report presents guidelines for estimating operating costs for use in benchmarking US Department of Energy (DOE) low-level mixed waste thermal treatment systems. The guidelines are based on operating cost experience at the DOE Toxic Substances Control Act (TSCA) mixed waste incinerator at the K-25 Site at Oak Ridge. In presenting these guidelines, it should be made clear at the outset that it is not the intention of this report to present operating cost estimates for new technologies, but only guidelines for estimating such costs

  1. Construction and Operation Costs of Wastewater Treatment and Implications for the Paper Industry in China.

    Science.gov (United States)

    Niu, Kunyu; Wu, Jian; Yu, Fang; Guo, Jingli

    2016-11-15

    This paper aims to develop a construction and operation cost model of wastewater treatment for the paper industry in China and explores the main factors that determine these costs. Previous models mainly involved factors relating to the treatment scale and efficiency of treatment facilities for deriving the cost function. We considered the factors more comprehensively by adding a regional variable to represent the economic development level, a corporate ownership factor to represent the plant characteristics, a subsector variable to capture pollutant characteristics, and a detailed-classification technology variable. We applied a unique data set from a national pollution source census for the model simulation. The major findings include the following: (1) Wastewater treatment costs in the paper industry are determined by scale, technology, degree of treatment, ownership, and regional factors; (2) Wastewater treatment costs show a large decreasing scale effect; (3) The current level of pollutant discharge fees is far lower than the marginal treatment costs for meeting the wastewater discharge standard. Key implications are as follows: (1) Cost characteristics and impact factors should be fully recognized when planning or making policies relating to wastewater treatment projects or technology development; (2) There is potential to reduce treatment costs by centralizing wastewater treatment via industrial parks; (3) Wastewater discharge fee rates should be increased; (4) Energy efficient technology should become the future focus of wastewater treatment.

  2. Theoretical and experimental researches on the operating costs of a wastewater treatment plant

    Science.gov (United States)

    Panaitescu, M.; Panaitescu, F.-V.; Anton, I.-A.

    2015-11-01

    Purpose of the work: The total cost of a sewage plants is often determined by the present value method. All of the annual operating costs for each process are converted to the value of today's correspondence and added to the costs of investment for each process, which leads to getting the current net value. The operating costs of the sewage plants are subdivided, in general, in the premises of the investment and operating costs. The latter can be stable (normal operation and maintenance, the establishment of power) or variables (chemical and power sludge treatment and disposal, of effluent charges). For the purpose of evaluating the preliminary costs so that an installation can choose between different alternatives in an incipient phase of a project, can be used cost functions. In this paper will be calculated the operational cost to make several scenarios in order to optimize its. Total operational cost (fixed and variable) is dependent global parameters of wastewater treatment plant. Research and methodology: The wastewater treatment plant costs are subdivided in investment and operating costs. We can use different cost functions to estimate fixed and variable operating costs. In this study we have used the statistical formulas for cost functions. The method which was applied to study the impact of the influent characteristics on the costs is economic analysis. Optimization of plant design consist in firstly, to assess the ability of the smallest design to treat the maximum loading rates to a given effluent quality and, secondly, to compare the cost of the two alternatives for average and maximum loading rates. Results: In this paper we obtained the statistical values for the investment cost functions, operational fixed costs and operational variable costs for wastewater treatment plant and its graphical representations. All costs were compared to the net values. Finally we observe that it is more economical to build a larger plant, especially if maximum loading

  3. A review on the sustainability of constructed wetlands for wastewater treatment: Design and operation.

    Science.gov (United States)

    Wu, Haiming; Zhang, Jian; Ngo, Huu Hao; Guo, Wenshan; Hu, Zhen; Liang, Shuang; Fan, Jinlin; Liu, Hai

    2015-01-01

    Constructed wetlands (CWs) have been used as a green technology to treat various wastewaters for several decades. CWs offer a land-intensive, low-energy, and less-operational-requirements alternative to conventional treatment systems, especially for small communities and remote locations. However, the sustainable operation and successful application of these systems remains a challenge. Hence, this paper aims to provide and inspire sustainable solutions for the performance and application of CWs by giving a comprehensive review of CWs' application and the recent development on their sustainable design and operation for wastewater treatment. Firstly, a brief summary on the definition, classification and application of current CWs was presented. The design parameters and operational conditions of CWs including plant species, substrate types, water depth, hydraulic load, hydraulic retention time and feeding mode related to the sustainable operation for wastewater treatments were then discussed. Lastly, future research on improving the stability and sustainability of CWs were highlighted. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. The Treatment of Six Sigma in Introductory Operations Management Textbooks: Clearing Up the Confusion

    Science.gov (United States)

    Ravinder, Handanhal; Misra, Ram B.

    2016-01-01

    This paper critically examines the treatment of the statistical basis for Six Sigma and process capability in popular operations management textbooks. It discusses areas of confusion and suggest ways of treating the topic that make sense to instructors as well as students. Even though Six Sigma was introduced almost 30 years ago, misconceptions…

  5. Satisfaction with pain relief after operative treatment of an ankle fracture

    NARCIS (Netherlands)

    Helmerhorst, Gijs T. T.; Lindenhovius, Anneluuk L. C.; Vrahas, Mark; Ring, David; Kloen, Peter

    2012-01-01

    Background: American patients are prescribed more opioid pain medication than Dutch patients after operative treatment of an ankle fracture, but it is possible that pain is undertreated in Dutch patients. This study tests if there is a difference in pain and satisfaction with pain relief between

  6. Evaluation of Climate Change Impact on Drinking Water Treatment Plant Operation

    Science.gov (United States)

    It is anticipated that global climate change will adversely impact source water quality in many areas of the United States and, therefore, will influence the design and operation of current and future drinking water treatment systems. Some of these impacts may lead to violations ...

  7. Operational fluid radwaste treatment technology - recent state and outlooks for optimization

    International Nuclear Information System (INIS)

    Lastovicka, Z.; Kreisl, I.; Taras, P.

    2000-01-01

    Based on the Dukovany NPP (EDU) order, IPRON a.s. performed in the year 1999 the 'Concept Study of Neutralization of Semi-Liquid RAW Originating in the EDU Processes'. This paper summarizes the conclusions of the Study while emphasizing the sludge and sorbent treatment under the conditions of Czech NPPs operating the VVER blocks. (author)

  8. The effect of UV treatment on highly polluted and normal operated swimming pools

    DEFF Research Database (Denmark)

    Spiliotopoulou, Aikaterini; Kaarsholm, Kamilla Marie Speht; Andersen, Henrik Rasmus

    2017-01-01

    “It should be light blue, transparent” (Mario Andrada, speakerman, Olympic Games, Rio, 2016) was the comment for the “green lake”. Swimming pools are sensitive recirculating systems. A malfunction in water treatment units or a poor operating decision could possibly lead to health-endangering or a...

  9. Influence of wastewater treatment plants' operational conditions on activated sludge microbiological and morphological characteristics.

    Science.gov (United States)

    Amanatidou, Elisavet; Samiotis, Georgios; Trikoilidou, Eleni; Tzelios, Dimitrios; Michailidis, Avraam

    2016-01-01

    The effect of wastewater composition and operating conditions in activated sludge (AS) microbiological and morphological characteristics was studied in three AS wastewater treatment plants (WWTPs): (a) a high organic load slaughterhouse AS WWTP, operating at complete solids retention, monitored from its start-up and for 425 days; (b) a seasonally operational, low nitrogen load fruit canning industry AS WWTP, operating at complete solids retention, monitored from its start-up and until the end of the season (87 days); (c) a municipal AS WWTP, treating wastewater from a semi-combined sewer system, monitored during the transitions from dry to rainy and again to dry periods of operation. The sludge microbiological and morphological characteristics were correlated to nutrients' availability, solids retention time, hydraulic retention time, dissolved oxygen, mixed liquor suspended solids (MLVSS), organic load (F/M) and substrate utilization rate. The AS WWTPs' operation was distinguished in periods based on biomass growth phase, characterized by different biological and morphological characteristics and on operational conditions. An anoxic/aerobic selector minimizes the readily biodegradable compounds in influent, inhibiting filamentous growth. Plant performance controlling is presented in a logic flowchart in which operational parameters are linked to microbial manipulation, resulting in a useful tool for researchers and engineers.

  10. Intermittent operation of ultra-low pressure ultrafiltration for decentralized drinking water treatment.

    Science.gov (United States)

    Peter-Varbanets, Maryna; Gujer, Willi; Pronk, Wouter

    2012-06-15

    River water was treated by ultrafiltration at a relatively low transmembrane pressure (40 mbar). As observed before, flux stabilization occurred after several days of operation although no back-flushing or cross flow was applied. Interruptions in flux were applied by temporary offset of the transmembrane pressure. After restoration of the transmembrane pressure, the initial flux was higher than the stable flux level, and the flux recovery depended on the standstill time. Furthermore, if a short cross flow was applied after standstill, the flux was restored to an even higher level. In all cases, the flux decreased again during operation to reach finally the same stable level as before standstill. In order to evaluate the influence of intermittent operation as practiced for water treatment on a household level, daily interruptions of flux were applied. An optimum of total daily water production rate was obtained at 21 h of operation and 3 h of standstill per day. A model was developed which can describe the impact of intermittent operation on the flux depending on the duration of the standstill and operating periods. This enables the prediction of production capacity of the system operated intermittently. The flux increase during standstill could be explained by a relaxation and expansion of the biofouling layer, while the higher flux after forward-flushing was caused by this layer being partially sloughed off. Household water treatment with the process presented here will generally be operated on a discontinuous basis. The results show that such operation schemes do not compromise the permeability of the system, but actually lead to higher fluxes after standstill. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Chemical aspects of the commissioning and early operation of the BNL pond water treatment plant

    International Nuclear Information System (INIS)

    Bradbury, D.; Elder, G.B.

    1981-11-01

    An account is given of the chemical aspects of the work done in commissioning and setting-to-work the pond water treatment plant at BNL. The plant is designed to maintain the fuel pond within the specified chemical conditions for Magnox fuel storage. In normal operation the treatment requirements are met by anion exchange, i.e. the carbonate and other impurity anions in the pond water are replaced by hydroxide held on an anion exchange resin. This method is referred to as ''anion only''. In the commissioning tests the performance of the plant was substantiated by passing simulated pond water of the correct chemical composition through the plant and monitoring the water quality at the plant outlet. During the first phase of operation on the pond itself the plant was operated in non-standard fashion to convert the chemistry from the previous ''carbonate'' regime to the required conditions. (author)

  12. Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies.

    Science.gov (United States)

    Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon

    2016-06-01

    An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level.

  13. Centralized Drinking Water Treatment Operations Shape Bacterial and Fungal Community Structure.

    Science.gov (United States)

    Ma, Xiao; Vikram, Amit; Casson, Leonard; Bibby, Kyle

    2017-07-05

    Drinking water microbial communities impact opportunistic pathogen colonization and corrosion of water distribution systems, and centralized drinking water treatment represents a potential control for microbial community structure in finished drinking water. In this article, we examine bacterial and fungal abundance and diversity, as well as the microbial community taxonomic structure following each unit operation in a conventional surface water treatment plant. Treatment operations drove the microbial composition more strongly than sampling time. Both bacterial and fungal abundance and diversity decreased following sedimentation and filtration; however, only bacterial abundance and diversity was significantly impacted by free chlorine disinfection. Similarly, each treatment step was found to shift bacterial and fungal community beta-diversity, with the exception of disinfection on the fungal community structure. We observed the enrichment of bacterial and fungal taxa commonly found in drinking water distribution systems through the treatment process, for example, Sphingomonas following filtration and Leptospirillium and Penicillium following disinfection. Study results suggest that centralized drinking water treatment processes shape the final drinking water microbial community via selection of community members and that the bacterial community is primarily driven by disinfection while the eukaryotic community is primarily controlled by physical treatment processes.

  14. Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration.

    Science.gov (United States)

    Missel, M; Pedersen, J H; Hendriksen, C; Tewes, M; Adamsen, L

    2016-11-01

    Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast-track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients' daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital-to-home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau-Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post-operative trajectory the patients' resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub-themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast-track surgery. Clinicians should be aware of patients' experiences of illness to facilitate patient reconstitution of own identity. © 2015 John Wiley & Sons Ltd.

  15. Six-year experiences in the operation of a low level liquid waste treatment plant

    International Nuclear Information System (INIS)

    Wen, S.-J.; Hwang, S.-L.; Tsai, C.-M.

    1980-01-01

    The operation of a low level liquid waste treatment plant is described. The plant is designed for the disposal of liquid waste produced primarily by a 40 MW Taiwan Research Reactor as well as a fuel fabrication plant for the CANDU type reactor and a radioisotopes production laboratory. The monthly volume treated is about 600-2500 ton of low level liquid waste. The activity levels are in the range of 10 -5 -10 -3 μCi/cm 3 . The continuous treatment system of the low level liquid waste treatment plant and the treatment data collected since 1973 are discussed. The advantages and disadvantages of continuous and batch processes are compared. In the continuous process, the efficiency of sludge treatment, vermiculite ion exchange and the adsorption of peat are investigated for further improvement. (H.K.)

  16. Operational conditions: legal capacity of a patient soldier refusing medical treatment.

    Science.gov (United States)

    Kelly, Janet C

    2011-11-01

    Using a three-dimensional ethical role-specific model, this article considers the dual loyalty conflict between following military orders and professional codes of practice in an operational military environment when a patient soldier refuses life-saving medical treatment and where their legal capacity is questionable. The article suggests that although every competent patient has the right to refuse medical treatment even though they may die as a consequence. Ordinarily, it is unethical to exert any undue influence on a patient to accept medical treatment, in a military operational environment where attack from the enemy is likely, it may be reasonable and understandable to exert undue influence over a patient when they lack legal capacity.

  17. Spas for gynaecological complaints in the follow-up treatment of women operated and irradiated for cancer

    International Nuclear Information System (INIS)

    Baatz, H.; Verband Deutscher Badeaerzte e.V., Bad Pyrmont

    1980-01-01

    The therapeutical value of the two main fields of gynaecological balneotherapy, and treatment and brine treatment, is about equal, so that the therapy of choice depends mostly on the 12 possible indications. Mud therapy is never indicated for the post-operative treatment of woman who have undergone primary cancer therapy. It is contra-indicated during cancer treatment as well as afterwards. Brine therapy is the method of choice for post-operative treatment. (orig./MG) [de

  18. Clinical application of an improved utero-operator in the interventional treatment of infertility

    International Nuclear Information System (INIS)

    Huang Yaoming; Zhang Guangfu; Li Detai

    2002-01-01

    Objective: To evaluate the effectiveness of an improved utero-operator in the interventional treatment of tube obstruction infertility, and to make a comparison with other methods. Methods: One hundred cases of infertile women with tubal obstruction were divided into 3 groups and treated separately under TV fluoroscopy with 3 different methods and follow-up examination was made up to 24 months. Among the 100 cases, 60 cases were treated with improved utero-operator (109 tubes), 20 with Cook cupped coaxial catheter (36 tubes), and 20 with emulsoid double-cavity tube (20 tubes). Result: Among the improved utero-operator group, Cook cupped coaxial catheter group, and emulsoid double-cavity tube group, the successful rate of selective catheterization was 92.7%, 80.6% and 80.0%, respectively. The successful rate of recanalization was 72.3%, 72.4% and 71.4%, respectively. The pregnancy rate was 36.4%, 35.7% and 36.4%, respectively. Improved utero-operator has the highest successful rate in selective catheterization (x 2 = 4.275, P < 0.05). Conclusion: Improved utero-operator has a high successful rate of selective catheterization in selective salpingography and treatment of tube obstruction infertility, and it is an easy and stable method which spends less time and received less X-ray. It is an ideal treating method at the moment

  19. Treatment of a Slaughterhouse Wastewater using Sequencing Batch Reactors at a Shortened Operating Cycle

    Directory of Open Access Journals (Sweden)

    Suwadi Saikomon

    2017-01-01

    Full Text Available This laboratory-scale study employed sequencing batch reactor (SBR technology to investigate the effect of two operational parameters [i.e. solids retention time (SRT and anoxic time ratios] regarding the treatment of a slaughterhouse wastewater. Results indicated that organic matter removal, expressed as chemical oxygen demand (COD, was very high, consistently exceeding the 95 % level. In addition, the total nitrogen (TN removal ranged between 82 and 94 %, while total phosphorus (TP removal fluctuated between 88 and 94 %. In general, the reactors exhibited a high degree of operational stability during treatment. Although the investigated range of the two operational parameters appeared to have a minimal effect on the process performance (expressed as % carbon or nutrient removal, the corresponding COD and TN specific consumption rates were noticeably affected by the variation in the anoxic time ratios. Furthermore, the operating cycle length of 8 h employed in this study resulted in improved performance, in terms of nitrogen removal, compared to other studies conducted at longer operating cycles.

  20. Integrated radwaste treatment system lessons learned from 2 1/2 years of operation

    International Nuclear Information System (INIS)

    Baker, M.N.; Fussner, R.J.

    1997-05-01

    The Integrated Radwaste Treatment System (IRTS) at the West Valley Demonstration Project (WVDP) is a pretreatment scheme to reduce the amount of salts in the high-level radioactive waste (vitrification) stream. Following removal of cesium-137 (Cs-137) by ion-exchange in the Supernatant Treatment System (STS), the radioactive waste liquid is volume-reduced by evaporation. Trace amounts of Cs-137 in the resulting distillate are removed by ion-exchange, then the distillate is discharged to the existing plant water treatment system. The concentrated product, 37 to 41 percent solids by weight, is encapsulated in cement producing a stable, low-level waste form. The Integrated Radwaste Treatment System (IRTS) operated in this mode from May 1988 through November 1990, decontaminating 450,000 gallons of high-level waste liquid; evaporating and encapsulating the resulting concentrates into 10,393 71-gallon square drums. A number of process changes and variations from the original operating plan were required to increase the system flow rate and minimize waste volumes. This report provides a summary of work performed to operate the IRTS, including system descriptions, process highlights, and lessons learned

  1. Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India.

    Science.gov (United States)

    Shewade, Hemant Deepak; Nair, Dina; Klinton, Joel S; Parmar, Malik; Lavanya, J; Murali, Lakshmi; Gupta, Vivek; Tripathy, Jaya Prasad; Swaminathan, Soumya; Kumar, Ajay M V

    2017-12-01

    Worldwide, there's concern over high pre-diagnosis and pre-treatment attritions or delays in Multidrug resistant tuberculosis (MDR-TB) diagnosis and treatment pathway (DTP). We conducted this operational research among patients with presumptive MDR-TB in north and central Chennai, India to determine attrition and turnaround times (TAT) at various steps of DTP and factors associated with attrition. Study was conducted in Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all patients with presumptive MDR-TB (eligible for DST) in 2014. Of 628 eligible for DST, 557 (88%) underwent DST and 74 (13%) patients were diagnosed as having MDR-TB. Pre-diagnosis and pre-treatment attrition was 11% (71/628) and 38% (28/74) respectively. TAT [median (IQR)] to test from eligibility for DST and initiate DR-TB treatment from diagnosis were 14 (9,27) and 18 (13,36) days respectively. Patients with smear negative TB and detected in first quarter of 2014 were less likely to undergo DST. Patients in first quarter of 2014 had significantly lower risk of pre-treatment attrition. There was high uptake of DST. However, urgent attention is required to reduce pre-treatment attrition, improve TAT to test from eligibility for DST and improve DST among patients with smear-negative TB. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  2. Comparisons of interdisciplinary ballast water treatment systems and operational experiences from ships.

    Science.gov (United States)

    Bakalar, Goran

    2016-01-01

    There are high functioning and low functioning ballast water treatment systems on board ships. In this study, five systems were analysed so as to methodically examine the operational difficulties for ship crew members while giving important consideration to sustainable environment practices. Multi-criteria analysis, a questionnaire, survey and interviews were used as the research method so as to ascertain and corroborate existing problems on board ships, and the reliability of the systems was calculated. The co-insistency, maintenance and the efficiency of the systems, were shown as being the major problem as there are no systems for tracking ship ballast operations from land. The treatment system that used oxidants was, through multi criteria analysis, evaluated as being the best and was ranked first. However, the survey results showed that the ship's crew had serious problems with this system which difficult to solve during the ship's operations with cargo. The deoxygenation system was the most appropriate according to ballast water treatment criteria in the port or at sea. The treatment system which used electrolysis with oxidant was better in terms of efficacy and the treatment system electrolysis with ultra violet light was better in terms of the criterion environment pollution footprint. During further research, it was shown that 7 % of the surveyed crew members had major problems with operating ballast water treatment systems, including the system which was ranked first through multi criteria analysis. They by-passed these systems while continuing to ballast or de-ballast. It was calculated that of the total time needed for the ballast water treatment system operation, 9 % of this time was used for repairs or maintenance of the systems. Some examples are changing a used UV bulb, cleaning the filter or controlling the amount of oxidant which would be discharged into the sea. A conclusion was made and solution was suggested. The study results emphasised

  3. Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

    Science.gov (United States)

    Lotti, Marco

    2017-06-01

    Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-06-15

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

  5. Emissions model of waste treatment operations at the Idaho Chemical Processing Plant

    International Nuclear Information System (INIS)

    Schindler, R.E.

    1995-03-01

    An integrated model of the waste treatment systems at the Idaho Chemical Processing Plant (ICPP) was developed using a commercially-available process simulation software (ASPEN Plus) to calculate atmospheric emissions of hazardous chemicals for use in an application for an environmental permit to operate (PTO). The processes covered by the model are the Process Equipment Waste evaporator, High Level Liquid Waste evaporator, New Waste Calcining Facility and Liquid Effluent Treatment and Disposal facility. The processes are described along with the model and its assumptions. The model calculates emissions of NO x , CO, volatile acids, hazardous metals, and organic chemicals. Some calculated relative emissions are summarized and insights on building simulations are discussed

  6. The effects of operational and environmental variations on anaerobic wastewater treatment systems: a review

    Energy Technology Data Exchange (ETDEWEB)

    Leitao, R.C. [Embrapa Agroindustria Tropical (Brazilian Agricultural Research Corporation, Inst. of Tropical Agroindustry), Fortaleza (Brazil); Haandel, A.C. van [Federal University of Campina Grande (Brazil); Zeeman, G.; Lettinga, G. [Wageningen Univ. (Netherlands)

    2006-06-15

    With the aim of improving knowledge about the stability and reliability of anaerobic wastewater treatment systems, several researchers have studied the effects of operational or environmental variations on the performance of such reactors. In general, anaerobic reactors are affected by changes in external factors, but the severity of the effect is dependent upon the type, magnitude, duration and frequency of the imposed changes. The typical responses include a decrease in performance, accumulation of volatile fatty acids, drop in pH and alkalinity, change in biogas production and composition, and sludge washout. This review summarises the causes, types and effects of operational and environmental variation on anaerobic wastewater treatment systems. However, there still remain some unclear technical and scientific aspects that are necessary for the improvement of the stability and reliability of anaerobic processes. (author)

  7. Coal fly ash as adsorptive material for treatment of a real textile effluent: operating parameters and treatment efficiency.

    Science.gov (United States)

    Zaharia, Carmen; Suteu, Daniela

    2013-04-01

    The experimental results performed after the application of one single-stage treatment by sorption onto coal fly ash are evaluated in order to decolorize a real textile effluent of a private company specializing in manufacturing of cotton fabrics (i.e., sorption performance applied for a real textile effluent collected after the fabric dyeing, rinsing, and final finishing steps). The experiments are focused on studying the effect of initial textile effluent pH, adsorbent dose, temperature and adsorption time, considered as operating parameters of sorption process for high pollutant removals (e.g., organic pollutants as dyes, phenols, polymeric, and degradation compounds), and decoloration. The results indicate high values of decoloration degree (55.42-83.00%) and COD removal (44.44-61.11%) when it is worked at pH ≤2 with coal ash dose of 12-40 g/L, temperature higher than 20-25 °C, and continuous static operating regime (with an initial agitation step of 3-5 min). The treated textile effluent fulfills the quality demand, and is recyclable, inside reused or discharged after a stage of neutralization (standard pH of 6.5-8.5 for all textile effluent discharges). Also, the final effluent is able to follow the common path to the central biological treatment plant (i.e., a centralized treatment plant for all companies acting in the industrial site area with mechanical-biological steps for wastewater treatment) or may be directly discharged in the nearly watercourse.

  8. Identifying the microbial communities and operational conditions for optimized wastewater treatment in microbial fuel cells.

    Science.gov (United States)

    Ishii, Shun'ichi; Suzuki, Shino; Norden-Krichmar, Trina M; Wu, Angela; Yamanaka, Yuko; Nealson, Kenneth H; Bretschger, Orianna

    2013-12-01

    Microbial fuel cells (MFCs) are devices that exploit microorganisms as "biocatalysts" to recover energy from organic matter in the form of electricity. MFCs have been explored as possible energy neutral wastewater treatment systems; however, fundamental knowledge is still required about how MFC-associated microbial communities are affected by different operational conditions and can be optimized for accelerated wastewater treatment rates. In this study, we explored how electricity-generating microbial biofilms were established at MFC anodes and responded to three different operational conditions during wastewater treatment: 1) MFC operation using a 750 Ω external resistor (0.3 mA current production); 2) set-potential (SP) operation with the anode electrode potentiostatically controlled to +100 mV vs SHE (4.0 mA current production); and 3) open circuit (OC) operation (zero current generation). For all reactors, primary clarifier effluent collected from a municipal wastewater plant was used as the sole carbon and microbial source. Batch operation demonstrated nearly complete organic matter consumption after a residence time of 8-12 days for the MFC condition, 4-6 days for the SP condition, and 15-20 days for the OC condition. These results indicate that higher current generation accelerates organic matter degradation during MFC wastewater treatment. The microbial community analysis was conducted for the three reactors using 16S rRNA gene sequencing. Although the inoculated wastewater was dominated by members of Epsilonproteobacteria, Gammaproteobacteria, and Bacteroidetes species, the electricity-generating biofilms in MFC and SP reactors were dominated by Deltaproteobacteria and Bacteroidetes. Within Deltaproteobacteria, phylotypes classified to family Desulfobulbaceae and Geobacteraceae increased significantly under the SP condition with higher current generation; however those phylotypes were not found in the OC reactor. These analyses suggest that species

  9. Control and decision strategies in wastewater treatment plants for operation improvement

    CERN Document Server

    Santín, Ignacio; Vilanova, Ramón

    2017-01-01

    This book examines the operation of biological wastewater treatment plants (WWTPs), with a focus on maintaining effluent water quality while keeping operational costs within constrained limits. It includes control operation and decision schemes and is based on the use of benchmarking scenarios that yield easily reproducible results that readers can implement for their own solutions. The final criterion is the effect of the applied control strategy on plant performance – specifically, improving effluent quality, reducing costs and avoiding violations of established effluent limits. The evaluation of the different control strategies is achieved with the help of two Benchmark Simulation Models (BSM1, BSM2). Given the complexity of the biological and biochemical processes involved and the major fluctuations in the influent flow rate, controlling WWTPs poses a serious challenge. Further, the importance of control goal formulation and control structure design in relation to WWTP process control is widely recogniz...

  10. Surgical treatment of secondary epilepsy after craniocerebral operation: a report of 25 cases

    Directory of Open Access Journals (Sweden)

    Chong-de SU

    2013-03-01

    Full Text Available Objective  To explore the preoperative evaluation and operative indications for intractable secondary epilepsy after craniocerebral operation, and to summarize the experiences of second craniotomy for epileptogenic zone resection, so as to improve the treatment efficacy of epilepsy secondary to neurosurgery. Methods  From Jan. 2005 to May 2012, a total of 25 patients with secondary epilepsy after craniocerebral operation were evaluated carefully by assessment of medical history and pre-operative video electroencephalography (VEEG examination. Electroencephalography or implantation of subdural electrodes for localizing the epileptogenic zone was conducted in each patient during and after epileptic attack. The epileptogenic zone was confirmed by electroencephalography, MRI and CT scanning before the second operation. The operation was performed along the original incision for complete exposure of the brain scar zone. After localization of the position and range of spike waves with cortical electrodes, the brain scar and epileptogenic focus were removed microscopically. After resection, re-examination was conducted with the cortical electrodes till brain wave rhythm became normal. Results  No death or severe complication was found in the 25 patients. During a follow-up period of 6 months to 7 years, 18 patients were seizure free (Engel's class Ⅰ, 5 patients were Engel's class Ⅱ, and 2 patients were Engel's class Ⅲ. No post-operative attack was found in 18 cases (72%, and 9 of them had their drugs withdrawn. Conclusion  The medication effect of secondary epilepsy after craniocerebral operation is far from perfect, and second craniotomy could attain satisfactory results.

  11. The pivotal role of the intermediate fragment in initial operative treatment of olecranon fractures

    Directory of Open Access Journals (Sweden)

    Hierholzer Christian

    2011-02-01

    Full Text Available Abstract Background In order to improve initial operative treatment of complex olecranon fractures we searched for new determining details. We assumed that the intermediate fragment plays a decisive role for anatomic restoration of the trochlear notch and consecutive outcome of initial operative treatment. Methods 80 patients operated with diagnosis of complex olecranon fracture were identified in an 8-year-period from trauma unit files at two European Level 1 Trauma Centers. Retrospective review of all operative reports and radiographs/computer-tomography scans identified patients with concomitance of an intermediate fragment. The Patient-Rated Elbow Evaluation Score was calculated for 45 of 80 patients at a minimum of 8 months postoperatively (range 8-84 months. Results 29 patients were treated with stable internal fixation with figure-of-eight tension band wire fixation and 51 patients with posterior plate osteosynthesis with/without intramedullary screw. An intermediate fragment was seen in 52 patients. In 29 of these 52 patients, the intermediate fragment was described in operative report. 24 of these 29 patients were treated with posterior plate osteosynthesis, and 5 patients with figure-of-eight tension band wiring. Complications included superficial infection (2 patients, secondary dislocation (3 patients and heterotopic ossifications (1 patient. Functional outcome demonstrated a total PREE score of 9 points on average in 45 of 80 patients. Conclusion An extraordinary amount of patients showed an intermediate fragment. Consideration, desimpaction and anatomic reduction of the intermediate fragment are necessary preconditions for anatomic restoration of the trochlear notch. There is no clear benefit for plating versus tension band wiring according to our data. In the operative report precise description of the fracture pattern including presence of an intermediate fragment is recommended.

  12. Cost of Immediate Surgery Versus Non-operative Treatment for Trigger Finger in Diabetic Patients.

    Science.gov (United States)

    Luther, Gaurav Aman; Murthy, Praveen; Blazar, Philip E

    2016-11-01

    As health care costs continue to rise, providers must increasingly identify and implement cost-effective practice measures without sacrificing quality of care. Corticosteroid injections are an established treatment for trigger finger; however, numerous clinical trials have documented the limited efficacy of these injections in the diabetic population. Furthermore, the most cost-effective treatment strategy for diabetic trigger finger has not been determined. The purpose of this study was to perform a decision analysis to identify the least costly strategy for effective treatment of diabetic trigger finger using existing evidence in the literature. Four treatment strategies for diabetic trigger finger were identified: (1) 1 steroid injection followed by surgical release, (2) 2 steroid injections followed by surgical release, (3) immediate surgical release in the operating room, and (4) immediate surgical release in the clinic. A literature review was conducted to determine success rates of the different treatment strategies. Costing analysis was performed using our institutional reimbursement from Medicare. One-way sensitivity and threshold analysis was utilized to determine the least costly treatment strategy. The least costly treatment strategy was immediate surgical release in the clinic. In patients with insulin-dependent diabetes mellitus, this strategy results in a 32% and a 39% cost reduction when compared with treatment with 1 or 2 corticosteroid injections, respectively. For 1 or 2 corticosteroid injections to be the most cost-effective strategy, injection failure rates would need to be less than 36% and 34%, respectively. The overall cost of care for immediate surgical release in the clinic was $642. Diabetic trigger finger is a common problem faced by hand surgeons, with a variety of acceptable treatment algorithms. Management of diabetic trigger finger with immediate surgical release in the clinic is the most cost-effective treatment strategy, assuming a

  13. A Guide for Developing Standard Operating Job Procedures for the Tertiary Chemical Treatment - Lime Precipitation Process Wastewater Treatment Facility. SOJP No. 6.

    Science.gov (United States)

    Petrasek, Al, Jr.

    This guide describes the standard operating job procedures for the tertiary chemical treatment - lime precipitation process of wastewater treatment plants. Step-by-step instructions are given for pre-start up, start-up, continuous operation, and shut-down procedures. In addition, some theoretical material is presented along with some relevant…

  14. APACHE II SCORING SYSTEM AND ITS MODIFICATION FOR THE ASSESSMENT OF DISEASE SEVERITY IN CHILDREN WHO UNDERWENT POLYCHEMOTHERAPY

    Directory of Open Access Journals (Sweden)

    А. V. Sotnikov

    2014-01-01

    Full Text Available Short-term disease prognosis should be considered for the appropriate treatment policy based on the assessment of disease severity in patients with acute disease. The adequate assessment of disease severity and prognosis allows the indications for transferring patients to the resuscitation and intensive care department to be defined more precisely. Disease severity of patients who underwent polychemotherapy was assessed using APACHE II scoring system.

  15. Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures.

    Science.gov (United States)

    de Aquino, Marcello Simão; Haddad, Alessandra; Ferreira, Lydia Masako

    2013-06-01

    There are increasingly more patients seeking minimally invasive procedures, which have become more effective and safer in reducing the signs of facial aging. This study included 40 female adult patients who voluntarily underwent selected minimally invasive procedures (filling with hyaluronic acid and botulinum toxin injection) for facial rejuvenation. All patients were followed for a period of 6 months. They were evaluated with the use of questionnaires, a quality-of-life questionnaire (DLQI), the self-esteem scale of Rosenberg (EPM/Rosenberg), and a pain scale. The minimally invasive procedures resulted in improvement in quality of life and self-esteem, which were stronger the first 3 months after the procedures but remained at a higher level than that before treatment, even after 6 months. Hyaluronic acid with lidocaine in the formula is more comfortable for the patient as it makes the injection less painful. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  16. Conservative versus operative treatment of displaced noncomminuted tibial shaft fractures. A retrospective comparative study.

    Science.gov (United States)

    den Outer, A J; Meeuwis, J D; Hermans, J; Zwaveling, A

    1990-03-01

    The results of conservative (mainly, functional bracing) and operative treatment (mainly, plate fixation) have been compared in a retrospective study of 170 displaced noncomminutive tibial shaft fractures. The characteristics of the fractures in both treatment groups showed no significant differences. The follow-up analysis revealed no statistical differences in outcome between the two methods. However, because of the many factors analyzed and the restricted number of patients studied, it is impossible to compare all factors independently. Surgical treatment resulted in a higher rate of complications (such as implant failure, osteitis, and refracture) and a longer total hospitalization time. Conservative treatment showed a longer duration of fracture healing and a higher rate of malalignment. Malalignments of up to 10 degrees with no adverse effects have been seen so far. In conservative treatment, two fracture types were identified with a higher rate of malalignment: short oblique isolated tibial fractures and fully dislocated transverse crural fractures. Conservative therapy is favored, because there is less discomfort for the patient and the treatment is cost contained.

  17. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures

    Science.gov (United States)

    Wei, Ning; Yuwen, Peizhi; Liu, Wei; Zhu, Yanbin; Chang, Wenli; Feng, Chen; Chen, Wei

    2017-01-01

    Abstract Background: The relative efficacy of operative and nonoperative treatments for the displaced intra-articular calcaneal fractures (DIACF) remains uncertain. Object: We conducted a meta-analysis to compare the effectiveness of operative and nonoperative treatments in treating patients with DIACF. Methods: Databases including Cochrane Library, Medline, Embase, CBM, CNKI, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. Comparisons were performed between operative treatment group and nonoperative treatment group. The quality of included studies was assessed using the Newcastle–Ottawa Scale. RevMan 5.3 was used for data analysis. The primary outcome measures were anatomical measures (changes in Böhler angle and calcaneal height and width), functional measures (shoe problems, resuming preinjury work, and residual pain), and complications (including superficial and deep wound infection, skin flap necrosis, neurovascular injury, secondary arthrodesis, reflex sympathetic dystrophy, osteotomy, thromboembolism, and compartment syndromes). Results: Eighteen trials (8 randomized controlled trials and 10 controlled clinical trials) including 1467 patients were considered. For anatomical measurements, the overall mean differences (MDs) for the mean Böhler angle, calcaneal height and width were 15.39 (95% confidence interval [CI] 9.12–21.67), 6.55 (95% CI 2.67–10.43), and 7.05 (95% CI −7.83 to −6.27), respectively. In functional measures, the overall effect MD of American Orthopedic Foot and Ankle Society was 6.23 (95% CI 5.22–17.67) and 0.38 (95% CI 0.22–0.67). The overall relative risks (RRs) of wearing shoes, resuming preinjury work, and having residual pain were 0.32 (95% CI 0.32–1.00), 0.56 (95% CI 0.40–0.77), and 0.90 (95% CI 0.68–1.20), respectively. The overall RR of the incidence of complications was 2.00 (95% CI 1.51–2.64). Conclusion: Operative treatment of

  18. [Common types of massive intraoperative haemorrhage, treatment philosophy and operating skills in pelvic cancer surgery].

    Science.gov (United States)

    Wang, Gang-cheng; Han, Guang-sen; Ren, Ying-kun; Xu, Yong-chao; Zhang, Jian; Lu, Chao-min; Zhao, Yu-zhou; Li, Jian; Gu, Yan-hui

    2013-10-01

    To explore the common types of massive intraoperative bleeding, clinical characteristics, treatment philosophy and operating skills in pelvic cancer surgery. We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012. Their clinical data were retrospectively analyzed. The clinical features of massive intraoperative bleeding were analyzed, the treatment experience and lessons were summed up, and the operating skills to manage this serious issue were analyzed. In this group of 19 patients, 7 cases were of presacral venous plexus bleeding, 5 cases of internal iliac vein bleeding, 6 cases of anterior sacral venous plexus and internal iliac vein bleeding, and one cases of internal and external iliac vein bleeding. Six cases of anterior sacral plexus bleeding and 4 cases of internal iliac vein bleeding were treated with suture ligation to stop the bleeding. Six cases of anterior sacral and internal iliac vein bleeding, one cases of anterior sacral vein bleeding, and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis. One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein. Among the 19 patients, 18 cases had effective hemostasis. Their blood loss was 400-1500 ml, and they had a fair postoperative recovery. One patient died due to massive intraoperative bleeding of ca. 4500 ml. Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein. The operator should go along with the treatment philosophy to save the life of the patient above all, and to properly perform suture ligation or compression hemostasis according to the actual situation, and with mastered crucial operating hemostatic skills.

  19. Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries.

    Science.gov (United States)

    Mulders, M A M; van Eerten, P V; Goslings, J C; Schep, N W L

    2017-10-01

    Although secondary displacement following closed reduction and plaster immobilisation is high, several guidelines still recommend non-operative treatment for displaced distal radius fractures with an adequate closed reduction. The purpose of this study was to evaluate functional outcomes, measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, in non-operative treated patients with displaced distal radius fractures and an adequate closed reduction confirmed on radiograph. From a retrospective database, we reviewed non-operative treated adult patients with an unilateral displaced distal radius fracture and adequate closed reduction confirmed on radiograph. The primary outcome was the DASH score at 12months. DASH scores were prospectively collected pre-trauma and at three, six and 12months. Secondary outcome was the number of subsequent surgeries due to secondary displacement or a symptomatic malunion, and their possible predictors. Additionally, the difference in DASH scores between patients who were treated due to secondary displacement and asymptomatic malunion was compared. One-hundred and sixteen patients were included. The median age was 62 years and 79% was female. Fractures were classified according to the AO/OTA classification as follows: AO/OTA type A (49%), AO/OTA type B (3%), AO/OTA type C (48%). After 12months the median DASH score was 15. Forty-six (40%) patients underwent subsequent surgery due to a secondary displacement or symptomatic malunion. No significant differences in DASH scores between patients who were treated non-operatively and patients who received subsequent surgery were found. Younger patients were more likely to undergo subsequent surgery. Patients with a symptomatic malunion had significant higher DASH scores compared to patients with secondary displacement. Non-operative treatment of displaced distal radius fractures after adequate closed reduction confirmed on radiograph leads to acceptable functional

  20. CLINICAL OUTCOME AFTER OPERATIVE TREATMENT IN FLOATING SHOULDER- A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Nabarun Saha

    2017-06-01

    Full Text Available BACKGROUND The ‘floating shoulder’ is a rare injury consisting of ipsilateral fractures of the clavicle and glenoid neck. Although it may appear to be bony injury, studies suggest that ligamentous disruption associated with ipsilateral clavicle fracture and scapular neck fracture contributes to such entity. More commonly floating shoulder is defined as double disruption of the superior shoulder suspensory complex. Open reduction and internal fixation of both the fractures is the treatment of choice. We have made this study to assess clinical outcome after operative treatment of floating shoulder by DASH score. MATERIALS AND METHODS This is a study of 10 cases of floating shoulder injury operated in the same sitting by anterior approach for fracture clavicle and Judet’s posterior approach for scapula fracture from Jan 2014 to Oct 2016. All cases were assessed with DASH score at the end of six months. RESULTS Results of our study shows that majority of patients had excellent to good results with improvement in DASH score from 92.8 to 16.8 at final follow up. No major complications. All patients had radiological signs of union at the end of 1 year. CONCLUSION Surgical intervention should be considered for all floating shoulder injuries. open reduction and internal fixation not only increases stability but also to improves functional outcome of the patient. DASH score is an effective method to assess clinicofunctional outcome in post-operative cases of floating shoulder.

  1. Risk of Subluxation or Dislocation After Operative Treatment of Terrible Triad Injuries.

    Science.gov (United States)

    Zhang, Dafang; Tarabochia, Matthew; Janssen, Stein; Ring, David; Chen, Neal

    2016-12-01

    The management of terrible triad injuries has evolved over the last 2 decades to include routine radial head fixation or replacement, reattachment of the lateral collateral ligament, with or without coronoid fixation. Our objective was to determine the likelihood of and factors associated with subluxation or dislocation after operative treatment of terrible triad injuries among a large group of surgeons using current techniques. Retrospective cohort study. Two level I trauma centers. A total of 107 patients with operatively treated terrible triad injuries from January 2000 to June 2015. Review of patient- and surgery-related factors during the first postoperative month. Radiographic subluxation of the ulnohumeral joint. One hundred of the 107 patients (93%) treated with open fixation of terrible triad injuries had no radiographic subluxation or redislocation. Two patients (2%) had slight transient radiographic subluxation ("drop sign") that corrected with active exercises within weeks of surgery. Five patients (5%) had persistent radiographic subluxation, 3 treated with a second surgery (3%). When treated within 2 weeks of injury, recurrent subluxation or dislocation after operative fixation of terrible triad injuries was rare (1%), provided that the radial head was replaced and the lateral collateral ligament reattached. Radiographic subluxation is very uncommon with current operative management of terrible triad injuries of the elbow within 2 weeks. Patients treated more than 2 weeks after injury might benefit from ancillary fixation to limit subluxation (ie, cross pinning, external fixation, or internal joint stabilizer). Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  2. Some design and operating aspects of the Ranger uranium mine treatment plant

    International Nuclear Information System (INIS)

    Baily, P.A.

    1984-01-01

    Environmental considerations were key factors in the design of the Ranger Uranium Mines treatment plant. The mine is located adjacent to the Kakadu National Park and has an average rainfall of 1.6m per annum. No contaminated water or liquid effluents are to be released from the project area and thus water management is a key design and operating fact. Particulate and gas emission criteria influenced design as did occupational hygiene factors (dust, radon, housekeeping, maintenance access). Equipment selection and engineering standards were conservative and resulted in the plant attaining design performance in less than three months from the date of commissioning. A number of mechanical and operational problems were experienced. However, none of these problems have had a significant effect on production

  3. Impairment of wound healing after operative treatment of mandibular fractures, and the influence of dexamethasone.

    Science.gov (United States)

    Snäll, Johanna; Kormi, Eeva; Lindqvist, Christian; Suominen, Anna Liisa; Mesimäki, Karri; Törnwall, Jyrki; Thorén, Hanna

    2013-12-01

    Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p=0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Development of a method for the characterization and operation of UV-LED for water treatment.

    Science.gov (United States)

    Kheyrandish, Ataollah; Mohseni, Madjid; Taghipour, Fariborz

    2017-10-01

    Tremendous improvements in semiconductor technology have made ultraviolet light-emitting diodes (UV-LEDs) a viable alternative to conventional UV sources for water treatment. A robust and validated experimental protocol for studying the kinetics of microorganism inactivation is key to the further development of UV-LEDs for water treatment. This study proposes a protocol to operate UV-LEDs and control their output as a polychromatic radiation source. In order to systematically develop this protocol, the results of spectral power distribution, radiation profile, and radiant power measurements of a variety of UV-LEDs are presented. A wide range of UV-LEDs was selected for this study, covering various UVA, UVB, and UVC wavelengths, viewing angles from 3.5° to 135°, and a variety of output powers. The effects of operational conditions and measurement techniques were investigated on these UV-LEDs using a specially designed and fabricated setup. Operating conditions, such as the UV-LED electrical current and solder temperature, were found to significantly affect the power and peak wavelength output. The measurement techniques and equipment, including the detector size, detector distance from the UV-LED, and potential reflection from the environment, were shown to influence the results for many of the UV-LEDs. The results obtained from these studies were analyzed and applied to the development of a protocol for UV-LED characterization. This protocol is presented as a guideline that allows the operation and control of UV-LEDs in any structure, as well as accurately measuring the UV-LED output. Such information is essential for performing a reliable UV-LED assessment for the inactivation of microorganisms and for obtaining precise kinetic data. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. FRACTURES OF THE FIFTH METATARSAL RESULTS OF THE EARLY OPERATIVE TREATMENT OF ACUTE DISPLACED FRACTURES

    Directory of Open Access Journals (Sweden)

    Slaviša Mihaljević

    2004-04-01

    Full Text Available Background. Fracture of the proximal 5th metatarsal bone (MTB reach almost 2% of all fractures of the foot. Conservative treatment is method of choice in almost all cases. Selected cases can benefit from acute surgery especially if the proximal fragment is severe displaced or the excessive articular step off is present.Materials and methods. In a 4 year period 14 patients were operated due to the acute fracture of proximal 5th MTB. All patients were treated in less than 2 weeks after the injury. 10 patients had base avulsion fracture in zone I and 4 had Jones fracture in zone II with dislocation of fragments? 5 mm, articular step off of 2 mm and 30% of articulation surface. We used tension bend wire in 9 cases (64%, partially threaded cancellous screw in 4 cases (28% and bone sutures in 1 case (7%. Postoperatively all patients used crutches with nonweight bearing for 4 weeks and afterwards partial weight bearing till the end of the treatment. All patients were practicing active exercises for ankle, foot and toes. The results were evaluated according to the Maryland Foot Score (MFS at least 20 months after injury.Results. 13 patients (93% were included in follow up. 12 patients were evaluated as excellent and only one as a good. All 13 patients have no or slight pain with no change in ADL or work ability. 9 patients (69% reached full functional result and 4 (31% patients had slight limitation during distance walk. Patients reached full weight bearing in average 7 weeks (5–13.Conclusions. Early operative treatment of selected cases allows fast return to preoperative activity without long term functional sequel. Both operative procedures, screw fixation and tension wire, yielded comparable and excellent end result.

  6. Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA.

    Science.gov (United States)

    O'Malley, Martin; DeSandis, Bridget; Allen, Answorth; Levitsky, Matthew; O'Malley, Quinn; Williams, Riley

    2016-05-01

    Proximal fractures of the fifth metatarsal (zone II and III) are common in the elite athlete and can be difficult to treat because of a tendency toward delayed union, nonunion, or refracture. The purpose of this case series was to report our experience in treating 10 NBA players, determine the healing rate, return to play, refracture rate, and role of foot type in these athletes. The records of 10 professional basketball players were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) whereas the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features evaluated included fourth-fifth intermetatarsal, fifth metatarsal lateral deviation, calcaneal pitch, and metatarsus adductus angles. Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. There were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest metatatarsus adductus angles. Most athletes were pes planus and 9 of 10 had a bony prominence under the fifth metatarsal styloid. This is the largest published series of operatively treated professional basketball players who exemplify a specific patient population at high risk for fifth metatarsal fracture. These players were large and possessed a unique foot type that seemed to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type had forefoot metatarsus adductus and a fifth metatarsal that was curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high fourth-to-fifth intermetatarsal, fifth metatarsal lateral deviation, and metatarsus adductus angles as well as prominent fifth metatarsal styloids in order to improve fracture

  7. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. Operation and control of ion-exchange processes for treatment of radioactive wastes

    International Nuclear Information System (INIS)

    Emelity, L.A.

    1967-01-01

    A manual dealing with the application of ion-exchange materials to the treatment of radioactive wastes and reviewing the facilities currently using this method. This book is one of three commissioned by the IAEA on the principal methods of concentrating radioactive wastes. The content of this document is: (i) Historical review related to removal of radioactivity; (ii) Principles of ion exchange (iii) Ion-exchange materials; (iv) Limitations of ion exchangers; (v) Application of ion exchange to waste processing; (vi) Operational procedures and experiences; (vii) Cost-of-treatment by ion-exchange. The document also gives a list of producers of ion-exchange material and defines some relevant terms. 101 refs, 31 figs, 27 tabs

  9. Operating experiences with a molten carbonate fuel cell at Stuttgart-Möhringen wastewater treatment plant.

    Science.gov (United States)

    Locher, C; Meyer, C; Steinmetz, H

    2012-01-01

    Fuel cells on wastewater treatment plants are a relatively new technology to convert biogas from anaerobic digestion into thermal and electrical energy. Since the end of 2007, a type of MCFC fuel cell (>250 kW(el), 180 kW(th)) has been installed at Stuttgart-Möhringen wastewater treatment plant. The goals of this research project are to raise the power self-sufficiency in Stuttgart-Möhringen, to further optimise high temperature fuel cells using biogas and to gain practical experience. After approximately 9,000 h of operation, a mean electrical 'gross'-efficiency of 44% was achieved. To fully exploit this high electrical efficiency, it is essential to keep the energy consumption of peripheral devices (gas pressure unit, gas cleaning unit, etc.) of the fuel cell as low as possible.

  10. SU-F-T-80: A Mobile Application for Intra-Operative Electron Radiotherapy Treatment Planning

    International Nuclear Information System (INIS)

    Williams, C; Crowley, E; Wolfgang, J

    2016-01-01

    Purpose: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment. Methods: We developed a mobile application using HTML5 and Javascript that can be deployed to tablet devices suitable for use in the operating room. The user selects the desired treatment parameters cone diameter, bevel angle, and energy (a total of 141 datasets) and desired bolus. The application generates an interactive display that allows the user to dynamically select points on the depth-dose curve and to visualize the shape of the corresponding isodose contours. The user can indicate a prescription isodose line or depth. The software performs a monitor unit calculation and generates a PDF report. Results: We present our application, which is now used routinely in our IORT practice. It has been employed successfully in over 23 cases. The interactivity of the isodose distributions was found to be of particular use to physicians who are less-frequent IORT users, as well as for the education of residents and trainees. Conclusion: This software has served as a useful tool in IORT planning, and demonstrates the need for treatment planning tools that are designed for the specialized challenges encountered in IORT. This software is the subject of a license agreement with the IntraOp Medical Corporation. This software is the subject of a license agreement between Massachusetts General Hospital / Partners Healthcare and the IntraOp Medical Corporation. CLW is consulting on

  11. SU-F-T-80: A Mobile Application for Intra-Operative Electron Radiotherapy Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Williams, C [Brigham and Women’s Hospital & Dana Farber Cancer Institute, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Crowley, E; Wolfgang, J [Harvard Medical School, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

    2016-06-15

    Purpose: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment. Methods: We developed a mobile application using HTML5 and Javascript that can be deployed to tablet devices suitable for use in the operating room. The user selects the desired treatment parameters cone diameter, bevel angle, and energy (a total of 141 datasets) and desired bolus. The application generates an interactive display that allows the user to dynamically select points on the depth-dose curve and to visualize the shape of the corresponding isodose contours. The user can indicate a prescription isodose line or depth. The software performs a monitor unit calculation and generates a PDF report. Results: We present our application, which is now used routinely in our IORT practice. It has been employed successfully in over 23 cases. The interactivity of the isodose distributions was found to be of particular use to physicians who are less-frequent IORT users, as well as for the education of residents and trainees. Conclusion: This software has served as a useful tool in IORT planning, and demonstrates the need for treatment planning tools that are designed for the specialized challenges encountered in IORT. This software is the subject of a license agreement with the IntraOp Medical Corporation. This software is the subject of a license agreement between Massachusetts General Hospital / Partners Healthcare and the IntraOp Medical Corporation. CLW is consulting on

  12. [Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations].

    Science.gov (United States)

    Uyar Türkyilmaz, Esra; Eryilmaz, Nuray Camgöz; Güzey, Nihan Aydin; Moraloğlu, Özlem

    2016-01-01

    Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Femoral shaft fractures in young children (<5 years of age): operative and non-operative treatments in clinical practice.

    Science.gov (United States)

    Rapp, M; Kaiser, M M; Grauel, F; Gielok, C; Illing, P

    2016-12-01

    Femoral shaft fractures comprise around 4 % of all long-bone fractures in childhood. There is controversy about the treatment of fractures in children below 5 years, between those preferring non-operative methods, such as casting or traction, and those supporting elastic stable intramedullary nailing (ESIN). This retrospective study evaluates the day-by-day treatment of femoral shaft fractures in children aged 6-60 months in four major paediatric surgery trauma centres in Germany from 1 January 2004 to 31 December 2011 by chart review. We analysed all patient-related data, causes of fracture, fracture type, treatment method and potential post-treatment complications. We identified 225 patients (male to female 2:1) with femoral shaft fractures. Around 2/3 of these resulted from falls of less than 1 m or 1-3 m, the most frequent result (>40 %) being a long spiral fracture. All 19 children below 1 year of age were treated by casting or traction. Between the ages of 12 and 24 months (n = 56), different treatment concepts were preferred (1/5 ESIN, 2/5 traction and 2/5 spica casting). Between 24 and 36 months, operative and non-operative therapies were equally distributed. In children older than 36 months (n = 64), most fractures were treated by ESIN: six children by external fixation and 14 by other treatments like spica casting, plate osteosynthesis or a combination of methods. 42 changes of treatment were performed: traction to spica casting or secondary operative treatment and 21 complications occurred (nails left in place for too long, skin defects or wound infections). Spica casting of femoral shaft fractures or, in some cases, traction is still the preferred treatment in the first and second years of life. In the third year, children are treated operatively as well as non-operatively, although now there is no current evidence of better short-term outcomes in operatively treated children. But elastic stable intramedullary nailing is the standard

  14. Design and operation of UASB—A/O process for treatment starch and VB12 wastewater

    Directory of Open Access Journals (Sweden)

    Yuanyuan CHEN

    2016-12-01

    Full Text Available Starch and VB12 wastewater with higher COD and ammonia nitrogen concentration, contains a large number of difficult biodegradable material, complex composition, is difficult to deal with. In recent years, with the increasingly stringent wastewater discharge standards, require the use of a stable and efficient wastewater treatment process for purification treatment of high concentration of ammonia nitrogen in wastewater and the refractory organic pollutants, to achieve discharge standards. Upflow Anaerobic Sludge Blanket (UASB—Anoxic/Oxic(A/O process was employed in a wastewater treatment of starch and Vitamin B12 wastewater, which was 5 000 m3/d with highly concentrated organic pollutants and ammonia. The efficiency and reliability of the process has been proven. The results of the system operation show that the concentration of the effluent COD, ammonia and total nitrogen (TN were at 78.4 mg/L, 18.7 mg/L and 41.1 mg/L, and the treatment efficiencies of COD, ammonia and TN reached over 99%, 92.1%, 82.7%, respectively, when the influent COD and TN concentration were in the ranges of 8 544~9 720 mg/L and 240~250 mg/L. The quality of the treated wastewater met the first-class discharge standards in Integrated Wastewater Discharge Standard(GB 8978—1996.

  15. Rescue pre-operative treatment with Lugol's solution in uncontrolled Graves' disease.

    Science.gov (United States)

    Calissendorff, Jan; Falhammar, Henrik

    2017-05-01

    Graves' disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol's solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005-2015 and treated with Lugol's solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Twenty-seven patients were included. Lugol's solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5-9 days of iodine therapy (free T4 53-20 pmol/L, P  = 0.0002; free T3 20-6.5 pmol/L, P  = 0.04; heart rate 87-76 beats/min P  = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n  = 2, rash and vomiting n  = 1, swelling of fingers n  = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Treatment of uncontrolled hyperthyroidism with Lugol's solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol's solution could be recommended pre-operatively in Graves' disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred. © 2017 The authors.

  16. Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

    Science.gov (United States)

    Falhammar, Henrik

    2017-01-01

    Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred. PMID:28325735

  17. Fatores preditivos do tratamento operatório na úlcera péptica hemorrágica Predictors of operative treatment in patients sustaining bleeding peptic ulcers

    Directory of Open Access Journals (Sweden)

    JOSÉ GUSTAVO PARREIRA

    2002-12-01

    Full Text Available OBJETIVO: Avaliar os fatores preditivos de tratamento operatório nos doentes com úlceras pépticas hemorrágicas. MÉTODOS: Através de um estudo retrospectivo, foram analisados os prontuários dos doentes com úlceras pépticas hemorrágicas admitidos de 1998 a 2001. Foram avaliados 200 doentes, com idade entre 17 e 97 anos e média etária de 52 + 18 anos, sendo 153 (76,5% do sexo masculino. Dados vitais à admissão, antecedentes mórbidos, achados e tratamento endoscópico, bem como a evolução e tratamento definitivo foram revisados. Empregou-se o teste t de student e qui-quadrado para a análise estatística, considerando-se o valor de pOBJECTIVE: To analyze the predictors of operative treatment in patients sustaining bleeding peptic ulcers. METHODS: Retrospective analysis of the patients admitted owing to bleeding peptic ulcers from 1998 to 2001. Vital signs upon admission, associated diseases, endoscopy data, evolution and definitive care were evaluated. Patients who underwent surgery were compared with the others in order to identify the predictors of the operative treatment. Student's t and chi squared test were employed for statistical analysis, considering p< 0,05 as significant. RESULTS: Two hundred patients were included in the study group. The age ranged between 17 and 97 years (mean 52 + 18, and 153 patients (76.5% were male. Shock upon admission was present in 27 (13.5%. The endoscopic exam performed at admission showed that 101 patients sustained ulcers in the duodenum and 99 in the stomach, which were classified as Forrest Ia in 5 (2.5%, Ib in 20 (10%, IIa in 48 (24% and IIb in 48 (24%. Twenty five (12.5% patients needed operation, and 23 (92% were submitted to gastrectomy with Billroth's II reconstruction. The operative treatment were more frequently performed in patients sustaining chronic alcoholic intake (p=0.002, cigarette smoking (p=0.02, diabetes mellitus (p=0.01, chronic peptic disease (p=0.05, shock upon admission

  18. A follow-up study of hypertensive patients after operative treatment of unilateral renovascular or renal disease

    DEFF Research Database (Denmark)

    McNair, A; Nielsen, M D; Gammelgaard, P A

    1979-01-01

    A study of 44 hypertensive patients with unilateral renovascular or renal parenchymal disease is presented. All patients underwent corrective surgery. Out of the 44 operated patients, five did not participate in the follow-up examination. The remaining 39 patients constitute the study population....... The effects of surgery on the hypertensive state could be evaluated in 35 patients, whereas four died less than two months after the operation. Follow-up studies were carried out at 8-60 months after the operation. The average period of observation was 32 months; 24 patients were observed for more than two...... years. As a group, the patients had severe hypertension with extensive target organ damage and widespread atherosclerosis. A fairly rigorous selection process was applied, and an unsatisfactory response to medical management was considered a point of major importance. In the majority of cases...

  19. Comparison of libido, Female Sexual Function Index, and Arizona scores in women who underwent laparoscopic or conventional abdominal hysterectomy

    Science.gov (United States)

    Kayataş, Semra; Özkaya, Enis; Api, Murat; Çıkman, Seyhan; Gürbüz, Ayşen; Eser, Ahmet

    2017-01-01

    Objective: The aim of the present study was to compare female sexual function between women who underwent conventional abdominal or laparoscopic hysterectomy. Materials and Methods: Seventy-seven women who were scheduled to undergo hysterectomy without oophorectomy for benign gynecologic conditions were included in the study. The women were assigned to laparoscopic or open abdominal hysterectomy according to the surgeons preference. Women with endometriosis and symptomatic prolapsus were excluded. Female sexual function scores were obtained before and six months after the operation from each participant by using validated questionnaires. Results: Pre- and postoperative scores of three different quationnaires were found as comparable in the group that underwent laparoscopic hysterectomy (p>0.05). Scores were also found as comparable in the group that underwent laparotomic hysterectomy (p>0.05). Pre- and postoperative values were compared between the two groups and revealed similar results with regard to all three scores (p>0.05). Conclusion: Our data showed comparable pre- and the postoperative scores for the two different hysterectomy techniques. The two groups were also found to have similar pre- and postoperative score values. PMID:28913149

  20. Online total organic carbon (TOC) monitoring for water and wastewater treatment plants processes and operations optimization

    Science.gov (United States)

    Assmann, Céline; Scott, Amanda; Biller, Dondra

    2017-08-01

    Organic measurements, such as biological oxygen demand (BOD) and chemical oxygen demand (COD) were developed decades ago in order to measure organics in water. Today, these time-consuming measurements are still used as parameters to check the water treatment quality; however, the time required to generate a result, ranging from hours to days, does not allow COD or BOD to be useful process control parameters - see (1) Standard Method 5210 B; 5-day BOD Test, 1997, and (2) ASTM D1252; COD Test, 2012. Online organic carbon monitoring allows for effective process control because results are generated every few minutes. Though it does not replace BOD or COD measurements still required for compliance reporting, it allows for smart, data-driven and rapid decision-making to improve process control and optimization or meet compliances. Thanks to the smart interpretation of generated data and the capability to now take real-time actions, municipal drinking water and wastewater treatment facility operators can positively impact their OPEX (operational expenditure) efficiencies and their capabilities to meet regulatory requirements. This paper describes how three municipal wastewater and drinking water plants gained process insights, and determined optimization opportunities thanks to the implementation of online total organic carbon (TOC) monitoring.

  1. TAX TREATMENT OF CARBON CREDIT OPERATIONS IN BRAZILIAN COMPANIES WITH CDM PROJECTS

    Directory of Open Access Journals (Sweden)

    Vanderlei dos Santos

    2012-06-01

    Full Text Available The aim in this study is to identify the tax treatment applied to carbon credit operations in Brazilian companies that are developing projects in the context of the Clean Development Mechanism (CDM. Therefore, an exploratory research with a qualitative approach was developed. Data were collected with the help of questionnaire, forwarded to all Brazilian companies with CDM projects that received approval from the Inter-Ministerial Commission on Global Climate Change (CIMGC without safeguards, according to the list of the Brazilian Ministry of Science and Technology. Out of 117 companies listed, only five answered the research instrument, which represents an accessibility sample. The results show that, as for the tax treatment applied in the companies under analysis, IRPJ and CSLL should be charged on carbon credit operations. Regarding PIS, COFINS, ISS, some companies considered that these taxes are due and others that they are not. There is a consensus, though, about the fact that ICMS and IOF should not be charged. In conclusion, no uniform understanding exists as of yet about due taxes in the research sample, as no specific fiscal legislation exists yet on carbon credits in Brazil.

  2. What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

    Science.gov (United States)

    Claessen, Femke M A P; Braun, Yvonne; van Leeuwen, Wouter F; Dyer, George S; van den Bekerom, Michel P J; Ring, David

    2016-02-01

    Surgical site infections are one of the more common major complications of elbow fracture surgery and can contribute to other adverse outcomes, prolonged hospital stays, and increased healthcare costs. We asked: (1) What are the factors associated with a surgical site infection after elbow fracture surgery? (2) When taking the subset of closed elbow fractures only, what are the factors associated with a surgical site infection? (3) What are the common organisms isolated from an elbow infection after open treatment? One thousand three hundred twenty adult patients underwent surgery for an elbow fracture between January 2002 and July 2014 and were included in our study. Forty-eight of 1320 patients (4%) had a surgical site infection develop. Thirty-four of 1113 patients with a closed fracture (3%) had a surgical site infection develop. For all elbow fractures, use of plate and screw fixation (adjusted odds ratio [OR]= 2.2; 95% CI, 1.0-4.5; p = 0.041) and use of external fixation before surgery (adjusted OR = 4.7; 95% CI, 1.1-21; p = 0.035) were associated with higher infection rates. When subset analysis was performed for closed fractures, only smoking (adjusted OR = 2.2; 95% CI, 1.1-4.5; p = 0.023) was associated with higher infection rates. Staphylococcus aureus was the most common bacteria cultured (59%). The only modifiable risk factor for a surgical site infection after open reduction and internal fixation was cigarette smoking. Plate fixation and temporary external fixation are likely surrogates for more complex injuries, therefore no recommendations should be inferred from this association. Surgeons should counsel patients who smoke. Level IV, prognostic study.

  3. Effect on the treatment of congenital ptosis in two kinds of operation method

    Directory of Open Access Journals (Sweden)

    Yun-Jia Jiang

    2014-12-01

    Full Text Available AIM:To compare the functional and cosmetic effects of two different surgical techniques for congenital ptosis. METHODS: The patients were divided into four groups according to the operation method: Patients undertook bilateral fascial suspension surgery as Group A(42 eyes of 21 cases; Patients undertook bilateral levator muscle shortening surgery as Group B(38 eyes of 19 cases; Patients undertook unilateral fascial suspension surgery as Group C(24 eyes of 24 cases; Patients undertook unilateral levator muscle shortening surgery as Group D(29 eyes of 29 cases. Each group patients were followed for postoperative function and appearance effect. RESULTS: 1Early postoperative of two operation function success rate was up to 100%, the function of levator muscle shortening surgery was 97.01% in the late postoperative, was higher than bilateral fascial suspension surgery(87.88%, with statistical difference in both surgerys(PP >0.05; In the late postoperative, the mean grades for “Lid Contour” and “Lid Crease” of Group B were better than that of Group A(PPCONCLUSION: Two kinds of operation method have good effects on the treatment of congenital ptosis. In terms of cosmetic effect, levator muscle shortening surgery is better.

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

    Science.gov (United States)

    Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz

    2011-01-01

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

  5. Post-operative treatment of malignant salivary gland tumours of the palate with iodine-125 brachytherapy

    International Nuclear Information System (INIS)

    Stannard, Clare E.; Hering, Egbert; Hough, Jan; Knowles, Ruth; Munro, Roger; Hille, Jos

    2004-01-01

    Background and purpose: Malignant minor salivary gland tumours are usually small and clinically indistinguishable from benign lesions. Surgery is the treatment of choice with post-operative radiotherapy for involved margins or unfavourable histology. We assessed the results of a series of such patients treated with iodine-125 brachytherapy in the form of a temporary applicator or implant. Patients and methods: There were nine patients with T1/T2 tumours of the hard and/or soft palate that had been excised. All had close or involved margins. Six were treated with a dental applicator alone, two with an applicator and additional I-125 seeds in tubes and one with an implant alone. The applicator consists of two layers of plastic made from a dental impression enclosing a predetermined number of I-125 seeds, 9-39, glued to one surface and a layer of ash metal to protect the tongue. It was inserted 1-3 months post-operatively and delivered 35-62 Gy, median 56 Gy, at 5-7 mm depth over 58-156 h, median 120 h, at 0.26-0.67 Gy/h, median 0.45 Gy/h. Results: The patients have been followed up for 32-158 months, median 50 months, and there were no recurrences. The applicator was well tolerated. A confluent mucositis developed which lasted 3-4 weeks. One patient developed a mucosal ulcer which healed spontaneously. Conclusions: Brachytherapy is an effective way of delivering post-operative radiotherapy to the hard and soft palate in patients with malignant salivary gland tumours that have been incompletely excised or have unfavourable histology. Local control is excellent, treatment time is short and morbidity is minimal

  6. Effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery

    Directory of Open Access Journals (Sweden)

    Qing-Hua Xia

    2016-08-01

    Full Text Available Objective: To explore the effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery and its feasibility. Methods: A total of 80 patients who were admitted in ENT department from June, 2012 to June, 2015 for nasal endoscope surgery were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the observation group were given nifedipine delayed-release tablets for advanced blood pressure control before operation, and were given routine blood pressure control during operation; while the patients in the control group were only given blood pressure control during operation. The changes of blood pressure, mean central arterial pressure, and heart rate before anesthesia (T0, after intubation (T1, during operation (T2, extubation when waking (T3, 30 min after extubation (T4, and 3 h after back to wards (T5 in the two groups were compared. The intraoperative situation and the surgical field quality in the two groups were compared. Results: SBP, DBP, and MAP levels at T1-5 in the two groups were significantly lower than those at T0. SBP, DBP, and MAP levels at T2 were significantly lower than those at other timing points, and were gradually recovered after operation, but were significantly lower than those at T0. The effect taking time of blood pressure reducing, intraoperative nitroglycerin dosage, and postoperative wound surface exudation amount in the observation group were significantly less than those in the control group. The surgical field quality scores in the observation group were significantly superior to those in the control group. Conclusions: Advanced blood pressure control with nifedipine delayed-release tablets can stabilize the blood pressure during the perioperative period in patients underwent nasal endoscope surgery, and enhance the surgical field qualities.

  7. Operative treatment of early infection after internal fixation of limb fractures (exclusive of severe open fractures).

    Science.gov (United States)

    Bonnevialle, P

    2017-02-01

    Early infection after open reduction and internal fixation (ORIF) of a limb bone is defined as bacteriologically documented, deep and/or superficial surgical-site infection (SSI) diagnosed within 6months after the surgical procedure. This interval is arbitrarily considered sufficient to obtain fracture healing. The treatment of early infection after ORIF should be decided by a multidisciplinary team. The principles are the same as for revision arthroplasty. Superficial SSIs should be differentiated from deep SSIs, based on the results of bacteriological specimens collected using flawless technique. A turning point in the local microbial ecology occurs around the third or fourth week, when a biofilm develops around metallic implants. This biofilm protects the bacteria. The treatment relies on both non-operative and operative measures, which are selected based on the time to occurrence of the infection, condition of the soft tissues, and stage of bone healing. Both the surgical strategy and the antibiotic regimen should be determined during a multidisciplinary discussion. When treating superficial SSIs after ORIF, soft-tissue management is the main challenge. The treatment differs according to whether the hardware is covered or exposed. Defects in the skin and/or fascia can be managed using reliable reconstructive surgery techniques, either immediately or after a brief period of vacuum-assisted closure. In deep SSIs, deciding whether to leave or to remove the hardware is difficult. If the hardware is removed, the fracture site can be stabilised provisionally using either external fixation or a cement rod. Once infection control is achieved, several measures can be taken to stimulate bone healing before the end of the classical 6-month interval. If the hardware was removed, then internal fixation must be performed once the infection is eradicated. Copyright © 2016. Published by Elsevier Masson SAS.

  8. Relevance of intra operative radiotherapy in the treatment of uterine carcinoma - Lyon preliminary experience

    International Nuclear Information System (INIS)

    Gerard, J.P.; Braillon, G.; Gilly, F.N.; Romestaing, P.; Sentenac, I.; Rocher, F.P.; Berger, C.; Chipier, V.; Dargent, D.; Chabert, P.; Raudrant, D.; Adeleine, P.

    1994-01-01

    Aim: Retrospective analysis of Intra operative Radiotherapy (IORT) in recurrent uterine carcinoma (RUC) and prospective pilot study of IORT in advanced cervix cancer (ACC) with high risk of local failure. Patients-Treatments: (1) RUC: from 1988 to 1991, 34 patients with RUC have been treated. Primary cancer was: cervix uterus: 28, endometrium: six. Site of recurrence: centro pelvis: four, latero pelvis: 25, lombo aortic: five. Total gross resection was only possible in 12 patients. A dose of 15 to 22 Gy was given by IORT according to the residual tumour size. External beam irradiation was added in 16 patients; (2) ACC: January 1991 to November 1992, 20 patients were included in this pilot study, stage IIB: seven, stage III: 12, stage IV: 1. Preoperative retroperitoneal pelviscopy showed 13 pN1 patients and NMR imaging ten tumours of 6 cm or larger in diameter. Treatment started with concomitant pelvic irradiation (44 Gy) and one concomitant cycle of 5 Fu-CDDP, followed by a short course of high dose rate upper vagina brachytherapy (4Gy). Four weeks later a radical Wertheim operation was performed together with IORT on the lateral pelvis. Results: (1) RUC: overall survival (Kaplan Meier) at 4 years is 32% (±8). Local relapse in the field of IORT was observed in six patients. Grade 2-3 complications: six patients (radiation proctitis, neuritis, vertebral collapse, ureteral stenosis); (2) ACC: the median follow up is short (18 months). Four cases of pelvic relapse, no postoperative death. The first line radio chemotherapy was associated with two G3 early complications. Postoperative radiation complication was less than 10% G3. Discussion: promising results of IORT in RUC have been observed especially if no irradiation is given during the primary treatment. Good feasibility of the pilot study of IORT in ACC was also observed. It could be followed by a multicentric feasibility trial. (authors). 38 refs., 4 tabs., 1 fig

  9. Comparison between tramadol hydrochloride & nalbuphine hydrochloride in the treatment of per-operative shivering after spinal anaesthesia.

    Science.gov (United States)

    Haque, M F; Rashid, M H; Rahaman, M S; Islam, M R

    2011-04-01

    Per-operative shivering following spinal anaesthesia is a common problem in the operation theatre. Adequate management of shivering during operation is one of the goals of anesthesiologists for the benefit of the patient. Because there are many unpleasant and harmful effects caused by shivering in many patients especially respiratory and cardiac disease patients. For this reason aggressive and optimal treatment of per-operative shivering is essential to reduce the morbidity of the patients. Our observations were that occurrence of shivering was more in younger patients than older patients, thin patients than obese patients, anxious patients than non-anxious patients and more frequent in patients who received vasoconstrictor drugs, administration of fluid at running rate just before or during operation, administration of cold local anaesthetic agents (by taking drug from the freeze) into subarachnoid space. And shivering was better managed by administration of nalbuphine HCl and surface skin warming (wrapping of the skin). There are many studies regarding the incidence, prevention & treatment of post-operative shivering but there is no study regarding the incidence & treatment of per-operative shivering by nalbuphine following spinal anaesthesia. This study was designed to compare the anti-shivering efficacy and side effects (Nausea, Vomiting, and Somnolence) of tramadol hydrochloride with that of nalbuphine hydrochloride in the treatment of per-operative shivering following spinal anaesthesia. This study was also done to observe the incidence of shivering during operation following spinal anesthesia.

  10. Operative modalities and exposure to pesticides during open field treatments among a group of agricultural subcontractors.

    Science.gov (United States)

    Vitali, Matteo; Protano, Carmela; Del Monte, Annalisa; Ensabella, Francesca; Guidotti, Maurizio

    2009-07-01

    This paper reports the results of a field study of occupational pesticide exposure (respiratory and dermal) among a group of Italian agricultural subcontractors. These workers consistently use pesticides during much of the year, thus resulting in a high exposure risk. Ten complete treatments were monitored during spring/summer. Pesticides that were applied included azinphos-methyl, dicamba, dimethoate, terbuthylazine, and alachlor. Several observations were made on worker operative modalities and the use of personal protective equipment (PPE) during work. Total potential and actual exposure ranged from 14 to 5700 microg and from 0.04 to 4600 microg, respectively. Dermal exposure contributed substantially more than inhalation to the total exposure (93.9-100%). Hand contamination ranged from 0.04 to 4600 microg and was the major contributor to dermal exposure. Penetration through specific protective garments was less than 2.4% in all cases, although penetration through general work clothing was as high as 26.8%. The risk evaluation, based on comparison between acceptable daily intake and total absorbed doses, demonstrates that it is presumable to expect possible health effects for workers regularly operating without PPE and improper tractors. Comparisons between exposure levels and operative modalities highlighted that complete PPE and properly equipped tractors contributed to a significant reduction in total exposure to pesticides during agricultural activities. In conclusion, monitored agricultural subcontractors presented very different levels of pesticide exposure due to the high variability of operative modalities and use of PPE. These results indicate the need to critically evaluate the efficacy of training programs required for obtaining a pesticide license in Italy.

  11. Trends in Resident Operative Teaching Opportunities for Treatment of Intracranial Aneurysms.

    Science.gov (United States)

    Piazza, Matthew; Nayak, Nikhil; Ali, Zarina; Heuer, Gregory; Sanborn, Matthew; Stein, Sherman; Schuster, James; Grady, M Sean; Malhotra, Neil R

    2017-07-01

    The International Subarachnoid Aneurysm Trial heralded a paradigm shift in the treatment of intracranial aneurysms. During this same time frame, neurosurgical training programs increased in size and scope. The present study examines the impact of trends in surgical clipping and the endovascular treatment of intracranial aneurysms, over one decade, and the neurosurgical resident complement on the resident teaching environment using the Nationwide Inpatient Sample (NIS). The NIS was used to estimate the number of aneurysms treated with either surgical clipping and endovascular methods from 2002 through 2011 at teaching institutions. Teaching opportunities per year per resident or chief resident were calculated as the ratio of the number of specified cases to the average number of neurosurgical trainees by year. Annualized trends were assessed. Over the study period, the percent change in odds of occurrence of a clipped ruptured aneurysm was -15.6% per year (P institutions. This corresponded to a decline in teaching opportunities for clipped ruptured aneurysms for both residents and chief residents (P < 0.001). In contrast, teaching opportunities for endovascular treatment of both ruptured and unruptured aneurysms increased dramatically over the study period. There has been a significant decrease in opportunity for operative exposure to craniotomy for ruptured aneurysm clipping over the past decade, whereas the volume of endovascular procedures for aneurysms has dramatically increased, highlighting the need for a shift in training strategy for those neurosurgeons graduating from residency desiring to subspecialize in neurovascular neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. [Operative treatment of flexor pollicis longus tendon with Krackow suture, functional results--preliminary results].

    Science.gov (United States)

    Bumbasirević, Marko Z; Andjelković, Sladjana; Lesić, Aleksandar R; Sudjić, Vojo S; Palibrk, Tomislav; Tulić, Goran Dz; Radenković, Dejan V; Bajec, Djordje D

    2010-01-01

    Surgical treatment of the injuried flexor tensons is the important part of hand surgery. Tendon adhesions, ruptures, joint contcatures-stifness are only one part of the problem one is faced during the tendon treatment. In spite of improvement in surgical technique and suture material, the end result of sutured flexor tendons still represent a serious problem. To present of operative treatment of flexor pollicis longus injury with Krakow suture technique. All patients are treated in the first 48 hours after the accident. The regional anesthesia was performed with use of turniquet. Beside spare debridement, the reconstruction of digital nerves was done. All patients started with active and pasive movements-excercises on the first postoperative day. Follow-up was from 6 to 24 months. In evaluation of functional recovery the grip strenght, pinch strenght, range of movements of interphalangeal and metacarpophalangeal joiht and DASH score were used. In the last two years there were 30 patients, 25 males (83.33%) and 5 females (16.66%). Mean age was 39.8 years, ranged from 17 to 65 years. According to mechanism of injury the patients were divided in two groups: one with sharp and other with wider zone of injury. Concomitant digital nerve lesions was noticed in 15 patients (50%). the Krackow sutrue allowed early rehabilitation, which prevent tendon adhesions, enabled faster and better functional recovery.

  13. Risk factors for deep surgical site infection following operative treatment of ankle fractures.

    Science.gov (United States)

    Ovaska, Mikko T; Mäkinen, Tatu J; Madanat, Rami; Huotari, Kaisa; Vahlberg, Tero; Hirvensalo, Eero; Lindahl, Jan

    2013-02-20

    Surgical site infection is one of the most common complications following ankle fracture surgery. These infections are associated with substantial morbidity and lead to increased resource utilization. Identification of risk factors is crucial for developing strategies to prevent these complications. We performed an age and sex-matched case-control study to identify patient and surgery-related risk factors for deep surgical site infection following operative ankle fracture treatment. We identified 1923 ankle fracture operations performed in 1915 patients from 2006 through 2009. A total of 131 patients with deep infection were identified and compared with an equal number of uninfected control patients. Risk factors for infection were determined with use of conditional logistic regression analysis. The incidence of deep infection was 6.8%. Univariate analysis showed diabetes (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.0, 4.9), alcohol abuse (OR = 3.8, 95% CI = 1.6, 9.4), fracture-dislocation (OR = 2.0, 95% CI = 1.2, 3.5), and soft-tissue injury (a Tscherne grade of ≥1) (OR = 2.6, 95% CI = 1.3, 5.3) to be significant patient-related risk factors for infection. Surgery-related risk factors were suboptimal timing of prophylactic antibiotics (OR = 1.9, 95% CI = 1.0, 3.4), difficulties encountered during surgery, (OR = 2.1, 95% CI = 1.1, 4.0), wound complications (OR = 4.8, 95% CI = 1.6, 14.0), and fracture malreduction (OR = 3.4, 95% CI = 1.3, 9.2). Independent risk factors for infection identified by multivariable analyses were tobacco use (OR = 3.7, 95% CI = 1.6, 8.5) and a duration of surgery of more than ninety minutes (OR = 2.5, 95% CI = 1.1, 5.7). Cast application in the operating room was independently associated with a decreased infection rate (OR = 0.4, 95% CI = 0.2, 0.8). We identified several modifiable risk factors for deep surgical site infection following operative treatment of ankle fractures.

  14. [Anesthetic Management of an Infant who Underwent Awake-intubation for Her Pharyngeal Injury Caused by a Toothbrush].

    Science.gov (United States)

    Nakano, Yoko; Suzuki, Hiroaki; Arai, Takero; Hashimoto, Yuichi; Okuda, Yasuhisa

    2016-04-01

    A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush. After the intubation, we administered fentanyl 25 μg rocuronium 15 mg and sevoflulane 3-5% to her, and then she underwent arteriography. The neurosurgeon found no sign of major arterial injury nor traumatic aneurysm nor CNS involvement. She went to the ICU intubated after the removal of the toothbrush. She was extubated 5 days after operation. One of the benefits of the Glidescope is that we can share the visual image, and we chose it this time. When we expect a difficult airway during management for oropharyngeal trauma, we have to consider the way to manage the airway.

  15. A Guide for Developing Standard Operating Job Procedures for the Tertiary Multimedia Filtration Process Wastewater Treatment Facility. SOJP No. 7.

    Science.gov (United States)

    Petrasek, Al, Jr.

    This guide describes the standard operating job procedures for the tertiary multimedia filtration process of wastewater treatment plants. The major objective of the filtration process is the removal of suspended solids from the reclaimed wastewater. The guide gives step-by-step instructions for pre-start up, start-up, continuous operation, and…

  16. A Guide for Developing Standard Operating Job Procedures for the Pump Station Process Wastewater Treatment Facility. SOJP No. 3.

    Science.gov (United States)

    Perley, Gordon F.

    This is a guide for standard operating job procedures for the pump station process of wastewater treatment plants. Step-by-step instructions are given for pre-start up inspection, start-up procedures, continuous routine operation procedures, and shut-down procedures. A general description of the equipment used in the process is given. Two…

  17. A Guide for Developing Standard Operating Job Procedures for the Digestion Process Wastewater Treatment Facility. SOJP No. 10.

    Science.gov (United States)

    Schwing, Carl M.

    This guide describes standard operating job procedures for the digestion process of wastewater treatment facilities. This process is for reducing the volume of sludge to be treated in subsequent units and to reduce the volatile content of sludge. The guide gives step-by-step instructions for pre-startup, startup, continuous operating, shutdown,…

  18. A Guide for Developing Standard Operating Job Procedures for the Grit Removal Process Wastewater Treatment Facility. SOJP No. 2.

    Science.gov (United States)

    Deal, Gerald A.; Montgomery, James A.

    This guide describes standard operating job procedures for the grit removal process of wastewater treatment plants. Step-by-step instructions are given for pre-start up inspection, start-up, continuous operation, and shut-down procedures. A description of the equipment used in the process is given. Some theoretical material is presented. (BB)

  19. A CLINICAL STUDY OF OPERATIVE TREATMENT FOR LUMBAR INTERVERTEBRAL DISC PROLAPSE

    Directory of Open Access Journals (Sweden)

    Anilkumar S. D

    2016-09-01

    Full Text Available BACKGROUND Amongst painful diseases, sciatica occupies a foremost place by reason of its prevalence, its production by a great variety of conditions, the great disablement it may produce and its tending to relapse all of which have led to its recognition as one of the great scourges of humanity. Intervertebral disc prolapse is the important and common cause of low back pain and sciatica. Here, the subject of laminectomy and discectomy in the treatment of proven intervertebral disc prolapse in the lower lumbar region is reviewed and its results examined. AIM OF STUDY This study was undertaken in order to evaluate the following objectives. PRIMARY Analysis of clinical parameters and per operative findings of lumbar intervertebral disc prolapse. SECONDARY Analysis of clinical parameters and surgical outcome in lumbar intervertebral disc prolapse with respect to improvement in pain and neurological status. MATERIALS AND METHODS The study was undertaken in 22 patients who attended the Orthopaedic Department of Mount Zion Medical College, Adoor, between August 2014 to July 2015. All of them were suffering from a prolapsed lumbar vertebral disc as shown by clinical examination and investigations. Lumbar laminectomy and discectomy constituted the operative procedure for all of them. RESULTS In acute onset cases and cases with short duration, results were good. By six months, 80% of patients recorded of good pain relief, 80% of patients returned to work within six 6 months, 60% of patients showed good neurological recovery by 6 months. Laminectomy and discectomy in proven cases of lumbar intervertebral disc prolapse is a rewarding procedure. LT definitely relieved pain in all cases and improved morbidity and neurological deficits in most of the cases. CONCLUSION 1. Laminectomy and discectomy is an effective method of treatment in herniation of lumbar intervertebral disc. 2. The procedure is ideally done in those with the disc prolapse proved with the

  20. The effect of UV treatment on highly polluted and normal operated swimming pools

    DEFF Research Database (Denmark)

    Spiliotopoulou, Aikaterini; Kaarsholm, Kamilla Marie Speht; Andersen, Henrik Rasmus

    2017-01-01

    Water samples from 2 indoor public swimming pool facilities with significantly different organic matter concentrations in the recirculation were tested to evaluate UV-induced effects on water chemistry. The aim of the study was to investigate the impact of poor water quality due to increased...... organic carbon (TOC) and the potential effect of increased nitrate concentration on disinfection by-product (DBP) formation in pool water. Concentration change on total trihalomethanes (TTHM) was investigated utilising medium pressure UV treatment in conjunction with chlorine. Post-UV chlorine consumption...... increased, UV dose-dependently. The post-UV chlorination clearly induced TTHM formation in both polluted and normal operated pools. However, elevated TOC concentration did not increase significantly the DBP formation. Regarding the brominated fraction of the halogens in the formed TTHMs, it appeared...

  1. Microalgae cultivation as tertiary unit operation for treatment of pharmaceutical wastewater associated with lipid production.

    Science.gov (United States)

    Hemalatha, Manupati; Venkata Mohan, S

    2016-09-01

    Microalgae based treatment was studied to polish sequential batch reactor (SBR) treated pharmaceutical wastewater under mixotrophic mode of operation with simultaneous biomass/lipid production. At the end of biomass growth phase (BGP), carbon removal efficiency was observed to be 73% along with good removal of nitrates (62%). Since microalgae assimilate nutrients from wastewater for growth, an increment in total biomass productivity (2.8g/l) was observed. Subjecting to nutrient stress phase (NSP), total lipid content of 17.2% with neutral lipids of 6.2% was observed under light condition. Contrarily, dark condition depicted total lipid content of 15.8% with neutral lipids constituting 6.5%. The nutrient stress in combination with light showed marked influence on the profile of saturated and unsaturated fatty acids. Integration of microalgae cultivation improves environmental sustainability and enables greener routes of biofuels and value added products synthesis in a biorefinery approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Treatment of pairing correlations based on the equations of motion for zero-coupled pair operators

    International Nuclear Information System (INIS)

    Andreozzi, F.; Covello, A.; Gargano, A.; Ye, L.J.; Porrino, A.

    1985-01-01

    The pairing problem is treated by means of the equations of motion for zero-coupled pair operators. Exact equations for the seniority-v states of N particles are derived. These equations can be solved by a step-by-step procedure which consists of progressively adding pairs of particles to a core. The theory can be applied at several levels of approximation depending on the number of core states which are taken into account. Some numerical applications to the treatment of v = 0, v = 1, and v = 2 states in the Ni isotopes are performed. The accuracy of various approximations is tested by comparison with exact results. For the seniority-one and seniority-two problems it turns out that the results obtained from the first-order theory are very accurate, while those of higher order calculations are practically exact. Concerning the seniority-zero problem, a fifth-order calculation reproduces quite well the three lowest states

  3. Long-term Outcomes of Operative and Nonoperative Treatment of Congenital Coxa Vara.

    Science.gov (United States)

    Roberts, David W; Saglam, Yavuz; De La Rocha, Adriana; Frasquillo, Brigid N; Tulchin-Francis, Kirsten; Kim, Harry K W

    2018-04-01

    Congenital coxa vara (CCV) is a rare hip condition with few long-term studies. The purpose of this study was to assess clinical, radiographic, and functional outcomes after operative and nonoperative treatment of CCV, assess reliability of radiographic parameters, and investigate risk factors for recurrence after surgery. Retrospective review was performed of all CCV patients treated at 1 institution from 1980 to 2010. In addition, patients were recalled for additional follow-up x-rays, modified Harris Hip Score (mHHS), and gait analysis. Radiographic measurements [neck-shaft angle (NSA), head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), and femoral neck length (FNL)] were assessed for reliability using intraclass correlation coefficients. Multivariate analysis was performed to identify risk factors for recurrence after surgery. Forty-six hips in 32 patients were reviewed. Mean age at presentation was 5.4±4.9 years. Mean follow-up was 11.8±5.8 years. Valgus proximal femoral osteotomy was performed in 27 hips (20 patients). Initial deformity was greater in the operative group (NSA 90±17 degrees, HEA 68±19 degrees) versus nonoperative patients (NSA 122±19 degrees, HEA 34±14 degrees) (Pfair-poor functional outcomes (mHHS<79). Valgus osteotomy corrects severe deformity in CCV with improved clinical and radiographic outcomes. HEA and NSA are the most reliable radiographic measurements of proximal femoral deformity in CCV. Recurrence is not uncommon, but no predictors were identified. Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment. Level III-retrospective cohort.

  4. Evaluation Of Communal Wastewater Treatment Plant Operating Anaerobic Baffled Reactor And Biofilter

    Directory of Open Access Journals (Sweden)

    Evy Hendriarianti

    2016-02-01

    Full Text Available Construction of communal Waste Water Treatment Plant, WWTP in city of Malang since 1998 but until recently had never done an evaluation the performance. Communal WWTP performance evaluation is needed to see how far the efficiency of processing result. Until now, Environmental Agency Malang City only measure effluent from WWTP Communal  to know the suitability  with domestic wastewater quality standards. Effluent quality data in 2014 showed value above the quality standard of domestic wastewater from East Java Governor Regulation No. 72 in 2013 for parameters BOD and COD. WWTP Communal USRI research objects are on a six (6 locations by involving the user community during the planning, construction, operation and maintenance. Technology choice of ABR followed by a biofilter reactor with the stone media proved capable of processing organic matter of BOD and COD with the removal levels respectively by 78% -99% and 71% -99%. As for the parameters of TSS, NO3 and PO4 have the ranges of removal respectively by 56% -100%, (43% - 72%, (2% - 13%. Ratio BOD and COD in influent are low and ranged from 0.22 to 0.41. From the evaluation shows that high organic matter concentrations in influent along with the HRT and operation time high will result in a higher removal level

  5. SEMI-BATCH OPERATED CONSTRUCTED WETLANDS PLANTED WITH PHRAGMITES AUSTRALIS FOR TREATMENT OF DYEING WASTEWATER

    Directory of Open Access Journals (Sweden)

    SOON-AN ONG

    2011-10-01

    Full Text Available The objective of present study is to evaluate the using of constructed wetland under semi-batch operation for the treatment of azo dye Acid Orange 7 (AO7 containing wastewater. The emergent plant selected in our study was Phragmites australis. Toxic signs were observed at the Phragmites australis after the addition of AO7 into the wetland reactors but it can adapt to the wastewater as shown in the increase of stem as the operation continue. Our result shows that the artificial aeration and the presence of Phragmites australis had a significant impact on the removal of organic matters, AO7, aromatic amines and NH4-N. The COD removal efficiency in the aerated and non-aerated wetland reactors was 95 and 62%, respectively. The NH4-N removal efficiency in the aerated wetland reactor (86% was significantly higher than the non-aerated wetland reactor (14 %. All wetland reactors show high removal efficiency of AO7 (> 94% but only the aerated wetland reactor perform better in the removal of aromatic amines.

  6. Performance of atraumatic restorative treatment (ART) depending on operator-experience.

    Science.gov (United States)

    Jordan, Rainer A; Gaengler, Peter; Markovic, Ljubisa; Zimmer, Stefan

    2010-01-01

    Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

  7. Benefits and drawbacks of thermal pre-hydrolysis for operational performance of wastewater treatment plants.

    Science.gov (United States)

    Phothilangka, P; Schoen, M A; Wett, B

    2008-01-01

    This paper presents benefits and potential drawbacks of thermal pre-hydrolysis of sewage sludge from an operator's prospective. The innovative continuous Thermo-Pressure-Hydrolysis Process (TDH) has been tested in full-scale at Zirl wastewater treatment plant (WWTP), Austria, and its influence on sludge digestion and dewatering has been evaluated. A mathematical plant-wide model with application of the IWA Activated Sludge Model No.1 (ASM1) and the Anaerobic Digestion Model No.1 (ADM1) has been used for a systematic comparison of both scenarios--operational plant performance with and without thermal pre-hydrolysis. The impacts of TDH pre-hydrolysis on biogas potential, dewatering performance and return load in terms of ammonia and inert organic compounds (Si) have been simulated by the calibrated model and are displayed by Sankey mass flow figures. Implementation of full scale TDH process provided higher anaerobic degradation efficiency with subsequent increased biogas production (+75-80%) from waste activated sludge (WAS). Both effects--enhanced degradation of organic matter and improved cake's solids content from 25.2 to 32.7% TSS--promise a reduction in sludge disposal costs of about 25%. However, increased ammonia release and generation of soluble inerts Si was observed when TDH process was introduced. IWA Publishing 2008.

  8. Non-Operative Treatment in Children and Adolescents with Atlantoaxial Rotatory Subluxation

    Directory of Open Access Journals (Sweden)

    Erol Yalnız

    2012-09-01

    Full Text Available Objective: Atlantoaxial rotatory subluxation (AARS is an uncommon lesion seen mainly in children and adolescents. A retrospective analysis of 12 patients with AARS treated non-operatively is presented in this study. Material and Methods: Twelve patients with AARS who were treated non-operatively were evaluated retrospectively in terms of recent trauma and respiratory tract infection history, accompanying injuries, radiological findings, duration of symptoms, amount and duration of traction and clinical results of the treatment. Results: Traumatic AARS was present in 8 patients. No evidence of trauma was found in 4 patients. Type I subluxations in 10 and type II subluxations in 2 patients were found according to the Fielding and Hawkins classification. All patients were treated using bed-side mentooccipital tractions. The mean duration of bed-side mentooccipital traction was 3,75 days and the mean amount of load was 1.8 kg. All patients were kept in Philadelphia collars for additional 3 weeks after the clinical recovery. No limitations and pain in head movements were present in any patient at the sixth month follow-up examinations.Conclusion: Paediatric patients with neck pain and torticollis should be investigated concerning trauma and recent respiratory tract infection history in order to avoid any delay in diagnosis of a possible AARS.

  9. Operative Treatment of Hepatic Hydatid Cysts: A Single Center Experience in Israel, a Nonendemic Country

    Science.gov (United States)

    Maoz, Daniel; Greif, Franklin; Chen, Jacob

    2013-01-01

    Background. Hydatid cyst disease is a zoonosis caused by Echinococcus genera. The disease is endemic to certain rural areas in the world. Operative treatment is the main component in curing hydatid cysts of the liver. Objective. Describing the unique characteristics of the hydatid cyst patients in Israel, a nonendemic country. Methods. Data was collected form 29 patients treated operatively in Rabin Medical Center from 1994 to 2007. Results. The study included 18 females and 11 males with an average age of 54.9 years. Fifty-two% of the patients immigrated as children from Arab countries to Israel, 21% were Arab-Israelis leaving in the north and center of Israel, and 24% immigrated from the former Communist Bloc. Pericystectomy was performed in 20/29, and cyst unroofing was performed in 9/29. Hydatid cysts average size was 10.7 cm, and the cysts were located in the right or left or involved both lobes in 62%, 28%, and 10% of the lesions, respectively. Postoperative mortality occurred in one case, and severe morbidity occurred in 4 patients. Conclusions. Hydatid cyst disease in Israel is uncommon and is mostly seen in distinct 3 demographic groups. Despite the relatively low patient volume, good results in terms of morbidity, mortality, and recurrence were achieved. PMID:24175100

  10. Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial.

    Science.gov (United States)

    Kim, Kwan-Sub; Yeo, Nam-Kyung; Kim, Seong-Su; Park, Woong-Sub; Kwak, Su-Hyun; Cho, Sang-Hyeon; Sung, Gyu-Wan; Kim, Hae-Sook; Yi, Sang-Wook; Cho, Hae Jun

    2018-05-01

    Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P .05). Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.

  11. Evaluation of radiation dose during sent-graft treatment using a hybrid operating room system

    International Nuclear Information System (INIS)

    Haga, Yoshihiro; Kaga, Yuji; Chida, Koichi

    2015-01-01

    In recent years, aortic aneurysm treatment with stent graft grafting in the X-ray fluoroscopy is increasing. This is an endovascular therapy, because it is a treatment which includes the risk of radiation damage, having to deal with radiation damage, to know in advance is important. In this study, in order to grasp the trend of exposure stent graft implantation in a hybrid operating room (OR) system, focusing on clinical data (entrance skin dose and fluoroscopy time), was to count the total. In TEVAR and EVAR, fluoroscopy time became 13.40 ± 7.27 minutes, 23.67 ± 11.76 minutes, ESD became 0.87 ± 0.41 mGy, 1.11 ± 0.57 mGy. (fluoroscopy time of EVAR was 2.0 times than TEVAR. DAP of EVAR was 1.2 times than TEVAR). When using the device, adapted lesions and usage are different. This means that care changes in exposure-related factors. In this study, exposure trends of the stent graft implantation was able to grasp. It can be a helpful way to reduce/optimize the radiation dose in a hybrid OR system. (author)

  12. [Evaluation of Radiation Dose during Stent-graft Treatment Using a Hybrid Operating Room System].

    Science.gov (United States)

    Haga, Yoshihiro; Chida, Kouichi; Kaga, Yuji; Saitou, Kazuhisa; Arai, Takeshi; Suzuki, Shinichi; Iwaya, Yoshimi; Kumasaka, Eriko; Kataoka, Nozomi; Satou, Naoto; Abe, Mitsuya

    2015-12-01

    In recent years, aortic aneurysm treatment with stent graft grafting in the X-ray fluoroscopy is increasing. This is an endovascular therapy, because it is a treatment which includes the risk of radiation damage, having to deal with radiation damage, to know in advance is important. In this study, in order to grasp the trend of exposure stent graft implantation in a hybrid operating room (OR) system, focusing on clinical data (entrance skin dose and fluoroscopy time), was to count the total. In TEVAR and EVAR, fluoroscopy time became 13.40 ± 7.27 minutes, 23.67 ± 11.76 minutes, ESD became 0.87 ± 0.41 mGy, 1.11 ± 0.57 mGy. (fluoroscopy time of EVAR was 2.0 times than TEVAR. DAP of EVAR was 1.2 times than TEVAR.) When using the device, adapted lesions and usage are different. This means that care changes in exposure-related factors. In this study, exposure trends of the stent graft implantation was able to grasp. It can be a helpful way to reduce/optimize the radiation dose in a hybrid OR system.

  13. Translating removal efficiencies into operational performance indices of wastewater treatment plants.

    Science.gov (United States)

    Silva, Catarina; Quadros, Sílvia; Ramalho, Pedro; Alegre, Helena; Rosa, Maria João

    2014-06-15

    Removal efficiencies are often used to assess the performance of a single or a group of unit operations/processes (UOPs) of a wastewater treatment plant (WWTP). However, depending on the influent concentration (Cin), the same efficiency of removal (Er) may be insufficient or excessive to achieve the UOP or WWTP effluent quality requirements, expressed by concentration limit values (LVs). This paper proposes performance indices (PXs), Er-based, as new metrics for benchmarking, i.e. for assessing and improving the performance of each UOP or treatment step and ultimately of the WWTP as a multi-barrier system, and comprehensively describes the stepwise method of translating Ers into PXs. PXs are dimensionless and vary between 0 and 300 to define three performance levels: unsatisfactory (0-100), acceptable (100-200) and good (200-300) performance. The method developed takes into consideration Cin and LV, and the reference values for judging the performance are given from Er-Cin typical ranges and Er vs. Cin model curves, LV based and field data based. The general equations of the Er model curves are derived. A set of six curves is calibrated for TSS (Total Suspended Solids) and COD (Chemical Oxygen Demand) removal by primary sedimentation and activated sludge systems (carbon or combined carbon and nutrients removal), using 5-year (2006-2010) field data from five Portuguese WWTPs. A statistical analysis of the PX results is additionally proposed to assess treatment reliability. The new method is applied in two WWTPs and the PX results are compared with those of conventional measures - Er and performance indicators (PIs). The results demonstrate that, whereas a simplistic Er-driven or PI-driven management of the WWTPs shows limitations, the developed PXs are adequate measures for benchmarking removal efficiencies towards WWTP reliability and sustainability. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Enhancing the ecological and operational characteristics of water treatment units at TPPs based on baromembrane technologies

    Science.gov (United States)

    Chichirova, N. D.; Chichirov, A. A.; Filimonova, A. A.; Saitov, S. R.

    2017-12-01

    The innovative baromembrane technologies for water demineralization were introduced at Russian TPPs more than 25 years ago. While being used in the power engineering industry of Russia, these technologies demonstrated certain advantages over the traditional ion-exchange and thermal technologies of makeup water treatment for steam boilers. Water treatment units based on the baromembrane technology are compact, easy to operate, and highly automated. The experience gained from the use of these units shows that their reliability depends directly on preliminary water treatment. The popular water pretreatment technology with coagulation by aluminum oxychloride proved to be inefficient during the seasonal changes of source water quality that occurs at some stations. The use of aluminum coagulant at pH 8 and higher does not ensure the stable and qualitative pretreatment regime: soluble aluminum forms slip on membranes of the ultrafiltration unit, thereby causing pollution and intoxication as well as leading to structural damages or worsening of mechanical properties of the membranes. The problem of increased pH and seasonal changes of the source water quality can be solved by substitution of the traditional coagulant into a new one. To find the most successful coagulant for water pretreatment, experiments have been performed on both qualitative and quantitative analysis of the content of natural organic matters in the Volga water and their structure. We have developed a software program and measured the concentrations of soluble aluminum and iron salts at different pH values of the source water. The analysis of the obtained results has indicated that iron sulfate at pH 6.0-10.2, in contrast to aluminum oxychloride, is not characterized by increased solubility. Thus, the basic process diagrams of water pretreatment based on baromembrane technologies with pretreatment through coagulation by iron salts and wastewater amount reducing from 60-40 to 5-2% have been introduced for

  15. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

    Directory of Open Access Journals (Sweden)

    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  16. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

    Directory of Open Access Journals (Sweden)

    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  17. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  18. Simulated versus realistic intra operative radiation therapy (I.O.R.T.) treatment in operating room: from knowledge of stray radiation to action

    International Nuclear Information System (INIS)

    Andreoli, S.; Moretti, R.; Catalano, M.; Locatelli, F.

    2006-01-01

    Intra-Operative Radiation Therapy (I.O.R.T.) is carried out with electron beams produced by a Linac (Linear Accelerator) generally used for conventional radiotherapy with external beam, or by dedicated accelerators that can be employed directly into an operating room. I.O.R.T. refers to the application of radiation during a surgical intervention, after the removal of a neoplastic mass. I.O.R.T. uses on the tumour area a direct irradiation, for the possible localisation of sub-clinic illness or macroscopic residue in the case of non-radical resection. Intra-Operative Radiotherapy foresees a single session only, generally preceded or followed by radiotherapy with external beam. It allows the achievement of a selective radiation boost on the tumour volume. In some cases, it can also be used as a one-time/stand alone treatment in initial cancer of small volume, or in unresectable malignancies for palliative purpose. The technical advantages of I.O.R.T. consist in the direct visual control of the target volume, and in the possibility to protect the healthy tissues by moving them away from the path of the radiation beam. The use of electron beams allows the administration of a homogeneous dose to a selected layer of tissues surrounding the tumour. The following professional staff forms the Operative Group: radiation oncologist, surgeon, anaesthetist, medical physicist, radiation technologist, nurse.The choice of a simulation geometry very similar to the clinical situation allows to evaluate radioprotection data very close to the real situation. For a fixed layout, an anthropomorphic phantom was positioned on the operating bed and a breast I.O.R.T. treatment was simulated positioning all the accessories of the operating room in their typical positions. A detailed dose mapping was performed with a Victoreen 450P ionisation chamber and with environment film-dosimeter on the walls of the operating room during the simulation of the clinical treatment. The simulation appears

  19. Complications after operative treatment of femoral shaft fractures in childhood and adolescence

    Directory of Open Access Journals (Sweden)

    Christiane Kruppa

    2018-02-01

    Full Text Available Purpose of the study was to retrospectively analyze the complication rates after operatively treated femoral shaft fractures in childhood and adolescence. Retrospective evaluation of 42 children with operatively treated femoral shaft fractures between 2000 and 2014. Fractures were classified as 27 A type, 12 B type and 3 C type fractures according the OTA/AO classification. 8 (19.05% fractures were open. Age averaged 10.2 years (3-16. Fracture treatment was recorded as temporary or definitive external fixation, ESIN, plate fixation or IMN. Complications such as wound infection, re-fractures, nonunion and malunion were analyzed. Six (14.29% fractures were temporarily stabilized using an external fixator. In 22 (52.38% children the femoral shaft fracture was stabilized using ESINs. 10 (23.81% children had a plate fixation and 9 (21.43% adolescents were treated using an IMN. ESIN treated children were significantly younger (P=0.000 and had less weight (P=0.000 than children treated with both other methods. Complications were two (4.76% superficial and two deep (4.76% wound infections, one (2.38% re-fracture with the ESIN in situ, one (2.38% nonunion and one (2.38% malunion. Six (14.29% children required a reoperation for a complication. Risk factors for complications were temporarily applied external fixators, open fractures, C Type fractures (P=0.031 and an increasing age (P=0.048 and weight (P=0.047 of the child. The majority of children in our study population were successfully treated using ESIN presenting a low complication rate. Complications were observed following open fractures and more complex fracture types. Furthermore we observed an increasing complication rate with increasing ages and weights of the children.

  20. Effects Influencing Plutonium-Absorber Interactions and Distributions in Routine and Upset Waste Treatment Plant Operations

    Energy Technology Data Exchange (ETDEWEB)

    Delegard, Calvin H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sinkov, Sergey I. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Fiskum, Sandra K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-05-01

    This report is the third in a series of analyses written in support of a plan to revise the Hanford Waste Treatment and Immobilization Plant (WTP) Preliminary Criticality Safety Evaluation Report (CSER) that is being implemented at the request of the U.S. Department of Energy (DOE) Criticality Safety Group. A report on the chemical disposition of plutonium in Hanford tank wastes was prepared as Phase 1 of this plan (Delegard and Jones 2015). Phase 2 is the provision of a chemistry report to describe the potential impacts on criticality safety of waste processing operations within the WTP (Freer 2014). In accordance with the request from the Environmental and Nuclear Safety Department of the WTP (Miles and Losey 2012), the Phase 2 report assessed the potential for WTP process conditions within and outside the range of normal control parameters to change the ratio of fissile material to neutron-absorbing material in the waste as it is processed with an eye towards potential implications for criticality safety. The Phase 2 study also considered the implications should WTP processes take place within the credible range of chemistry upset conditions. In the present Phase 3 report, the 28 phenomena described in the Phase 2 report were considered with respect to the disposition of plutonium and various absorber elements. The phenomena identified in the Phase 2 report are evaluated in light of the Phase 1 report and other resources to determine the impacts these phenomena might have to alter the plutonium/absorber dispositions and ratios. The outcomes of the Phase 3 evaluations then can be used to inform subsequent engineering decisions and provide reasonable paths forward to mitigate or overcome real or potential criticality concern in plant operations.

  1. Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations

    Directory of Open Access Journals (Sweden)

    Ja Hong Kuh

    2017-06-01

    Full Text Available Background: In elderly patients who have atrial fibrillation (AF, surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP, the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. Methods: From October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was 8±11 (high risk. Results: Only 1 hospital death occurred (4%. The Kaplan-Meier method showed a high 5‐year cumulative survival rate (92%. At mean follow‐up of 51 months, 23 patients (89% had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium (53.4±7.5 cm and the 19 patients who did not have reduction plasty (48.7±5.7 cm. Conclusion: In patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

  2. Cationic PEGylated polycaprolactone nanoparticles carrying post-operation docetaxel for glioma treatment

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    Cem Varan

    2017-07-01

    Full Text Available Background: Brain tumors are the most common tumors among adolescents. Although some chemotherapeutics are known to be effective against brain tumors based on cell culture studies, the same effect is not observed in clinical trials. For this reason, the development of drug delivery systems is important to treat brain tumors and prevent tumor recurrence. The aim of this study was to develop core–shell polymeric nanoparticles with positive charge by employing a chitosan coating. Additionally, an implantable formulation for the chemotherapeutic nanoparticles was developed as a bioadhesive film to be applied at the tumor site following surgical operation for brain glioma treatment. To obtain positively charged, implantable nanoparticles, the effects of preparation technique, chitosan coating concentration and presence of surfactants were evaluated to obtain optimal nanoparticles with a diameter of less than 100 nm and a net positive surface charge to facilitate cellular internalization of drug-loaded nanoparticles. Hydroxypropyl cellulose films were prepared to incorporate these nanoparticle dispersions to complete the implantable drug delivery system.Results: The diameter of core–shell nanoparticles were in the range of 70–270 nm, depending on the preparation technique, polymer type and coating. Moreover, the chitosan coating significantly altered the surface charge of the nanoparticles to net positive values of +30 to +50 mV. The model drug docetaxel was successfully loaded into all particles, and the drug release rate from the nanoparticles was slowed down to 48 h by dispersing the nanoparticles in a hydroxypropyl cellulose film. Cell culture studies revealed that docetaxel-loaded nanoparticles cause higher cytotoxicity compared to the free docetaxel solution in DMSO.Conclusion: Docetaxel-loaded nanoparticles dispersed in a bioadhesive film were shown to be suitable for application of chemotherapeutics directly to the action site during

  3. Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Krystyna Serkies

    2016-12-01

    Full Text Available Purpose : To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT. The BT dose of 15 Gy (1 Gy/pulse/h was given on the following day after surgery. Results: No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%, subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years, among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96% and 87% (95% CI: 80-94%, respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97% and 89% (95% CI: 82-96%, respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91% evaluable patients. Conclusions : Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation

  4. Comparison of stability in the operative treatment of pelvic injuries in a finite element model.

    Science.gov (United States)

    Bodzay, Tamás; Flóris, István; Váradi, Károly

    2011-10-01

    The comparison of the stability of four surgical methods for the treatment of vertically and rotationally unstable type C pelvic ring injuries. We produced a type C pelvic ring injury (type Denis II fracture of the sacrum and symphysiolysis) on a finite element model, in the case of standing on both feet. We stabilized the symphysiolysis with a five-hole reconstruction plate; the sacrum fracture was fixed in the first experiment with two, two-hole reconstruction plates on the ventral surface, in the second one we applied dorsally the transsacral, narrow DC plate, in the third one with KFI-H plate, and in the last one with iliosacral screw. Finite element modeling was performed by the use of the ALGOR software. Not only bones and joints, but joints and mechanically important ligaments were modeled as well. We measured the shift between the two surfaces of the fracture gap, compared to the results of measurements accomplished on cadaver models. Larger shift could be elicited after transsacral plating than after direct plating. These results correspond to those of the parallel investigation of the bony ligamentous cadaver pelvis specimens. The shift values after KFI-H plating and iliosacral screw fixation are larger than after direct plating, but smaller than after transsacral plating. The tension created in the implants is less than the allowed values; therefore, the choice of operation should depend on the type of injury. The finite element model may be utilized for the comparison of different methods of osteosynthesis for the treatment of injuries described above. Due to several difficulties in investigations performed on cadaver specimens, this model has undoubted utility.

  5. Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion.

    Science.gov (United States)

    Hierholzer, Christian; Friederichs, Jan; Glowalla, Claudio; Woltmann, Alexander; Bühren, Volker; von Rüden, Christian

    2017-08-01

    The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome. Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

  6. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

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    Rak Vaclav

    2009-01-01

    Full Text Available Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17% in group A and 1/34 (3% in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Bφhler´s angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55% in group A and in 30/34 (85% in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the

  7. Hydrothermal Testing of K Basin Sludge and N Reactor Fuel at Sludge Treatment Project Operating Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Delegard, Calvin H.; Schmidt, Andrew J.; Thornton, Brenda M.

    2007-03-30

    The Sludge Treatment Project (STP), managed for the U. S. DOE by Fluor Hanford (FH), was created to design and operate a process to eliminate uranium metal from K Basin sludge prior to packaging for Waste Isolation Pilot Plant (WIPP). The STP process uses high temperature liquid water to accelerate the reaction, produce uranium dioxide from the uranium metal, and safely discharge the hydrogen. Under nominal process conditions, the sludge will be heated in pressurized water at 185°C for as long as 72 hours to assure the complete reaction (corrosion) of up to 0.25-inch diameter uranium metal pieces. Under contract to FH, the Pacific Northwest National Laboratory (PNNL) conducted bench-scale testing of the STP hydrothermal process in November and December 2006. Five tests (~50 ml each) were conducted in sealed, un-agitated reaction vessels under the hydrothermal conditions (e.g., 7 to 72 h at 185°C) of the STP corrosion process using radioactive sludge samples collected from the K East Basin and particles/coupons of N Reactor fuel also taken from the K Basins. The tests were designed to evaluate and understand the chemical changes that may be occurring and the effects that any changes would have on sludge rheological properties. The tests were not designed to evaluate engineering aspects of the process. The hydrothermal treatment affected the chemical and physical properties of the sludge. In each test, significant uranium compound phase changes were identified, resulting from dehydration and chemical reduction reactions. Physical properties of the sludge were significantly altered from their initial, as-settled sludge values, including, shear strength, settled density, weight percent water, and gas retention.

  8. Electrochemical treatment and operating cost analysis of textile wastewater using sacrificial iron electrodes.

    Science.gov (United States)

    Kobya, M; Demirbas, E; Akyol, A

    2009-01-01

    Electrocoagulation (EC) method with iron electrode was used to treat the textile wastewater in a batch reactor. Iron electrode material was used as a sacrificial electrode in monopolar parallel mode in this study. The removal efficiencies of the wastewater by EC were affected by initial pH of the solution, current density, conductivity and time of electrolysis. Under the optimal experimental conditions (initial pH 6.9, current density of 10 mA/cm(2), conductivity of 3,990 microS/cm, and electrolysis time of 10 min), the treatment of textile wastewater by the EC process led to a removal capacity of 78% of chemical oxygen demand (COD) and 92% of turbidity. The energy and electrode consumptions at the optimum conditions were calculated to be 0.7 kWh/kg COD (1.7 kWh/m(3)) and 0.2 kgFe/kg COD (0.5 kgFe/m(3)), respectively. Moreover, the operating cost was calculated as 0.2 euro/kg removed COD or 0.5 euro/m(3) treated wastewater. Zeta potential measurement was used to determine the charge of particle formed during the EC which revealed that Fe(OH)(3) might be responsible for the EC process.

  9. Characterization of wastewater treatment by two microbial fuel cells in continuous flow operation.

    Science.gov (United States)

    Kubota, Keiichi; Watanabe, Tomohide; Yamaguchi, Takashi; Syutsubo, Kazuaki

    2016-01-01

    A two serially connected single-chamber microbial fuel cell (MFC) was applied to the treatment of diluted molasses wastewater in a continuous operation mode. In addition, the effect of series and parallel connection between the anodes and the cathode on power generation was investigated experimentally. The two serially connected MFC process achieved 79.8% of chemical oxygen demand removal and 11.6% of Coulombic efficiency when the hydraulic retention time of the whole process was 26 h. The power densities were 0.54, 0.34 and 0.40 W m(-3) when electrodes were in individual connection, serial connection and parallel connection modes, respectively. A high open circuit voltage was obtained in the serial connection. Power density decreased at low organic loading rates (OLR) due to the shortage of organic matter. Power generation efficiency tended to decrease as a result of enhancement of methane fermentation at high OLRs. Therefore, high power density and efficiency can be achieved by using a suitable OLR range.

  10. Strategies for Reducing the Start-up Operation of Microbial Electrochemical Treatments of Urban Wastewater

    Directory of Open Access Journals (Sweden)

    Zulema Borjas

    2015-12-01

    Full Text Available Microbial electrochemical technologies (METs constitute the core of a number of emerging technologies with a high potential for treating urban wastewater due to a fascinating reaction mechanism—the electron transfer between bacteria and electrodes to transform metabolism into electrical current. In the current work, we focus on the model electroactive microorganism Geobacter sulfurreducens to explore both the design of new start-up procedures and electrochemical operations. Our chemostat-grown plug and play cells, were able to reduce the start-up period by 20-fold while enhancing chemical oxygen demand (COD removal by more than 6-fold during this period. Moreover, a filter-press based bioreactor was successfully tested for both acetate-supplemented synthetic wastewater and real urban wastewater. This proof-of-concept pre-pilot treatment included a microbial electrolysis cell (MEC followed in time by a microbial fuel cell (MFC to finally generate electrical current of ca. 20 A·m−2 with a power of 10 W·m−2 while removing 42 g COD day−1·m−2. The effective removal of acetate suggests a potential use of this modular technology for treating acetogenic wastewater where Geobacter sulfurreducens outcompetes other organisms.

  11. Improvements to the wastewater treatment from the beginning of the operation of Nuclear Asco

    International Nuclear Information System (INIS)

    Esparza Martin, J. L.; Boronat Medico, M.

    2014-01-01

    Sanitary sewage in the Central Nuclear de Asco (CNA), are subject to a series of physico-chemical and biological processes in the wastewater waste (WWTP) before being discharged to the River Ebro. Since the beginning of the exploitation of CNA, the number of workers and administrative restrictions have evolved so that they have forced the execution of modifications of lowest and highest wingspan to comply with applicable legal requirements in the field of discharges. The overall objective of this work is to present the different stages of evolution of the WWTP of CNA from the start of operation of the plant up to the present day. The specific objective is to show the latest enhancements implanted in the sewage treatment plant and the benefits obtained. With technical improvements carried out in the WWTP of CNA, fixed the problem of disposal coming from the central nitrogen, one of the key problems and reason of failure to comply with the parameters imposed by the administration. (Author)

  12. Treatment of industrial effluents in constructed wetlands: challenges, operational strategies and overall performance.

    Science.gov (United States)

    Wu, Shubiao; Wallace, Scott; Brix, Hans; Kuschk, Peter; Kirui, Wesley Kipkemoi; Masi, Fabio; Dong, Renjie

    2015-06-01

    The application of constructed wetlands (CWs) has significantly expanded to treatment of various industrial effluents, but knowledge in this field is still insufficiently summarized. This review is accordingly necessary to better understand this state-of-the-art technology for further design development and new ideas. Full-scale cases of CWs for treating various industrial effluents are summarized, and challenges including high organic loading, salinity, extreme pH, and low biodegradability and color are evaluated. Even horizontal flow CWs are widely used because of their passive operation, tolerance to high organic loading, and decolorization capacity, free water surface flow CWs are effective for treating oil field/refinery and milking parlor/cheese making wastewater for settlement of total suspended solids, oil, and grease. Proper pretreatment, inflow dilutions through re-circulated effluent, pH adjustment, plant selection and intensifications in the wetland bed, such as aeration and bioaugmentation, are recommended according to the specific characteristics of industrial effluents. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. [Surgical treatment of hallux valgus with new method: operative technique and review of 100 cases].

    Science.gov (United States)

    Lucijanić, Ivica; Bićanić, Goran; Pećina, Tatjana Cicvara; Pećina, Marko

    2011-01-01

    We present the operative technique and treatment results for a new three-dimensional method for hallux valgus correction. Lucijanić procedure was developed at the Department of Orthopaedic Surgery, General Hospital Karlovac, where patients enrolled in this study were treated from 2001 to 2008. Clinical and radiological evaluation was performed in 100 cases with a mean follow-up of 4.5 years. Mean American Orthopaedic Foot and Ankle Society score improved from 48.56 preoperatively to 92.34 points postoperatively. Average recovery time and return to work was 7.7 weeks. Result was excellent or good in 93%, fair in 5% and poor in 2% of feet. On the average hallux valgus angle decreased from 29.7 degrees to 9.3 degrees and on the average intermetatarsal angle decreased from 12.5 degrees to 5.2 degrees. First metatarsal inclination angle on average increased 5.3 degrees. First metatarsophalangeal joint congruence and tibial sesamoid position were corrected. The new method allows for correction of hallux valgus deformity in all three planes and for metatarsalgia attenuation.

  14. The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Abdurrahim Çolak

    Full Text Available Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74 underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90% were in NYHA class III; 34 (85% patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

  15. Characteristics of ion spectrum in a low energy nitrogen operated plasma focus: application to the metallic substrates thermal treatment

    International Nuclear Information System (INIS)

    Kelly, H.; Lepone, A.; Marquez, A.

    1998-01-01

    Full text: This work presents the nitrogen ion spectrum characteristics in a Plasma Focus device, determined using a Thomson spectrometer and a Faraday cup, operated in the secondary electron collective mode. It is also discussed the thermal treatment and the re coating induce by ions incident on a metallic surface (AISI 304 steel) placed in front of the coaxial gun, when the device is operated with a Ti implant at the end of the central electrode

  16. [Surgical treatment of primary thymoma].

    Science.gov (United States)

    Zhi, Xiu-yi; Liu, Bao-dong; Xu, Qing-sheng; Zhang, Yi; Su, Lei; Wang, Ruo-tian; Hu, Mu; Liu, Lei

    2007-02-13

    To summarize the clinical and pathologic features of thymoma and assess surgical treatment thereof. The clinical data of 66 thymoma patients, 35 males and 31 females, aged 40.8 (30 approximately 59), who underwent surgical treatment in the past 20 years, were analyzed. By Masaoka staging system, underwent extensive or radical or palliative operation, most commonly performed through a median sternotomy and frequently requires en-bloc resection of one or more adjacent structures. Fourteen of the 66 patients had associated myasthenia gravis (MG). The most common symptoms included chest pain, MG, cough, and dyspnea; only 11 of the 66 (16.7%) patients had no symptom. Masaoka staging revealed stage I in 29 patients (43.9%), stage II in 16 (24.2%), stage III in 19 (28.8%), and stage IV in 2 (3.0%). Fourteen of the 66 patients underwent radical resection, resection of the whole thymus and thymoma, 40 underwent simple resection of thymus, 5 underwent palliative resection of thymoma, and 6 underwent thymectomy exploration. Recurrence of tumor was observed in 4 patients. Postoperative radiotherapy and chemotherapy were performed 24 h after the operation, mainly in the cases of invasive or metastatic thymoma. One patient died within 30 days after the operation. Resection and postoperative radiotherapy or chemotherapy are necessary in treatment of thymoma, particularly complete thymectomy.

  17. Sludge Treatment Project Engineered Container Retrieval And Transfer System Prelminary Design Hazard And Operability Study

    International Nuclear Information System (INIS)

    Carro, C.A.

    2011-01-01

    This Hazard and Operability (HAZOP) study addresses the Sludge Treatment Project (STP) Engineered Container Retrieval and Transfer System (ECRTS) preliminary design for retrieving sludge from underwater engineered containers located in the 105-K West (KW) Basin, transferring the sludge as a sludge-water slurry (hereafter referred to as 'slurry') to a Sludge Transport and Storage Container (STSC) located in a Modified KW Basin Annex, and preparing the STSC for transport to T Plant using the Sludge Transport System (STS). There are six, underwater engineered containers located in the KW Basin that, at the time of sludge retrieval, will contain an estimated volume of 5.2 m 3 of KW Basin floor and pit sludge, 18.4 m 3 of 105-K East (KE) Basin floor, pit, and canister sludge, and 3.5 m 3 of settler tank sludge. The KE and KW Basin sludge consists of fuel corrosion products (including metallic uranium, and fission and activation products), small fuel fragments, iron and aluminum oxide, sand, dirt, operational debris, and biological debris. The settler tank sludge consists of sludge generated by the washing of KE and KW Basin fuel in the Primary Clean Machine. A detailed description of the origin of sludge and its chemical and physical characteristics can be found in HNF-41051, Preliminary STP Container and Settler Sludge Process System Description and Material Balance. In summary, the ECRTS retrieves sludge from the engineered containers and hydraulically transfers it as a slurry into an STSC positioned within a trailer-mounted STS cask located in a Modified KW Basin Annex. The slurry is allowed to settle within the STSC to concentrate the solids and clarify the supernate. After a prescribed settling period the supernate is decanted. The decanted supernate is filtered through a sand filter and returned to the basin. Subsequent batches of slurry are added to the STSC, settled, and excess supernate removed until the prescribed quantity of sludge is collected. The sand

  18. Perspectives on greenhouse gas emission estimates based on Australian wastewater treatment plant operating data.

    Science.gov (United States)

    de Haas, D W; Pepperell, C; Foley, J

    2014-01-01

    Primary operating data were collected from forty-six wastewater treatment plants (WWTPs) located across three states within Australia. The size range of plants was indicatively from 500 to 900,000 person equivalents. Direct and indirect greenhouse gas emissions were calculated using a mass balance approach and default emission factors, based on Australia's National Greenhouse Energy Reporting (NGER) scheme and IPCC guidelines. A Monte Carlo-type combined uncertainty analysis was applied to the some of the key emission factors in order to study sensitivity. The results suggest that Scope 2 (indirect emissions due to electrical power purchased from the grid) dominate the emissions profile for most of the plants (indicatively half to three quarters of the average estimated total emissions). This is only offset for the relatively small number of plants (in this study) that have significant on-site power generation from biogas, or where the water utility purchases grid electricity generated from renewable sources. For plants with anaerobic digestion, inventory data issues around theoretical biogas generation, capture and measurement were sometimes encountered that can skew reportable emissions using the NGER methodology. Typically, nitrous oxide (N(2)O) emissions dominated the Scope 1 (direct) emissions. However, N(2)O still only accounted for approximately 10 to 37% of total emissions. This conservative estimate is based on the 'default' NGER steady-state emission factor, which amounts to 1% of nitrogen removed through biological nitrification-denitrification processing in the plant (or indicatively 0.7 to 0.8% of plant influent total nitrogen). Current research suggests that true N(2)O emissions may be much lower and certainly not steady-state. The results of this study help to place in context research work that is focused on direct emissions from WWTPs (including N(2)O, methane and carbon dioxide of non-biogenic origin). For example, whereas non-biogenic CO(2

  19. SLUDGE TREATMENT PROJECT ENGINEERED CONTAINER RETRIEVAL AND TRANSFER SYSTEM PRELMINARY DESIGN HAZARD AND OPERABILITY STUDY

    Energy Technology Data Exchange (ETDEWEB)

    CARRO CA

    2011-07-15

    This Hazard and Operability (HAZOP) study addresses the Sludge Treatment Project (STP) Engineered Container Retrieval and Transfer System (ECRTS) preliminary design for retrieving sludge from underwater engineered containers located in the 105-K West (KW) Basin, transferring the sludge as a sludge-water slurry (hereafter referred to as 'slurry') to a Sludge Transport and Storage Container (STSC) located in a Modified KW Basin Annex, and preparing the STSC for transport to T Plant using the Sludge Transport System (STS). There are six, underwater engineered containers located in the KW Basin that, at the time of sludge retrieval, will contain an estimated volume of 5.2 m{sup 3} of KW Basin floor and pit sludge, 18.4 m{sup 3} of 105-K East (KE) Basin floor, pit, and canister sludge, and 3.5 m{sup 3} of settler tank sludge. The KE and KW Basin sludge consists of fuel corrosion products (including metallic uranium, and fission and activation products), small fuel fragments, iron and aluminum oxide, sand, dirt, operational debris, and biological debris. The settler tank sludge consists of sludge generated by the washing of KE and KW Basin fuel in the Primary Clean Machine. A detailed description of the origin of sludge and its chemical and physical characteristics can be found in HNF-41051, Preliminary STP Container and Settler Sludge Process System Description and Material Balance. In summary, the ECRTS retrieves sludge from the engineered containers and hydraulically transfers it as a slurry into an STSC positioned within a trailer-mounted STS cask located in a Modified KW Basin Annex. The slurry is allowed to settle within the STSC to concentrate the solids and clarify the supernate. After a prescribed settling period the supernate is decanted. The decanted supernate is filtered through a sand filter and returned to the basin. Subsequent batches of slurry are added to the STSC, settled, and excess supernate removed until the prescribed quantity of sludge is

  20. HYBRID TREATMENT OF COMPLEX COMBINED CORONARY AND VALVE DISEASE FOR PATIENTS WITH HIGH LEVEL OF OPERATIONAL RISK

    Directory of Open Access Journals (Sweden)

    G. V. Aniskevich

    2011-01-01

    Full Text Available The analysis of results of hybrid treatment of complex combined coronary and valve disease at patients with high level of operational risk between January 2005 and December 2010. The hybrid treatment of complex combined coronary and valve disease, provides performance of percutaneous coronary interventions (PCI in a combinati- on valve surgery. 118 patients, with a median age 64.4 ± 8.9 years, are included in research. 2 approaches of a hy- brid method of treatment – 2-Staged (n = 86 and a method «1-stop» (n = 32 are applied. The оperative mortality has made 4.2%. On the basis of the received results were the conclusion is drawn that at high-risk patients with complex combined coronary and valve disease the hybrid method of treatment allows to lower risk of operation

  1. Voiding patterns of adult patients who underwent hypospadias repair in childhood.

    Science.gov (United States)

    Jaber, Jawdat; Kocherov, Stanislav; Chertin, Leonid; Farkas, Amicur; Chertin, Boris

    2017-02-01

    This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  2. [Prognostic Analysis of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy Using QOL-ACD].

    Science.gov (United States)

    Fukui, Yasuhiro; Kashiwagi, Shinichiro; Takada, Koji; Goto, Wataru; Asano, Yuka; Morisaki, Tamami; Noda, Satoru; Takashima, Tsutomu; Onoda, Naoyoshi; Hirakawa, Kosei; Ohira, Masaichi

    2017-11-01

    We investigated into association of quality of life(QOL)and prognosis of breast cancer patients who underwent neoadjuvant chemotherapy(NAC). We retrospectively studied 228 patients with breast cancer who were performed NAC during a period between 2007 and 2015. TheQ OL score was measured with"The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs(QOL-ACD)". We evaluate association between QOL score with antitumor effect and prognosis. Changes in the QOL score between before and after NAC were compared as well. We divided 2 groups by QOL-ACD scoreinto high and low groups. Therapeautic effect of NAC on 75 patients were pathological complete response(pCR). QOL-ACD score was not significantly associated with pCR rate in both high and low groups(p=0.199). High group was significantly associated with higher survival rate in both of disease free survival(p=0.009, logrank)and overall survival(p=0.040, logrank). QOLACD score decreased after NAC in both of pCR and non-pCR patients. In conclusion, QOL evaluation using QOL-ACD could be an indicator of breast cancer patients' prognosis who underwent NAC.

  3. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  5. Use of Operant Performance to Guide and Evaluate Medical Treatment in an Adult Male Cynomolgus Macaque (Macaca fascicularis)

    Science.gov (United States)

    2011-11-01

    improve animal welfare in laboratory settings and to guide effective therapies and veterinary practices. The present study is a case report of...treatment. The affected monkey received ketoprofen, buprenorphine , or their combination but continued to perform poorly during daily operant behavioral...evening administration of buprenorphine (0.01 mg/kg IM) was added to the treatment regimen of ketoprofen (2.0 mg/kg IM) ad- ministration in the

  6. DIRECT trial. Diverticulitis recurrences or continuing symptoms: Operative versus conservative Treatment. A MULTICENTER RANDOMISED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    van de Wall Bryan JM

    2010-08-01

    Full Text Available Abstract Background Persisting abdominal complaints are common after an episode of diverticulitis treated conservatively. Furthermore, some patients develop frequent recurrences. These two groups of patients suffer greatly from their disease, as shown by impaired health related quality of life and increased costs due to multiple specialist consultations, pain medication and productivity losses. Both conservative and operative management of patients with persisting abdominal complaints after an episode of diverticulitis and/or frequently recurring diverticulitis are applied. However, direct comparison by a randomised controlled trial is necessary to determine which is superior in relieving symptoms, optimising health related quality of life, minimising costs and preventing diverticulitis recurrences against acceptable morbidity and mortality associated with surgery or the occurrence of a complicated recurrence after conservative management. We, therefore, constructed a randomised clinical trial comparing these two treatment strategies. Methods/design The DIRECT trial is a multicenter randomised clinical trial. Patients (18-75 years presenting themselves with persisting abdominal complaints after an episode of diverticulitis and/or three or more recurrences within 2 years will be included and randomised. Patients randomised for conservative treatment are treated according to the current daily practice (antibiotics, analgetics and/or expectant management. Patients randomised for elective resection will undergo an elective resection of the affected colon segment. Preferably, a laparoscopic approach is used. The primary outcome is health related quality of life measured by the Gastro-intestinal Quality of Life Index, Short-Form 36, EQ-5D and a visual analogue scale for pain quantification. Secondary endpoints are morbidity, mortality and total costs. The total follow-up will be three years. Discussion Considering the high incidence and the

  7. Factors in reliable treatment plant operation for the production of safe water.

    Science.gov (United States)

    Hendry, Bruce A

    2010-08-01

    This contribution to the International Congress on Production of Safe Water, Izmir, Turkey, 20-24 January, 2009, relates to general aspects of a water supply undertaking rather than to particular technologies or chemistries for water treatment. The paper offers a "creative problem solving" approach following Fogler and LeBlanc (Strategies for creative problem solving. Prentice Hall, NJ, 1995) as a model for generating sustainable solutions when water quality and safety problems arise. Such a structured approach presents a systematic methodology that can promote communication and goal-sharing across the inter-related, but often isolated and dispersed, functions of water scientists and researchers, engineers, operations managers, government departments and communities. A problem-solving strategy, or "heuristic", invokes five main steps (define; generate; decide; implement; evaluate). Associated with each step are various creative and enabling techniques, many of which are quite familiar to us in one form or another, but which we can use more effectively in combination and through our increased awareness and practice. For example, taking a fresh view of a problem can be promoted by a variety of "lateral thinking" tools. First-hand investigation of a problem can trigger new thinking about the real problem and its origins. A good strategy implementation will always address each and every step (though not necessarily every possible technique) and will use them at various stages in the search for and implementation of solutions. The creative nature of our experience with a problem-solving heuristic develops our facility to cope better with complex formal situations, as well as with less formal or everyday problem situations. A few anecdotes are presented that illustrate some of the author's experiences relating to factors involved in safe water supply. Here, the term "factors" may signify people and organisations as agents, as well as meaning those aspects of a problem

  8. Approximal sealings on lesions in neighbouring teeth requiring operative treatment: an in vitro study.

    Science.gov (United States)

    Cartagena, Alvaro; Bakhshandeh, Azam; Ekstrand, Kim Rud

    2018-02-07

    With this in vitro study we aimed to assess the possibility of precise application of sealant on accessible artificial white spot lesions (WSL) on approximal surfaces next to a tooth surface under operative treatment. A secondary aim was to evaluate whether the use of magnifying glasses improved the application precision. Fifty-six extracted premolars were selected, approximal WSL lesions were created with 15% HCl gel and standardized photographs were taken. The premolars were mounted in plaster-models in contact with a neighbouring molar with Class II/I-II restoration (Sample 1) or approximal, cavitated dentin lesion (Sample 2). The restorations or the lesion were removed, and Clinpro Sealant was placed over the WSL. Magnifying glasses were used when sealing half the study material. The sealed premolar was removed from the plaster-model and photographed. Adobe Photoshop was used to measure the size of WSL and sealed area. The degree of match between the areas was determined in Photoshop. Interclass agreement for WSL, sealed, and matched areas were found as excellent (κ = 0.98-0.99). The sealant covered 48-100% of the WSL-area (median = 93%) in Sample 1 and 68-100% of the WSL-area (median = 95%) in Sample 2. No statistical differences were observed concerning uncovered proportions of the WSL-area between groups with and without using magnifying glasses (p values ≥ .19). However, overextended sealed areas were more pronounced when magnification was used (p = .01). The precision did not differ between the samples (p = .31). It was possible to seal accessible approximal lesions with high precision. Use of magnifying glasses did not improve the precision.

  9. Operating and life-cycle costs for uranium-contaminated soil treatment technologies

    International Nuclear Information System (INIS)

    Douthat, D.M.; Armstrong, A.Q.

    1995-09-01

    The development of a nuclear industry in the US required mining, milling, and fabricating a large variety of uranium products. One of these products was purified uranium metal which was used in the Savannah River and Hanford Site reactors. Most of this feed material was produced at the US Department of Energy (DOE) facility formerly called the Feed Materials Production Center at Fernald, Ohio. During operation of this facility, soils became contaminated with uranium from a variety of sources. To avoid disposal of these soils in low-level radioactive waste burial sites, increasing emphasis has been placed on the remediating soils contaminated with uranium and other radionuclides. To address remediation and management of uranium-contaminated soils at sites owned by DOE, the DOE Office of Technology Development (OTD) evaluates and compares the versatility, efficiency, and economics of various technologies that may be combined into systems designed to characterize and remediate uranium-contaminated soils. Each technology must be able to (1) characterize the uranium in soil, (2) decontaminate or remove uranium from soil, (3) treat or dispose of resulting waste streams, (4) meet necessary state and federal regulations, and (5) meet performance assessment objectives. The role of the performance assessment objectives is to provide the information necessary to conduct evaluations of the technologies. These performance assessments provide the basis for selecting the optimum system for remediation of large areas contaminated with uranium. One of the performance assessment tasks is to address the economics of full-scale implementation of soil treatment technologies. The cost of treating contaminated soil is one of the criteria used in the decision-making process for selecting remedial alternatives

  10. Treatment results of non-operated lung cancer by radiotherapy and radiochemotherapy

    International Nuclear Information System (INIS)

    Seino, Yasuo; Watarai, Jiro; Kobayashi, Mitsuru; Sashi, Ryuji; Shindo, Masaaki; Kato, Toshio

    1993-01-01

    The treatment results of 152 non-operated lung cancer patients were analyzed. Median survival times (MST; months) for all patients based on the stage (UICC'87) were 28 M (n=12) for stage I, 18 M (n=16) for stage II, 8 M (n=58) for stage III A, 6 M (n=46) for stage III B, and 4 M (n=20) for stage IV. The effect of combined radiochemotherapy was quite evident in small cell lung cancer (SCLC) patients. Here, the MST of the radiotherapy alone group (n=11) was 5 M, whereas that of radiochemotherapy group (n=14) was 12 M (p<0.05). In non-small cell lung cancer (NSCLC), the effect of radiochemotherapy was recognized only in stage III A and III B patients. In this case, the MST of the radiotherapy alone group (n=50) was 6 M, whereas that of the radiochemotherapy group (n=38) was 9 M (p<0.05). The duration of time from the initial therapy to the occurrence of distant metastasis in stage III A and III B patients was longer in the radiochemotherapy group than in the radiotherapy alone group (p<0.05). As for the metastatic sites, a delay in the occurrence of brain, lung and pleural metastasis was also recognized in the radiochemotherapy group (p<0.05). In this retrospective study, the value of combined radiochemotherapy was evident in SCLC and stage III-NSCLC patients. However, there was considerable case to case variation in the dosage, combination of agents and timing of chemotherapy. Recently, more aggressive chemotherapy is now being applied. (author)

  11. Laboratory evaluation of airborne particulate control treatments for simulated aircraft crash recovery operations involving carbon fiber composite materials.

    Science.gov (United States)

    Ferreri, Matthew; Slagley, Jeremy; Felker, Daniel

    2015-01-01

    This study compared four treatment protocols to reduce airborne composite fiber particulates during simulated aircraft crash recovery operations. Four different treatments were applied to determine effectiveness in reducing airborne composite fiber particulates as compared to a "no treatment" protocol. Both "gold standard" gravimetric methods and real-time instruments were used to describe mass per volume concentration, particle size distribution, and surface area. The treatment protocols were applying water, wetted water, wax, or aqueous film-forming foam (AFFF) to both burnt and intact tickets of aircraft composite skin panels. The tickets were then cut using a small high-speed rotary tool to simulate crash recovery operations. Aerosol test chamber. None. Airborne particulate control treatments. Measures included concentration units of milligrams per cubic meter of air, particle size distribution as described by both count median diameter and mass median diameter and geometric standard deviation of particles in micrometers, and surface area concentration in units of square micrometers per cubic centimeter. Finally, a Monte Carlo simulation was run on the particle size distribution results. Comparison was made via one-way analysis of variance. A significant difference (pcrash recovery operations should include a treatment of the debris with water or wetted water. The resulting increase in particle size will make respiratory protection more effective in protecting the response crews.

  12. Impact of combinatory growth factor application on rabbit Achilles tendon injury with operative versus conservative treatment: a pilot study.

    Science.gov (United States)

    Konerding, Moritz A; Arlt, Friederike; Wellmann, Axel; Li, Vincent; Li, William

    2010-02-01

    Acute Achilles tendon (AT) rupture is a common injury with a comparatively high complication rate. Presently, surgical treatments compete with nonoperative treatment modalities. The aim of this study was to elucidate the possible beneficial effects of short-term combinatory application of growth factors on tendon healing during operative or conservative treatment. In this controlled laboratory study, the left ATs of 40 adult New Zealand White rabbits were transected and either sutured or treated conservatively. Half of the animals from each treatment modality group repetitively received a mixture of VEGF165, bFGF, and rPDGF which was administered peritendineally. The left legs were immobilized with external fixateurs for 6 weeks. The ATs were harvested 3 months after intervention. Tensile strength tests revealed no significant differences between operative and conservative treatments. Compared to the normal right ATs, 60% of the average breaking strength was reached 3 months after surgery. Growth factor application did not result in significant improvements. Only a tendency towards higher blood vessel densities was noted in the groups treated with the factors. Collagen type I/III ratios also displayed no significant differences. This study indicates that there is no difference in the biomechanical outcome of conservative versus operative AT rupture treatment and only a marginal impact of short-term combinatory growth and angiogenesis factor application.

  13. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP).

    Science.gov (United States)

    Kim, J Y; Bae, H S

    2001-01-01

    Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

  14. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment.

    Science.gov (United States)

    Lawrence, J Todd R; Patel, Neeraj M; Macknin, Jonathan; Flynn, John M; Cameron, Danielle; Wolfgruber, Hayley C; Ganley, Theodore J

    2013-05-01

    The optimal treatment of medial epicondyle fractures in pediatric athletes remains unclear. To evaluate the outcomes of operative and nonoperative management of medial epicondyle fractures in young athletes. Case series; Level of evidence, 4. The records of all children with fractures of the medial epicondyle over a 5-year period, with a minimum 2 years of follow-up at a pediatric tertiary referral center, were reviewed. Patients with intra-articular entrapment of the fracture fragment or ulnar nerve entrapment were excluded. Treatment decisions were made primarily based on injury mechanism and elbow laxity or instability. Patients were contacted and asked to complete a modified Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Complete data with 2-year follow-up were available for 20 athletes: 6 treated nonoperatively and 14 treated operatively. At the latest follow-up, both groups achieved excellent DASH scores. Half of each cohort required physical therapy, and 6 of 14 patients who received operative treatment reported numbness. All patients were either very or completely satisfied with their treatment. Fourteen patients were overhead athletes (8 treated operatively, 6 nonoperatively). Excellent DASH scores were achieved in both groups, and all overhead athletes were able to return to their sport at the next appropriate level. Seven patients were baseball pitchers and sustained a fracture while throwing (4 treated operatively, 3 nonoperatively). None felt their performance was limited after treatment, and excellent DASH scores were achieved in both groups. These data demonstrate that nonoperative treatment can be successful in young athletes with low-energy medial epicondyle avulsions, a stable elbow, and minimal fracture displacement. Surgical management can be successful in athletes who sustain more significant trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement after a fracture of the medial

  15. POST-OPERATIONAL TREATMENT OF RESIDUAL NA COOLLANT IN EBR-2 USING CARBONATION

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, S.; Knight, C.

    2011-03-08

    At the end of 2002, the Experimental Breeder Reactor Two (EBR-II) facility became a U.S. Resource Conservation and Recovery Act (RCRA) permitted site, and the RCRA permit1 compelled further treatment of the residual sodium in order to convert it into a less reactive chemical form and remove the by-products from the facility, so that a state of RCRA 'closure' for the facility may be achieved (42 U.S.C. 6901-6992k, 2002). In response to this regulatory driver, and in recognition of project budgetary and safety constraints, it was decided to treat the residual sodium in the EBR-II primary and secondary sodium systems using a process known as 'carbonation.' In early EBR-II post-operation documentation, this process is also called 'passivation.' In the carbonation process (Sherman and Henslee, 2005), the system containing residual sodium is flushed with humidified carbon dioxide (CO{sub 2}). The water vapor in the flush gas reacts with residual sodium to form sodium hydroxide (NaOH), and the CO{sub 2} in the flush gas reacts with the newly formed NaOH to make sodium bicarbonate (NaHCO{sub 3}). Hydrogen gas (H{sub 2}) is produced as a by-product. The chemical reactions occur at the exposed surface of the residual sodium. The NaHCO{sub 3} layer that forms is porous, and humidified carbon dioxide can penetrate the NaHCO{sub 3} layer to continue reacting residual sodium underneath. The rate of reaction is controlled by the thickness of the NaHCO{sub 3} surface layer, the moisture input rate, and the residual sodium exposed surface area. At the end of carbonation, approximately 780 liters of residual sodium in the EBR-II primary tank ({approx}70% of original inventory), and just under 190 liters of residual sodium in the EBR-II secondary sodium system ({approx}50% of original inventory), were converted into NaHCO{sub 3}. No bare surfaces of residual sodium remained after treatment, and all remaining residual sodium deposits are covered by a

  16. Heat treatment of long pulse operation for the JAERI ERL-FEL

    International Nuclear Information System (INIS)

    Sawamura, Masaru; Nagai, Ryoji; Kikuzawa, Nobuhiro; Hajima, Ryoichi; Minehara, Eisuke

    2005-01-01

    RF power sources are replaced from all-solid-state amplifiers to IOT amplifiers for the superconducting accelerators (SCAs) and a vacuum tube amplifier for the SHB of the JAERI ERL-FEL. A long pulse operation increased the pressure in the cryostat of the SCA. The single-cell SCA can be operated in 9% duty according to the time constant of the pressure decay in the cryostat. SHB can be operated in 4% duty which is limited by the frequency range of the tuners. The result of the ABAQUS calculation shows the more duty operation. (author)

  17. Vegetated treatment area (VTAs) efficiences for E. coli and nutrient removal on small-scale swine operations

    Science.gov (United States)

    As small-scale animal feeding operations work to manage their byproducts and avoid regulation, they need practical, cost-effective methods to reduce environmental impact. One such option is using vegetative treatment areas (VTAs) with perennial grasses to treat runoff; however, research is limited ...

  18. Operative Treatment of Intra-Articular Distal Radius Fractures With versus Without Arthroscopy : Study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    M.A.M. Mulders (Marjolein A. M.); C.A. Selles (Caroline); J.W. Colaris (Joost); R.W. Peters (Rolf); M. van Heijl (Mark); B.I. Cleffken (Berry); N.W.L. Schep (Niels)

    2018-01-01

    markdownabstract__Background:__ In the past several years, an increase in open reduction and internal fixation (ORIF) for intra-articular distal radius fractures has been observed. This technique leads to a quicker recovery of function compared to non-operative treatment. However, some patients

  19. Operative Treatment of Intra-Articular Distal Radius Fractures With versus Without Arthroscopy: study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    Mulders, Marjolein A. M.; Selles, Caroline A.; Colaris, Joost W.; Peters, Rolf W.; van Heijl, Mark; Cleffken, Berry I.; Schep, Niels W. L.

    2018-01-01

    Background: In the past several years, an increase in open reduction and internal fixation (ORIF) for intra-articular distal radius fractures has been observed. This technique leads to a quicker recovery of function compared to non-operative treatment. However, some patients continue to have a

  20. 46 CFR 54.25-20 - Low temperature operation-ferritic steels with properties enhanced by heat treatment (modifies...

    Science.gov (United States)

    2010-10-01

    ... VESSELS Construction With Carbon, Alloy, and Heat Treated Steels § 54.25-20 Low temperature operation—ferritic steels with properties enhanced by heat treatment (modifies UHT-5(c), UHT-6, UHT-23, and UHT-82... 46 Shipping 2 2010-10-01 2010-10-01 false Low temperature operation-ferritic steels with...

  1. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Z; Hansen, Peter R

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG). BACKGROUND: The benefit from post-operative clopidogrel in CABG...

  2. A Guide for Developing Standard Operating Job Procedures for the Sludge Conditioning & Dewatering Process Wastewater Treatment Facility. SOJP No. 11.

    Science.gov (United States)

    Schwing, Carl M.

    This guide describes standard operating job procedures for the sludge conditioning and dewatering process of wastewater treatment facilities. In this process, sludge is treated with chemicals to make the sludge coagulate and give up its water more easily. The treated sludge is then dewatered using a vacuum filter. The guide gives step-by-step…

  3. A Guide for Developing Standard Operating Job Procedures for the Primary Sedimentation Process Wastewater Treatment Facility. SOJP No. 4.

    Science.gov (United States)

    Charles County Community Coll., La Plata, MD.

    This guide describes standard operating job procedures for the primary sedimentation process of wastewater treatment plants. The primary sedimentation process involves removing settleable and suspended solids, in part, from wastewater by gravitational forces, and scum and other floatable solids from wastewater by mechanical means. Step-by-step…

  4. A Guide for Developing Standard Operating Job Procedures for the Screening & Grinding Process Wastewater Treatment Facility. SOJP No. 1.

    Science.gov (United States)

    Deal, Gerald A.; Montgomery, James A.

    This guide describes standard operating job procedures for the screening and grinding process of wastewater treatment facilities. The objective of this process is the removal of coarse materials from the raw waste stream for the protection of subsequent equipment and processes. The guide gives step-by-step instructions for safety inspection,…

  5. A Guide for Developing Standard Operating Job Procedures for the Sludge Thickening Process Wastewater Treatment Facility. SOJP No. 9.

    Science.gov (United States)

    Schwing, Carl M.

    This guide describes standard operating job procedures for the screening and grinding process of wastewater treatment facilities. The objective of this process is the removal of coarse materials from the raw waste stream for the protection of subsequent equipment and processes. The guide gives step-by-step instructions for safety inspection,…

  6. Carotid intima-media thickness and ınsulin resistance changes in patients who underwent sleeve gastrectomy: A prospective study.

    Science.gov (United States)

    Yorulmaz, G; Cilekar, M; Bilge, U; Akcan, E; Akalin, A

    2016-01-01

    Our aim was to examine changes in insulin resistance, Carotid Intima-Media Thickness (CIMT), in morbid obese patients without any known associated chronic diseases who underwent sleeve gastrectomy. The subjects of this study were patients with minimum BMI of 40, who did not have any known chronic diseases. Sleeve gastrectomy was performed and perioperative control endoscopy was performed. The following values were measured before the operation and after follow-up period after the operation: Fasting blood glucose and insulin, lipid profile, BMI, liver function tests, right and left CIMT. Furthermore, the patients' insulin resistance was calculated by HOMA method, and the values of 2.7. Six-teen patients (14 women and 2 men, average age: 39.12 ± 10.63 years), who did not have a known additional chronic disease, took part in the study. There was a significant difference between baseline and follow-up values of the patients, and the mean weight loss was 20.5%. Given the statistical evaluation of baseline and follow-up values, there was a significant difference in BMI, insulin resistance rates and right and left CIMT values. Bariatric surgery may provide some additional advantages for the management of cardiovascular risks in obese patients. However, it should be kept in mind that the most important components of fight against obesity are appropriate diet and exercise programs.

  7. Evaluating Application of Innovative Technologies to the Operation of a Wastewater Treatment Plant

    National Research Council Canada - National Science Library

    Eick, John

    1999-01-01

    An Advanced Wastewater Treatment Plant (AWTP) was installed at Camp Lejeune, NC, that incorporated tertiary treatment processes designed to protect the nutrient-sensitive nature of the receiving stream, the New River...

  8. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

    Directory of Open Access Journals (Sweden)

    Wever Jan

    2004-01-01

    Full Text Available Abstract Background Clinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now. Case presentation A 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed. Conclusion Non-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

  9. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne muscular dystrophy: a case report.

    Science.gov (United States)

    Brinkman, Justus-Martijn; Oddens, Jorg R; Van Royen, Barend J; Wever, Jan; Olsman, Jan G

    2004-01-08

    Clinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now. A 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed. Non-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

  10. COMPARATIVE ANALYSIS OF THE TREATMENT OF THE EOSINOPHILIC GRANULOMA WITH VERTEBRAL INVOLVEMENT USING ORTHOPEDIC CORSET AND SURGICAL OPERATION

    Directory of Open Access Journals (Sweden)

    A. I. Snetkov

    2010-01-01

    Full Text Available The results of treatment of 72 patients with pathological fracture of vertebra bodies against eosinophilic granuloma a spine are analysed. Orthopedic corset technologies are used in treatment of 42 patients, surgical treatment was applied. Orthopedic corset may be used in patients with eosinophilic granuloma of backbone. This method of treatment was used in a case of the absence of spine secondary deformations and neurologic semiology. Orthopedic corset treatment is associated with long immobilization on the average within 1,5-2 years and never leads to a complete recovery of the damaged spine. Surgical treatment consists in use only at loss of height of a body to 30-40%, when destruction of spine more severe it is necessary to use operative treatment in two stages. Absolute indications to surgical treatment are the neurologic deficit and secondary deformations of a spine. Surgical treatment allows to reduce terms of treatment till 3-4 months and quickly to return the patient to an active life.

  11. Enteral nutrition is superior to total parenteral nutrition for pancreatic cancer patients who underwent pancreaticoduodenectomy.

    Science.gov (United States)

    Liu, Changli; Du, Zhi; Lou, Cheng; Wu, Chenxuan; Yuan, Qiang; Wang, Jun; Shu, Guiming; Wang, Yijun

    2011-01-01

    To determine the effects of total parenteral nutrition (TPN) and enteral nutrition (EN) on biochemical and clinical outcomes in pancreatic cancer patients who underwent pancreaticoduodenectomy. From the year 2006 to 2008, 60 patients who underwent pancreaticoduodenectomy in Tianjin Third Central Hospital were enrolled in this study. They were randomly divided into the EN group and the TPN group. The biochemical and clinical parameters were recorded and analyzed between the two groups. There was no significant difference in the nutritional status, liver and kidney function, and blood glucose levels between the TPN and EN groups on the preoperative day, the 1st and 3 rd postoperative days. However, on the 7th postoperative day, there was significant difference between the two groups in 24 h urinary nitrogen, serum levels of, total protein (TP), transferrin (TF), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transpeptadase (GGT), blood urea nitrogen (BUN) and creatinine (Cr). On the 14th postoperative day, there was a significant difference between the two groups in terms of urinary levels of 24 h nitrogen, TP, TF, retinol binding protein, ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, BUN, Cr, and glucose. The incidence of delayed gastric emptying in the EN and TPN groups was 0% and 20%, respectively. Moreover, the incidence of pancreatic fistulas and hemorrhages in the EN group were 3.6% and 3.6%, versus 26.7% and 30% in the TPN group, respectively. EN is better than TPN for pancreatic cancer patients who received pancreaticoduodenectomy.

  12. Is non-operative management still justified in the treatment of ...

    African Journals Online (AJOL)

    Abstract. Background: Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal ... Followup data were available for 29 patients. Demographic ... required surgery. Key words: Adhesive small bowel obstruction, children, non-operative management ...

  13. DETERMINATION OF ACTIVATED SLUDGE MODEL ASDM PARAMETERS FOR WASTE WATER TREATMENT PLANT OPERATING IN THE SEQUENTIAL–FLOW TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    Dariusz Zdebik

    2015-01-01

    Full Text Available This paper presents a method for calibration of activated sludge model with the use of computer program BioWin. Computer scheme has been developed on the basis of waste water treatment plant operating in the sequential – flow technology. For calibration of the activated sludge model data of influent and treated effluent from the existing object were used. As a result of conducted analysis was a change in biokinetic model and kinetic parameters parameters of wastewater treatment facilities. The presented method of study of the selected parameters impact on the activated sludge biokinetic model (including autotrophs maximum growth rate, the share of organic slurry in suspension general operational, efficiency secondary settling tanks can be used for conducting simulation studies of other treatment plants.

  14. [Current Situation of Antibiotic Prophylaxis in Obesity and Metabolic Surgery - Data Analysis from the Study for Quality Assurance in Operative Treatment of Obesity in Germany].

    Science.gov (United States)

    Stroh, C; Wilhelm, B; Weiner, R; Ludwig, K; Benedix, F; Knoll, C; Lippert, H; Manger, T; Adipositas, Kompetenznetz

    2016-02-01

    Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities. Georg Thieme Verlag KG Stuttgart · New York.

  15. Operational amplifiers

    CERN Document Server

    Dostal, Jiri

    1993-01-01

    This book provides the reader with the practical knowledge necessary to select and use operational amplifier devices. It presents an extensive treatment of applications and a practically oriented, unified theory of operational circuits.Provides the reader with practical knowledge necessary to select and use operational amplifier devices. Presents an extensive treatment of applications and a practically oriented, unified theory of operational circuits

  16. Analysis of Ulcer Recurrences After Metatarsal Head Resection in Patients Who Underwent Surgery to Treat Diabetic Foot Osteomyelitis.

    Science.gov (United States)

    Sanz-Corbalán, Irene; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Morales, Esther; Molines-Barroso, Raúl; Alvaro-Afonso, Francisco Javier

    2015-06-01

    Metatarsal head resection is a common and standardized treatment used as part of the surgical routine for metatarsal head osteomyelitis. The aim of this study was to define the influence of the amount of the metatarsal resection on the development of reulceration or ulcer recurrence in patients who suffered from plantar foot ulcer and underwent metatarsal surgery. We conducted a prospective study in 35 patients who underwent metatarsal head resection surgery to treat diabetic foot osteomyelitis with no prior history of foot surgeries, and these patients were included in a prospective follow-up over the course of at least 6 months in order to record reulceration or ulcer recurrences. Anteroposterior plain X-rays were taken before and after surgery. We also measured the portion of the metatarsal head that was removed and classified the patients according the resection rate of metatarsal (RRM) in first and second quartiles. We found statistical differences between the median RRM in patients who had an ulcer recurrence and patients without recurrences (21.48 ± 3.10% vs 28.12 ± 10.8%; P = .016). Seventeen (56.7%) patients were classified in the first quartile of RRM, which had an association with ulcer recurrence (P = .032; odds ratio = 1.41; 95% confidence interval = 1.04-1.92). RRM of less than 25% is associated with the development of a recurrence after surgery in the midterm follow-up, and therefore, planning before surgery is undertaken should be considered to avoid postsurgical complications. © The Author(s) 2015.

  17. Post-operative pain treatment in Denmark from 2000 to 2009

    DEFF Research Database (Denmark)

    Nielsen, P R; Christensen, P A; Meyhoff, C S

    2012-01-01

    In Denmark, the first acute pain service (APS) was introduced in 1993. An important objective became to facilitate implementation of accelerated post-operative rehabilitation programmes (ACC) in selected procedures in abdominal, gynaecological and orthopaedic surgery. Therefore, it is of consider......, it is of considerable interest to study the association between the developments of post-operative pain management and the ACC by sequential analyses from 2000 to 2009.......In Denmark, the first acute pain service (APS) was introduced in 1993. An important objective became to facilitate implementation of accelerated post-operative rehabilitation programmes (ACC) in selected procedures in abdominal, gynaecological and orthopaedic surgery. Therefore...

  18. A Randomized Prospective Trial Comparing Paravertebral Block and General Anesthesia for Operative Treatment of Breast Cancer

    National Research Council Canada - National Science Library

    Weltz, Christina

    2003-01-01

    .... Experience to date has shown that this anesthetic modality is safe and effective, and associated with excellent post operative pain control and minimization of nausea and vomiting associated with general anesthesia...

  19. Operant Conditioning Principles in the Treatment of Learning and Behavior Problems with Delinquent Boys

    Science.gov (United States)

    Bednar, Richard L.; And Others

    1970-01-01

    This study on operant conditioning showed that both groups showed significant improvement in reading skills from pretest to posttest, but that the reinforced group showed significantly more improvement than the nonreinforced group. (Author)

  20. Comparison of Treatment Outcomes of Infertile Women by Clomiphene Citrate and Letrozole with Gonadotropins Underwent Intrauterine Insemination

    Directory of Open Access Journals (Sweden)

    Seyede Afsar Sharafy

    2012-01-01

    Full Text Available This study was designed to compare the effect of clomiphene and letrozole in ovulatory stimulation in infertile women under intrauterine insemination who referred to Mahdiyeh infertility clinic during 2008-2009. 106 infertile women were randomly divided into two equal groups. Patients were treated with 5 mg of letrozole daily (in letrozole group or 100 mg of clomiphene citrate daily (in clomiphene group for five days starting on day 3 of their menses. Dose and time of FSH was similar in the two groups. Number of follicles, endometrial thickness, Pregnancy rate and prevalence of complications were compared in the two groups. Mean (±SD of age in letrozole and clomiphene groups was 26.3 ±3.9 and 25.2 ±4.9 respectively (P=0.186. Average number of follicles was 2.5 ± 1.65 in letrozole group and 2.36 ± 1.4 in clomiphene group (P=0.764. β-hCG was positive in 11 (20.8% in letrozole and 12 (22.6% in clomiphene groups (P=0.814. Pregnancy rate was 20.8% and 22.6% in letrozole and clomiphene group respectively (P=0.814. There was no difference in rate of abortion between groups. Endometrial thickness (ET at the time of hCG administration in the letrozole (6.8 ±1.5 mm and in clomiphene (6.6 ±1.2 mm (P=0.615. But ET>7.4 mm was found in 2 cased (3.8% in clomiphene group and 12 cases (%22.8 in letrozole groups (P=0.01. It appears that letrozole and clomiphene have similar outcome infertile women under intrauterine insemination and these drugs are good alternative for each others.

  1. Percentages of NKT cells in the tissues of patients with non-small cell lung cancer who underwent surgical treatment.

    Science.gov (United States)

    Pyszniak, Maria; Rybojad, Paweł; Pogoda, Katarzyna; Jabłonka, Andrzej; Bojarska-Junak, Agnieszka; Tabarkiewicz, Jacek

    2014-03-01

    Natural killer T (NKT) cells are involved in the antitumor response by direct cytotoxicity and indirectly through activation of effector cells. Recent studies have shown a relationship between the number and function of NKT cells and clinical outcomes. NKT cells seem to represent a promising tool for immunotherapy of cancer. The aim of the study was to evaluate the distribution of NKT cells in peripheral blood, lymph nodes and tumor tissue of non-small cell lung cancer (NSCLC) patients, as well as development of the most efficient set of cytokines stimulating differentiation of NKT cells. We evaluated the percentage of iNKT+CD3+ cells in the tissues collected from patients with NSCLC. For the generation of NKT cells, we cultured cells isolated from the blood of 20 healthy donors and from the tissues of 4 NSCLC patients. Cells were stimulated with α-GalCer in combinations with cytokines. We noted significant differences in the percentages of NKT cells in the patients' tissues. The highest percentage of these cells was observed in the tumor tissue and the lowest in the lymph nodes. In vitro, in healthy donors all α-GalCer-cytokine combinations were effective in stimulation of NKT cells' proliferation. NKT cells' proliferation was the most efficiently stimulated by α-GalCer+IL-2+IL-7 and α-GalCer+IL-2+IFN-γ. Our results suggest that in the course of NSCLC, NKT cells migrate to the primary tumor and accumulate therein. All tested combinations of α-GalCer and cytokines were capable of generation of NKT cells in vitro.

  2. Operation and control of the critical variables of the process water treatment system in a juice factory

    International Nuclear Information System (INIS)

    Trejos Quesada, Juan Carlos

    2014-01-01

    The process water treatment system in a juice factory is studied to learn how to operate and chemically control the critical variables. The variables: concentration of total chlorine; Concentration of free chlorine; Total dissolved solids; alkalinity; hardness; PH; Turbidity are studied. A learning is obtained of the handling of equipment found in the industry, such as: pumps, dosing pumps controlled by frequency variables, static mixers, multimedia filters, carbon filters, storage tanks, electrovalves, flowmeters, pressure meters and equipment Ultraviolet radiation for disinfection. The operation of this equipment is learned to verify and maintain the critical variables in the specification range established by the company. A manual of operation of the system of water treatment and water analysis in the laboratory is carried out. The experience of the management of equipment for the treatment of water is acquired, comprehending integrally the system of water treatment and the process in general. A verification of the capacity of the equipment and the recommendation of the optimization of the system is realized for system improvements [es

  3. Analysis of operators' surface doses in the common endovascular and on-vascular interventional diagnosis and treatment

    International Nuclear Information System (INIS)

    Zhang Lin; Zhu Jianguo; Min Nan; Lu Feng

    2011-01-01

    Objective: To contrast the level of radiation doses of Lead protective clothing both inside and outside in different parts of the body of the first and second operators and touring nurse in common endovascular and non-vascular interventional diagnosis and treatment. Methods: We choose the common endovascular interventional diagnosis and treatment in the head, thorax, abdomen, such as Cerebral angiography, Coronary angiography, Transcatheter arterial chemoembolization and non-vascular interventional diagnosis and treatment such as Endoscopic Retrograde Cholangio-Pancreatography and Percutaneous transhepatic cholangial drainage as experiment objects. Put the thermoluminescence dosimeter on the different spots of Lead protective clothing of subjects (Inside and outside the lead cap and the lead collar, inside and outside of the lead protective clothing in chest and abdomen, left upper arm outside of lead protective clothing, back of the left hand) and X-ray machine outgoing port when the operation was going on. After that, measure the thermoluminescence dosimeter, calculate and analyze exposure doses inside and outside of the lead protective clothing. Results: The skin doses of operators in different types of interventional diagnosis and treatment are listed in Table 1to Table 4; exposure doses of touring nurses are very low; the doses of X-ray machine outgoing port are mostly over the measuring range. Conclusion: The protection of Lead clothes plays a significant role in these two types of interventional diagnosis and treatment based on the conclusion that the dose of inside of Lead clothes is less than that of outside. We should enhance the operators' protection and administration in the process of intervention and arise the conscious of self-protection, to avoid the unnecessary radiation exposure. (authors)

  4. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  5. Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision.

    Science.gov (United States)

    Uzun, Hakan; Bitik, Ozan; Kamburoğlu, Haldun Onuralp; Dadaci, Mehmet; Çaliş, Mert; Öcal, Engin

    2015-06-01

    Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction. We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them. There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps. Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

  6. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria.

    Science.gov (United States)

    Osifo, O D; Osaigbovo, E O

    2008-06-01

    To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.

  7. Research on common methods for evaluating the operation effect of integrated wastewater treatment facilities of iron and steel enterprises

    Science.gov (United States)

    Bingsheng, Xu

    2017-04-01

    Considering the large quantities of wastewater generated from iron and steel enterprises in China, this paper is aimed to research the common methods applied for evaluating the integrated wastewater treatment effect of iron and steel enterprises. Based on survey results on environmental protection performance, technological economy, resource & energy consumption, services and management, an indicator system for evaluating the operation effect of integrated wastewater treatment facilities is set up. By discussing the standards and industrial policies in and out of China, 27 key secondary indicators are further defined on the basis of investigation on main equipment and key processes for wastewater treatment, so as to determine the method for setting key quantitative and qualitative indicators for evaluation indicator system. It is also expected to satisfy the basic requirements of reasonable resource allocation, environmental protection and sustainable economic development, further improve the integrated wastewater treatment effect of iron and steel enterprises, and reduce the emission of hazardous substances and environmental impact.

  8. Department of Energy Idaho Operations Office evaluation of feasibility studies for private sector treatment of alpha and TRU mixed wastes

    International Nuclear Information System (INIS)

    1995-05-01

    The Idaho National Engineering Laboratory (INEL) is currently storing a large quantity of alpha contaminated mixed low level waste which will require treatment prior to disposal. The DOE Idaho Operations Office (DOE-ID) recognized that current knowledge and funding were insufficient to directly pursue services for the requisite treatment. Therefore, it was decided that private sector studies would be funded to clarify cost, regulatory, technology, and contractual issues associated with procuring treatment services. This report analyzes the three private sector studies procured and recommends a path forward for DOE in procuring retrieval, assay, characterization, and treatment services for INEL transuranic and alpha contaminated mixed low level waste. This report was prepared by a team of subject matter experts from the INEL referred to as the DOE-ID Evaluation Team

  9. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction.

    Science.gov (United States)

    Tazuke, Yuko; Okuyama, Hiroomi; Uehara, Shuichiro; Ueno, Takehisa; Nara, Keigo; Yamanaka, Hiroaki; Kawahara, Hisayoshi; Kubota, Akio; Usui, Noriaki; Soh, Hideki; Nomura, Motonari; Oue, Takaharu; Sasaki, Takashi; Nose, Satoko; Saka, Ryuta

    2015-12-01

    The aim of this study was to evaluate the long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal/alimentary reconstruction. We reviewed the medical records of four long-term survivors of tracheal agenesis and collected the following data: age, sex, type of tracheal agenesis, method of reconstruction, nutritional management, and physical and neurological development. The patients consisted of three boys and one girl, who ranged in age from 77 to 109months. The severity of their condition was classified as Floyd's type I (n=2), II (n=1), or III (n=1). Mechanical respiratory support was not necessary in any of the cases. Esophageal/alimentary reconstruction was performed using the small intestine (n=2), a gastric tube (n=1), and the esophagus (n=1). The age at esophageal reconstruction ranged from 41 to 55months. All of the cases required enteral nutrition via gastrostomy. Three of the patients were able to swallow a small amount of liquid and one was able to take pureed food orally. The physical development of the subjects was moderately delayed-borderline in childhood. Neurological development was normal in two cases and slightly delayed in two cases. None of the long-term survivors of tracheal agenesis required the use of an artificial respirator, and their development was close to normal. Future studies should aim to elucidate the optimal method for performing esophageal reconstruction to allow tracheal agenesis patients to achieve their full oral intake. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair.

    Science.gov (United States)

    Li, Shoujun; Ma, Kai; Hu, Shengshou; Hua, Zhongdong; Yang, Keming; Yan, Jun; Chen, Qiuming

    2014-09-01

    The study objective was to report the outcomes of biventricular repair in patients with double outlet right ventricle. Patients with double outlet right ventricle who underwent biventricular repair at Fuwai Hospital from January 2005 to December 2012 were included. Patients were excluded if double outlet right ventricle was combined with atrioventricular septal defect, heterotaxy syndrome, atrioventricular discordance, or univentricular physiology. A total of 380 consecutive patients with a mean age of 1.9 ± 2.1 years (range, 1 month to 6 years) were included. Varied types of biventricular repair were customized individually. Follow-up was 90.4% complete, and the mean follow-up time was 3.4 ± 3.9 years. There were 17 (4.5%) early deaths and 7 (2.1%) late deaths. Preoperative pulmonary hypertension was the only risk factor for early mortality. Postoperative significant left ventricular outflow tract obstruction was present in 9 survivors. Patients with noncommitted ventricular septal defect had a longer crossclamp time, longer cardiopulmonary bypass time, and higher incidence of postdischarge left ventricular outflow tract obstruction. There were 4 reoperations, all of which were caused by subaortic left ventricular outflow tract obstruction. All of the pressure gradients were decreased to less than 20 mm Hg after the modified Konno procedure with an uneventful postoperative course. Optimal results of varied types of biventricular repair for double outlet right ventricle have been acquired. Although noncommitted ventricular septal defect is technically difficult, the outcomes of patients are favorable. Late-onset left ventricular outflow tract obstruction is the main reason for reoperation but can be successfully relieved by the modified Konno procedure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  11. Newly Developed Sarcopenia as a Prognostic Factor for Survival in Patients who Underwent Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Ja Young Jeon

    Full Text Available The relationship between a perioperative change in sarcopenic status and clinical outcome of liver transplantation (LT is unknown. We investigated whether post-LT sarcopenia and changes in sarcopenic status were associated with the survival of patients.This retrospective study was based on a cohort of 145 patients from a single transplant center who during a mean of 1 year after LT underwent computed tomography imaging evaluation. The cross-sectional area of the psoas muscle of LT patients was compared with that of age- and sex-matched healthy individuals. The Cox proportional hazards regression model was used to determine whether post-LT sarcopenia and changes in sarcopenic status affect post-LT survival.The mean age at LT of the 116 male and 29 female patients was 50.2 ± 7.9 years; the mean follow-up duration was 51.6 ± 32.9 months. All pre-LT patients with sarcopenia still had sarcopenia 1 year after LT; 14 (15% patients had newly developed sarcopenia. The mean survival duration was 91.8 ± 4.2 months for non-sarcopenic patients and 80.0 ± 5.2 months for sarcopenic patients (log-rank test, p = 0.069. In subgroup analysis, newly developed sarcopenia was an independent negative predictor for post-LT survival (hazard ratio: 10.53, 95% confidence interval: 1.37-80.93, p = 0.024.Sarcopenia in LT recipients did not improve in any of the previously sarcopenic patients and newly developed within 1 year in others. Newly developed sarcopenia was associated with increased mortality. Newly developed sarcopenia can be used to stratify patients with regard to the risk of post-LT mortality.

  12. Treatment and conditioning of low-level radioactive waste in Belgium: initial operating results of the Cilva facility

    International Nuclear Information System (INIS)

    Monsch, O.; Renard, C.; Deckers, J.; Luycx, P.

    1995-01-01

    The Belgian National Radioactive Waste and Enriched Fissile Material Agency (ONDRAF), which is responsible for the management of all radioactive waste in Belgium, recently decided to commission the CILVA facility. Operation of this facility, which comprises a number of units for the treatment of low-level radwaste, has been contracted to ONDRAF's Belgoprocess subsidiary based at the Dessel site. A consortium comprising SGN and Fabricom was in charge of building the CILVA facility's waste preparation and conditioning (concrete solidification) units. The concrete solidification processes, which were devised and developed by SGN, have been qualified to secure ONDRAF certification of the process and the facility. This enabled active commissioning of the waste conditioning unit in mid-August 1994. Active commissioning of the waste preparation unit was carried out in several stages up to the beginning of 1995 in accordance with operating requirements. Initial operating results of the two units are presented. (author)

  13. [Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation].

    Science.gov (United States)

    Guan, Ting-Jin; Zheng, Liang-Guo; Sun, Peng; Li, Xing-Xue

    2014-05-01

    To explore the reason, key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation. From July 2007 to May 2012, clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years, and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating, fervescence, fresh seepage in the wound, and blood inflammatory index increased, etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect. All patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus, distal part of the wound present local red, swelling and with wave motion at 2 months after operation, staphylococcus aureus infection was confirmed after puncture and bacterial culture, and 1 thrum was found after local incision. The wound healed after change dressings for 1 week, without recurrence after followed up for 13 months. Preventing the risk factors before operation, minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects, and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection, early diagnosis, debridement, VSD negative pressure irrigation and drainage, to choosing sensitive antibiotics according to the results of drug sensitivity, may contribute to wound early healing and decrease complication.

  14. Pre-operative radiotherapy treatment in uterine cervix voluminous carcinoma clinic phase IB

    International Nuclear Information System (INIS)

    Petitto, J.V.

    1989-01-01

    Forty four patients with voluminous tumor of the uterine cervix were selected and submitted to preoperative radiation with radical dosages in pelvis and to radiation therapy alone. Results as to survival in both of the treatments were similar. Complication rates in both of the treatments were not higher than the acceptable levels. Hospitalization periods were not longer than the usual for Wertheim-Meigs surgery. (author)

  15. Evaluation of the results of operative treatment of hip dysplasia in ...

    African Journals Online (AJOL)

    Methods: The study included 35 patients (42 hips), they had been treated by different combinations of open reduction, femoral (shortening, derotation and varus) and pelvic (Salter or Dega) osteotomy. The age at the time of the operation ranged from 18 to 96 months. Results: At the end of follow-up (a mean of 33.5 months), ...

  16. Evaluation of the results of operative treatment of hip dysplasia in ...

    African Journals Online (AJOL)

    El-Sayed Abdel Halim Abdullah

    2012-02-25

    Feb 25, 2012 ... of open reduction, femoral (shortening, derotation and varus) and pelvic (Salter or Dega) osteot- omy. The age at the time of the operation ranged from 18 to 96 months. Results: At the end of follow-up (a mean of 33.5 months), the overall final clinical result was excel- lent in 13 (31%) patients, good in 24 ...

  17. Effects of dynamic operating conditions on nitrification in biological rapid sand filters for drinking water treatment

    DEFF Research Database (Denmark)

    Lee, Carson Odell; Boe-Hansen, Rasmus; Musovic, Sanin

    2014-01-01

    Biological rapid sand filters are often used to remove ammonium from groundwater for drinking water supply. They often operate under dynamic substrate and hydraulic loading conditions, which can lead to increased levels of ammonium and nitrite in the effluent. To determine the maximum nitrification...

  18. Human actions treatment in the Juragua NPP pre-operational PSA

    International Nuclear Information System (INIS)

    Ferro Fernandez, R.

    1996-01-01

    The human reliability analysis is an important part of the Probabilistic Safety Analysis (PSA). Because Juragua NPP PSA has been accomplished during construction stage of the plant, no specific operational procedures nor experience for human reliability analysis task taking into account the worlds current methodologies in this field and the actual situation of the plant. This papers describes the approach we followed

  19. [Intra-operative myelography in treatment of fractures of thoracolumbar spine].

    Science.gov (United States)

    Tomčovčík, L; Cuha, R; Raši, R

    2010-08-01

    The aim of this retrospective study was to evaluate the results of intra-operative myelography as the method used to assess the reduction of bone fragments from the posterior margin of the vertebral body. Forty patients with 42 comminuted fractures of the thoracolumbar spine were included in the study. The pre-operative spinal stenosis caused by bone fragments from the posterior margin of the vertebral body, as detected by CT scanning, ranged from 25 % to 85 %. Neurological deficit was due to injury in 19 patients and in one it developed post-operatively after the patient stood and walked. After ligamentotaxis and internal fixation, intra-operative myelography was used to show decompression of the spinal canal. A spinal block or severe constriction of contrast flow was an indication for hemilaminectomy (laminectomy) and direct decompression of the spinal canal. In the patients with neurological deficit and severe spinal stenosis persisting after ligamentotaxis and detectable by skiascopy, hemilaminectomy (laminectomy) and direct spinal decompression followed by intra-operative myelography were carried out. Intra-operative myelography was used 46 -times (20-times in 20 patients free from neurological deficit and 26-times in 20 patients with neurological deficit). In 38 cases (82.6 %) dural sac compression was not present (patients with neurological deficit, 13-times after ligamentotaxis, eight-times after ligamentotaxis and hemilaminectomy with direct decompression, twi- ce at repeat surgeryúúú patients without neurological deficit, 15-times). On two occasions (4.4 %) the contrast agent injected into the dural sac did not make the interior body part visible, on three occasions (6.5 %) contrast medium was injected extradurally, and dural sac compression following ligamentotaxis requiring hemilaminectomy (laminectomy) and direct decompression occurred in three cases (6.5 %). In the patients without neurological deficit, dural sac compression was not recorded. No

  20. Integrated constructed wetland systems: design, operation, and performance of low-cost decentralized wastewater treatment systems.

    Science.gov (United States)

    Behrends, L L; Bailey, E; Jansen, P; Houke, L; Smith, S

    2007-01-01

    Several different types of constructed wetland systems are being used as decentralized treatment systems including surface-flow, subsurface-flow, vertical-flow, and hybrid systems. Archetypical wetland systems have design strengths and weaknesses, and therefore it should be possible to design combined (integrated) systems to optimize a number of important treatment processes. This study provides comparative efficacy data for two integrated wetland treatment systems (IWTS) designed to enhance treatment of medium strength wastewater generated from a pilot-scale intensive fish farm. Results from the twenty eight months study included consistently high removal of COD (84% +) and ammonia nitrogen (93%) in both systems. Initially, phosphorus removal was also high (>90%) in both systems, but removal efficacy declined significantly over time. Nitrate removal was significantly better in the system that provided sequential aerobic and anoxic environments. Short hydraulic retention times coupled with sustained removal of COD and ammonia indicate that the ReCip components could be a least-cost wastewater treatment technology in the decentralized market sector.

  1. [Modified Evans osteotomy for the operative treatment of acquired pes planovalgus].

    Science.gov (United States)

    Zwipp, Hans; Rammelt, Stefan

    2006-06-01

    Restoration of the longitudinal arch of the foot and reorientation of the hindfoot for painful decompensating flatfoot (pes planovalgus) due to posterior tibial tendon dysfunction. Passively correctable, painful pes planovalgus of various etiologies such as stage II flatfoot as graded by Johnson & Strom mostly due to degeneration of the posterior tibial tendon in stage II-III as described by Jahss. Fixed pes planovalgus, osteoporosis of the calcaneus, advanced degenerative arthritis of the subtalar, talonavicular or calcaneocuboid joints. Transverse osteotomy of the anterior process of the calcaneus approximately 1.5 cm proximal of and parallel to the calcaneocuboid joint. Lengthening of the lateral column using the sandwich technique by the interposition of one to two autologous, tricortical bone grafts, which are structured to straighten the hindfoot and to move it toward neutral position. If the technique is performed correctly, the talus and the calcaneus are in alignment. When the talar head is externally rotated and the calcaneus is moved toward varus, this results in axial alignment of the abducted forefoot and straightening of the collapsed longitudinal arch of the foot. Between June 1995 and March 2003, 21 patients with stage II painful pes planovalgus as described by Johnson & Strom underwent a modified Evans osteotomy. In one case an arthrodesis of the first tarsometatarsal joint was carried out, and in four cases a lengthening of the gastrocnemius muscle according to Strayer. A replacement of the insufficient posterior tibial tendon was not necessary in any of the cases. With respect to complications one wound edge necrosis and one nonunion were seen. 15 patients (eleven women, four men, average age 54 years) were followed up for an average of 48 months (12-81 months) postoperatively. The Maryland Foot Score improved significantly from 49.6 points preoperatively to 87.8 points postoperatively (p radiographs were corrected to being close to the

  2. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

    Directory of Open Access Journals (Sweden)

    Moises Cohen

    2004-12-01

    Full Text Available Introduction: Quality of life can be defined as the expression of aconceptual model that tries to represent patient’s perspectivesand his/her level of satisfaction expressed by numbers. Theobjective of this study is to evaluate the parameters of quality oflife of 23 patients who underwent surgery for anterior cruciateligament reconstruction. Methods: We adopted SF-36, a generichealth-related evaluation questionnaire, to obtain informationregarding several aspects of patients’ health conditions, and theLysholm questionnaire, specific to evaluate the symptoms andfunction of the knee. The questionnaires were applied at two stagesof the treatment: pre- and postoperatively (after the rehabilitationprogram. Results: Before surgery, the Lysholm questionnairepresented the following results: excellent in 4% of the cases, goodin 22%, fair in 22%, and poor in 52%. After surgery (Lysholm e SF-36 the correlation level was approximately 44% (p = 0.041.Discussion: The correlation between the Lysholm and the SF-36questionnaires showed the following: the lower the level of pain,the higher the Lysholm score. The high scores presented by theLysholm questionnaire are directly proportional to physical andemotional aspects, and to functional capacity. Conclusion:Analysis of both questionnaires, as well as of their correlation,showed some improvement in patients´ quality of life. We werealso able to demonstrate the importance and usefulness of applyingthe two questionnaires at three different moments: before, duringand after physiotherapeutic intervention.

  3. The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes.

    Science.gov (United States)

    Terzioglu, Fusun; Turk, Rukiye; Yucel, Cigdem; Dilbaz, Serdar; Cinar, Ozgur; Karahalil, Bensu

    2016-06-01

    The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes. This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples' state anxiety scores were re-evaluated after embryo transfer (ET). A significant relationship was found between the depression score of women and pregnancy outcome (p 0.05) and lower depression scores (p positive pregnancy outcome. Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.

  4. Pilot-scale comparison of constructed wetlands operated under high hydraulicloading rates and attached biofilm reactors for domestic wastewater treatment

    DEFF Research Database (Denmark)

    Fountoulakis, M.S.; Terzakis, S.; Chatzinotas, A.

    2009-01-01

    Four different pilot-scale treatment units were constructed to compare the feasibility of treating domestic wastewater in the City of Heraklio, Crete, Greece: (a) a freewater surface (FWS) wetland system, (b) a horizontal subsurface flow (HSF) wetland system, (c) a rotating biological contactor (......-conventional wastewater treatment system depends on the construction and operation cost, the area demand and the required quality of effluent.......Four different pilot-scale treatment units were constructed to compare the feasibility of treating domestic wastewater in the City of Heraklio, Crete, Greece: (a) a freewater surface (FWS) wetland system, (b) a horizontal subsurface flow (HSF) wetland system, (c) a rotating biological contactor...... units) and higher in HSF and RBC (2.3 to 2.6 log units). HSF showed slightly lower but comparable effluent quality to that of RBC and PBF systems, but the construction cost and energy requirements for this system are significantly lower. Overall the final decision for the best non...

  5. MEDICAL SIMULATION IN MASTERING THE OPERATIVE TECHNIQUE FOR TREATMENT OF ECTOPIC PREGNANCY

    Directory of Open Access Journals (Sweden)

    Ye. A. Kolesnikova

    2014-01-01

    Full Text Available The purpose of this study is to introduce a new educational method for gynecologists to master the technique of laparoscopic surgery in case of ectopic pregnancy. This method involves using a computer Simulation Platform “Lap mentor” (Simbionix, USA.Thirty gynecologists, who had no experience of independent performance of laparoscopic gynecological surgery, were randomized into 2 groups of 15 people. Laparoscopic technique in both groups was mastered by performing operations in different clinical variants of ectopic pregnancy on a computer simulator. But doctors from the second group, according to the proposed learning method, also performed additional exercises aimed at developing specific laparoscopic skills (work with the camera, control of one or two instruments, separation of tissue using scissors and endosurgical monopolar electrodes.Comparison of groups at the final tests showed that gynecologists whose training included exercises to develop skills in laparoscopy showed significantly greater success in the performance of control tasks. All surgical techniques doctors performed faster and it took themless time to perform the operation than for their counter parts in the comparison group. Along with this movements of gynecologists from the second group were more precise and accurate, accompanied by a smaller number of vascular and organs injures than in the comparison group.Thus, application of the proposed method of mastering the laparoscopic skills in gynecology, including the performance of special training exercises with virtual operations, can significantly improve the surgical technique of specialists and their professional competence. Skills, obtained using this educational method, are of higher quality compared with the experience gained by simply repeating the operation on a computer simulator.

  6. Modified Latarjet Procedure Without Capsulolabral Repair for the Treatment of Failed Previous Operative Stabilizations in Athletes.

    Science.gov (United States)

    Ranalletta, Maximiliano; Rossi, Luciano A; Bertona, Agustin; Tanoira, Ignacio; Maignon, Gastón D; Bongiovanni, Santiago L

    2018-02-03

    To analyze time to return to sport, functional outcomes, and recurrences of the modified Latarjet procedure without capsulolabral repair in athletes with recurrent anterior shoulder instability after a failed previous operative stabilization. We included athletes with recurrent anterior shoulder instability with a previous failed operative stabilization treated with the modified Latarjet procedure without capsulolabral repair with a minimum of 2-year follow-up. Return to sports, range of motion, the Rowe score, a visual analog scale for pain in sport activity, and the Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Between June 2008 and June 2015, 68 athletes were treated with the modified Latarjet procedure without capsulolabral reconstruction for recurrent shoulder instability after a previous failed stabilization surgery. The mean follow-up was 44 months (range, 24-108 months), and the mean age at the time of operation was 26.8 years (range, 17-35 years). All the patients returned to sports, and 95% returned to the same sport they practiced before the surgery, all to the same level. No significant difference in shoulder range of motion was found between preoperative and postoperative results. The Rowe score, visual analog scale, and Athletic Shoulder Outcome Scoring System showed statistical improvement after operation (P Latarjet without capsulolabral repair produced excellent functional outcomes with most athletes returning to sport at the same level they had before the surgery without recurrences. Level IV, therapeutic, case series study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  7. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  8. Indication for the operative methods in surgical treatment of cervical spondylotic myelopathy

    International Nuclear Information System (INIS)

    Kobayashi, Akira; Inoue, Shunichi; Watabe, Tsuneo; Nagase, Joji; Harada, Yoshitada

    1984-01-01

    Indication for the operative methods for cervical spondylotic myelopathy was examined in 16 patients undergoing CT-myelography before and after operation. There was a highly significant correlation between the anteroposterior (A-P) diameter of the spinal cord and clinical symptoms. Patients with shorter A-P diameter of the spinal cord tended to have severer preoperative clinical symptoms. Clinical symptoms improved as the post operative A-P diameter of the spinal cord increased. Fixation with decompression of the anterior spinal cord should be indicated when constriction of 5 mm or less of the spinal cord is seen segmentally at the level of the intervertebral disc. Dilation of the spinal cavity should be indicated when the constriction of the spinal cord is 5 mm or less at all levels of the cervical spinal cord. In performing fixation with anterior decompression, 15 mm is considered to be the most suitable width for complete and safe decompression of the flattened spinal cord with a wide transverse diameter. (Namekawa, K)

  9. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis.

    Science.gov (United States)

    Chen, Bing-Lin; Guo, Jia-Bao; Zhang, Hong-Wei; Zhang, Ya-Jun; Zhu, Yi; Zhang, Juan; Hu, Hao-Yu; Zheng, Yi-Li; Wang, Xue-Qiang

    2018-02-01

    To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation. PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017. Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval. A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference = -0.94, 95% confidence interval = -1.87 to -0.00; midterm: mean difference = -1.59, 95% confidence interval = -2.24 to -9.94), improving function (midterm: mean difference = -7.84, 95% confidence interval = -14.00 to -1.68; long term: mean difference = -12.21, 95% confidence interval = -23.90 to -0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference = 6.25, 95% confidence interval = 0.43 to 12.08) and bodily pain (short term: mean difference = 5.42, 95% confidence interval = 0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference = 0.82, 95% confidence interval = 0.28 to 2.38). Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

  10. Stormwater Treatment Evaluation of a Constructed Floating Wetland after Two Years Operation in an Urban Catchment

    Directory of Open Access Journals (Sweden)

    Christopher Walker

    2017-09-01

    Full Text Available Constructed Floating Wetlands (CFW for stormwater treatment are increasingly used to treat urban runoff. However, studies of large-scale systems and the long-term evaluation of their treatment efficiency are scarce. This article presents the final results of a two-year study of the pollutant removal performance of a CFW in a stormwater pond capturing runoff from a low-residential catchment in South-East Queensland (Australia under subtropical conditions. Although the CFW treatment area to catchment ratio was only 0.14%, the results demonstrated a significant removal of both Total Suspended Solids (TSS and Total Phosphorus (TP from the stormwater inflows by the CFW. The efficiency ratios for TSS and TP were 81% and 52%, respectively. While the removal rate for total nitrogen was not significant for the CFW evaluated in this study, the ER was still 17%. However, the ERs for nitrate and nitrogen oxide were both 47%. The study results suggest that it may be possible to increase the pollution removal performance of the CFW by upsizing the system and including intermittent re-aeration zones in the surrounding stormwater pond. The results of this research study clearly demonstrate that CFW can be an effective treatment solution for the removal of pollution from urban stormwater runoff.

  11. Aspects of tuberculosis and HIV diagnosis, care and treatment in Rwandan health facilities: operational studies

    NARCIS (Netherlands)

    Kayigamba, R.F.

    2014-01-01

    This thesis outlines studies that were conducted between 2006 and 2010 in Rwandan clinical and public health settings to respond to some unresolved research priority questions. It describes and analyses sputum completion and conversion rates at two months of treatment and their determinants. It

  12. Operation of Wastewater Treatment Plants: A Field Study Training Program. Volume I, Instructor's Guide. Second Edition.

    Science.gov (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The objective of this instructor's guide is to help provide students with knowledge and skills for employment in the field of wastewater treatment. Included in each chapter outline are: (1) objectives, (2) instructional approach, (3) answers to the objective test in the student's text, and (4) an explanation of these answers. The material…

  13. Operation of Wastewater Treatment Plants: A Field Study Training Program. Volume III, Instructor's Guide. Second Edition.

    Science.gov (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The objective of this instructor's guide is to help provide students with knowledge and skills for employment in the field of wastewater treatment. Included in each chapter outline are: (1) objectives, (2) instructional approach, (3) answers to the objective test in the student's text, and (4) an explanation of these answers. The material…

  14. A Course on Operational Considerations in Wastewater Treatment Plant Design. Student Manual.

    Science.gov (United States)

    Stottler, Stag and Associates, San Antonio, TX.

    This manual was designed to furnish information for upgrading the design of wastewater treatment plant facilities and to serve as a resource for establishing criteria for upgrading these plants. The manual also furnishes information for modifying plant design to compensate for current organic and hydraulic overloads and/or to meet more stringent…

  15. Operation of Wastewater Treatment Plants: A Field Study Training Program. Volume II, Instructor's Guide. Second Edition.

    Science.gov (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The objective of this instructor's guide is to help provide students with knowledge and skills for employment in the field of wastewater treatment. Included in each chapter outline are: (1) objectives, (2) instructional approach, (3) answers to the objective test in the student's text, and (4) an explanation of these answers. The material…

  16. New approach to solar photo-Fenton operation. Raceway ponds as tertiary treatment technology

    Energy Technology Data Exchange (ETDEWEB)

    Carra, Irene; Santos-Juanes, Lucas [Department of Chemical Engineering, University of Almería, 04120, Almería (Spain); CIESOL, Joint Centre of the University of Almería-CIEMAT, 04120, Almería (Spain); Acién Fernández, Francisco Gabriel [Department of Chemical Engineering, University of Almería, 04120, Almería (Spain); Malato, Sixto [CIESOL, Joint Centre of the University of Almería-CIEMAT, 04120, Almería (Spain); Plataforma Solar de Almería (CIEMAT), 04200, Tabernas, Almería (Spain); Sánchez Pérez, José Antonio, E-mail: jsanchez@ual.es [Department of Chemical Engineering, University of Almería, 04120, Almería (Spain); CIESOL, Joint Centre of the University of Almería-CIEMAT, 04120, Almería (Spain)

    2014-08-30

    Graphical abstract: - Highlights: • Raceway ponds are used for the first time as photo-Fenton reactors. • Raceway ponds are effective and have high treatment capacity (48 mg/h m{sup 2} for 360 L). • The highest treatment capacity occurs with 5.5 mg Fe/L and 15 cm liquid depth. • Low iron concentrations are enough to oxidise the pesticide mixture. • Raceway ponds are a simple and low-cost alternative for micropollutant removal. - Abstract: The photo-Fenton process has proven its efficiency in the removal of micropollutants. However, the high costs usually associated with it prevent a spread of this technology. An important factor affecting costs is the kind of photoreactor used, usually tubular with a reflecting surface. Tubular reactors like compound parabolic collectors, CPCs, involve high capital costs. In comparison, the application of less costly reactors such as the extensive raceway ponds (RPRs) would help to spread the use of the photo-Fenton process as tertiary treatment at commercial scale. As far as the authors know, RPRs have never been used in advanced oxidation processes (AOPs) applications. This work is aimed at studying the applicability of RPRs to remove micropollutants with solar photo-Fenton. For this purpose, a pesticide mixture of commercial acetamiprid (ACTM) and thiabendazole (TBZ) (100 μg/L each) was used in simulated secondary effluent. Iron concentration (1, 5.5 and 10 mg/L) and liquid depth (5, 10 and 15 cm) were studied as process variables. TBZ was removed at the beginning of the treatment (less than 5 min), although ACTM removal times were longer (20–40 min for the highest iron concentrations). High treatment capacity per surface area was obtained (48 mg/h m{sup 2} with 5.5 mg Fe/L and 15 cm liquid depth), proving the feasibility of using RPRs for micropollutant removal.

  17. Novel Anaerobic Wastewater Treatment System for Energy Generation at Forward Operating Bases

    Science.gov (United States)

    2016-08-01

    Treated Water Clinoptilolite IX ERDC/CERL TR-16-13 4 reactor design, they can be made highly efficient in terms of physical foot- print and operational...clear that the flow was only exiting the reactor through the membrane (Figure 3d ). ERDC/CERL TR-16-13 11 Figure 3. Tracer testing to confirm water...The proprietary bi- oculture was provided by Phylein Inc, and consisted of a 1:1:1 VS mixture of citrus-, hog manure-, and cellulosic -based

  18. A New Treatment for Some Periodic Schrödinger Operators I: The Eigenvalue

    Science.gov (United States)

    He, Wei

    2018-02-01

    We study the problem of how the Floquet property manifests for periodic Schrödinger operators, which are known to have multiple of asymptotic spectral solutions. The main conclusions are made for elliptic potentials, we demonstrate that for each period of the elliptic function there is a relation about the Floquet exponent and the monodromy of wave function. Among them there are two relations not explained by the classical Floquwet theory. These relations produce both old and new asymptotic solutions consistent with results already known. Supported by the FAPESP No. 2011/21812-8, through IFT-UNESP

  19. Impact of full-field digital mammography on pre-operative diagnosis and surgical treatment of mammographic microcalcification.

    Science.gov (United States)

    Bundred, S M; Zhou, J; Whiteside, S; Morris, J; Wilson, M; Hurley, E; Bundred, N

    2014-01-01

    Accurate pre-operative diagnosis of impalpable breast lesions correlates closely with the number of surgical procedures required for treatment. Correct diagnosis of mammographic microcalcification (MM) as ductal carcinoma in situ (DCIS) or invasive breast cancer is important because lesions upgraded to malignant diagnosis at surgery require repeat surgical procedures in 44 % of cases. Despite correct pre-operative diagnosis of MM, 26 % require second therapeutic operations to achieve surgical clearance. Theoretically, improved conspicuity of malignant MM using digital mammography could improve diagnostic work-up and improve surgical outcomes for MM. To determine the impact of full-field digital mammography (FFDM) on the diagnostic accuracy and positive predictive value (PPV) of biopsy of MM and surgical management of MM, screening and symptomatic cases with MM (n = 1,479) were reviewed for women imaged between August 2007 and March 2010 using screen-film mammography (SFM) (n = 711), and using FFDM, imaged between April 2010 to March 2012 (n = 768). Demographic information including pre and postoperative diagnosis, and number and types of surgical procedures were recorded. Overall, 302 (128 invasive) and 251 (110 invasive) malignant lesions were diagnosed using SFM and FFDM, respectively. Reduction in PPV of biopsy was observed (SFM 42.5 %; FFDM 32.7 %, p cancers over two centimetres. This will increase concerns about treatment of lesions detected in the screening programme with widespread use of digital mammography.

  20. Treatment of automotive industry oily wastewater by electrocoagulation: statistical optimization of the operational parameters.

    Science.gov (United States)

    GilPavas, Edison; Molina-Tirado, Kevin; Gómez-García, Miguel Angel

    2009-01-01

    An electrocoagulation process was used for the treatment of oily wastewater generated from an automotive industry in Medellín (Colombia). An electrochemical cell consisting of four parallel electrodes (Fe and Al) in bipolar configuration was implemented. A multifactorial experimental design was used for evaluating the influence of several parameters including: type and arrangement of electrodes, pH, and current density. Oil and grease removal was defined as the response variable for the statistical analysis. Additionally, the BOD(5), COD, and TOC were monitored during the treatment process. According to the results, at the optimum parameter values (current density = 4.3 mA/cm(2), distance between electrodes = 1.5 cm, Fe as anode, and pH = 12) it was possible to reach a c.a. 95% oils removal, COD and mineralization of 87.4% and 70.6%, respectively. A final biodegradability (BOD(5)/COD) of 0.54 was reached.

  1. A Self Sustaining Solar-Bio-Nano Based Wastewater Treatment System for Forward Operating Bases

    Science.gov (United States)

    2017-06-21

    convert solar energy into high-quality thermal energy that is combined with biogas energy to efficiently and stably provide the required energy and...outcomes of this project clearly demonstrated a self-sustaining system that is not only a waste management tool but also an on-site renewable energy ...generation unit. Essentially, the technology developed by this project will advance military bases for their waste treatment and energy utilization

  2. Electro-peroxone treatment of the antidepressant venlafaxine: Operational parameters and mechanism.

    Science.gov (United States)

    Li, Xiang; Wang, Yujue; Zhao, Jian; Wang, Huijiao; Wang, Bin; Huang, Jun; Deng, Shubo; Yu, Gang

    2015-12-30

    Degradation of the antidepressant venlafaxine by a novel electrocatalytic ozonation process, electro-peroxone (E-peroxone), was studied. The E-peroxone treatment involves sparging ozone generator effluent (O2 and O3 gas mixture) into an electrolysis reactor that is equipped with a carbon-polytetrafluoroethylene cathode to electrocatalytically transform O2 in the bubbled gas to H2O2. The in-situ generate H2O2 then reacts with the bubbled O3 to yield OH, which can non-selectively degrade organic compounds rapidly in the solution. Thanks to the significant OH production, the E-peroxone treatment greatly enhanced both venlafaxine degradation and total organic carbon (TOC) removal as compared to ozonation and electrolysis alone. Under optimal reaction conditions, complete venlafaxine degradation and TOC elimination could be achieved within 3 and 120 min of E-peroxone process, respectively. Based on the by-products (e.g., hydroxylated venlafaxine, phenolics, and carboxylic acids) identified by UPLC-UV and UPLC/Q-TOF-mass spectrometry, plausible reaction pathways were proposed for venlafaxine mineralization by the E-peroxone process. The results of this study suggest that the E-peroxone treatment may provide a promising way to treat venlafaxine contaminated water. Copyright © 2015. Published by Elsevier B.V.

  3. Peri-operative antibiotic treatment of bacteriuria reduces early deep surgical site infections in geriatric patients with proximal femur fracture.

    Science.gov (United States)

    Langenhan, Ronny; Bushuven, Stefanie; Reimers, Niklas; Probst, Axel

    2018-04-01

    The aim of this study was to conduct a re-evaluation of current strategies for peri-operative prophylaxis of infections in orthopaedic surgery of geriatric patients (≥65 years) with proximal femoral fractures (PFF). Between 01/2010 and 08/2014 all post-operative infections after stabilization of PFF of 1,089 geriatric patients were recorded retrospectively. All patients pre-operatively received a single dose of 1.5 g cefuroxime (group 1). These were compared to prospectively determined post-operative rates of surgical site infection (SSI) of 441 geriatric patients, which were operated on between 09/2014 and 03/2017 due to PFF. In this second group we investigated the urinary tract on admission. Bacteriuria was treated with the pre-operative single dose of 1.5 g cefuroxime along with ciprofloxacin for five days, beginning on admission. Level of significance was set to p infection. Multi-resistant pathogens were found in 15 patients and pathogens were cefuroxime-resistant in 37. The differences of SSI after at least three months were 2.1% in group 1 and 0.45% in group 2 for all patients with surgery of PFF (p < 0.02) and for those with arthroplasty (p < 0.037) significant. The immediate antibiotic therapy of a prevalent bacteriuria for five days decreases the risk of SSI after surgery of PFF. Our single-centre study can only point out the problem of prevalent reservoirs of pathogens and the need for treatment. Evidence-based therapy concepts (indications of antibiotics, classes, duration) have to be developed in multi-centric and prospective studies.

  4. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Thomaidis, Tryfon; Charitoudis, Georgios; Kazakos, Konstantinos

    2017-01-01

    Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. 2. TPED for LDH does not present major differences in the improvement of quality of life regarding gender.

  5. [Mini-invasive technologies in treatment of acute cholecystitis in patients with high operational and anesthetic risk].

    Science.gov (United States)

    Ermolov, A S; Guliaev, A A; Ivanov, P A; Samsonov, V T; Rogal', M L; Timerbaev, V Kh; Trofimova, E Iu; Kudriashova, N E; Tlibekova, M A

    2014-01-01

    The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

  6. Intra-operative radiation therapy for malignant brain tumours: rationale, method, and treatment results of cerebral glioblastomas

    International Nuclear Information System (INIS)

    Matsutani, M.; Nakamura, O.; Nagashima, T.

    1994-01-01

    In radiation therapy for malignant brain tumours, the dose of radiation that can be safely delivered to a tumour is limited by the radiation tolerance of the adjacent normal brain tissue. Among various radiation modalities to produce local tumour eradication without unacceptable complications, we chose a large, single irradiation dose during the operation (intra-operative radiation therapy, IORT). In contrast to X-ray or Cobalt-60 gamma ray irradiation, IORT with a high-energy electron beam delivered by the Shimadzu 20 MeV betatron provides acceptable dose homogeneity with rapid fall-off of the radiation dose beyond the treatment volume. Thus, IORT has the advantage of precise demarcation of the target volume, minimum damage to surrounding normal tissues, and a high absorbed target dose (15-25 Gy in 5-10 min). On the basis of our experience with 170 patients treated by IORT, we established the treatment indications and method in patients with malignant brain tumours. IORT with a dose of 15-25 Gy was delivered to widely resected tumours followed by external radiation therapy. No acute or subacute complications were observed. Treatment results of 30 patients with glioblastoma treated by IORT (mean 18.3 Gy) combined with external radiation therapy (mean 58.5 Gy) resulted in a median survival of 119 weeks and a 2-year survival rate of 61 %. (authors)

  7. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    BACKGROUND AND PURPOSE: Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding...... length of stay (LOS) and patient satisfaction. PATIENTS AND METHODS: In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient...... comorbidity, or LOS. THR patients had shorter mean LOS than TKR patients, even though the median LOS was 2 days for both groups. THR patients were more satisfied than TKR patients in the first weeks after discharge. INTERPRETATION: Patient satisfaction is high following fast-track THR and TKR, with scores...

  8. Operative treatment with nerve repair can restore function in patients with traction injuries in the brachial plexus

    DEFF Research Database (Denmark)

    Stiasny, Jerzy; Birkeland, Peter

    2015-01-01

    surgical activity and reflect on the role for this new national centre. METHODS: Records from all our operated patients were reviewed retrospectively. For outcome analysis, we focused on patients who had sustained traction injuries with a surgical follow-up exceeding one year. We used either nerve grafting...... or transfers for nerve repairs based on the pattern of nerve injury seen intraoperatively. RESULTS: Overall, 24 patients were operated, and 12 patients were included in the outcome analysis. The six patients with upper brachial plexus palsies all regained shoulder function and useful elbow flexion. Of the six...... in patients with complete brachial plexus palsies. Our data suggest that nerve transfers may result in a better functional outcome than nerve grafting. We believe that there is a role for a Danish centre for the treatment of these injuries. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  9. Plant-wide modelling of phosphorus transformations in wastewater treatment systems: Impacts of control and operational strategies

    DEFF Research Database (Denmark)

    Solon, Kimberly; Flores Alsina, Xavier; Kazadi Mbamba, C

    2017-01-01

    The objective of this paper is to report the effects that control/operational strategies may have on plant-wide phosphorus (P) transformations in wastewater treatment plants (WWTP). The development of a new set of biological (activated sludge, anaerobic digestion), physico-chemical (aqueous phase......, precipitation, mass transfer) process models and model interfaces (between water and sludge line) were required to describe the required tri-phasic (gas, liquid, solid) compound transformations and the close interlinks between the P and the sulfur (S) and iron (Fe) cycles. A modified version of the Benchmark...... Simulation Model No. 2 (BSM2) (open loop) is used as test platform upon which three different operational alternatives (A1, A2, A3) are evaluated. Rigorous sensor and actuator models are also included in order to reproduce realistic control actions. Model-based analysis shows that the combination...

  10. Electro-peroxone treatment of the antidepressant venlafaxine: Operational parameters and mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Li, Xiang; Wang, Yujue; Zhao, Jian; Wang, Huijiao; Wang, Bin; Huang, Jun; Deng, Shubo; Yu, Gang, E-mail: yg-den@mail.tsinghua.edu.cn

    2015-12-30

    Highlights: • E-peroxone is a novel electrocatalytic ozonation process that couples ozonation with electrolysis to enhance pollutant decay. • Carbon-based cathodes are used to electrocatalytically produce H{sub 2}O{sub 2} from O{sub 2} in sparged O{sub 2} and O{sub 3} mixture. • The in-situ generated H{sub 2}O{sub 2} reacts with O{sub 3} to yield ·OH for pollutant mineralization. • Venlafaxine is mineralized much faster by E-peroxone than by ozonation and electrolysis. - Abstract: Degradation of the antidepressant venlafaxine by a novel electrocatalytic ozonation process, electro-peroxone (E-peroxone), was studied. The E-peroxone treatment involves sparging ozone generator effluent (O{sub 2} and O{sub 3} gas mixture) into an electrolysis reactor that is equipped with a carbon-polytetrafluoroethylene cathode to electrocatalytically transform O{sub 2} in the bubbled gas to H{sub 2}O{sub 2}. The in-situ generate H{sub 2}O{sub 2} then reacts with the bubbled O{sub 3} to yield ·OH, which can non-selectively degrade organic compounds rapidly in the solution. Thanks to the significant ·OH production, the E-peroxone treatment greatly enhanced both venlafaxine degradation and total organic carbon (TOC) removal as compared to ozonation and electrolysis alone. Under optimal reaction conditions, complete venlafaxine degradation and TOC elimination could be achieved within 3 and 120 min of E-peroxone process, respectively. Based on the by-products (e.g., hydroxylated venlafaxine, phenolics, and carboxylic acids) identified by UPLC–UV and UPLC/Q-TOF-mass spectrometry, plausible reaction pathways were proposed for venlafaxine mineralization by the E-peroxone process. The results of this study suggest that the E-peroxone treatment may provide a promising way to treat venlafaxine contaminated water.

  11. Electro-peroxone treatment of the antidepressant venlafaxine: Operational parameters and mechanism

    International Nuclear Information System (INIS)

    Li, Xiang; Wang, Yujue; Zhao, Jian; Wang, Huijiao; Wang, Bin; Huang, Jun; Deng, Shubo; Yu, Gang

    2015-01-01

    Highlights: • E-peroxone is a novel electrocatalytic ozonation process that couples ozonation with electrolysis to enhance pollutant decay. • Carbon-based cathodes are used to electrocatalytically produce H 2 O 2 from O 2 in sparged O 2 and O 3 mixture. • The in-situ generated H 2 O 2 reacts with O 3 to yield ·OH for pollutant mineralization. • Venlafaxine is mineralized much faster by E-peroxone than by ozonation and electrolysis. - Abstract: Degradation of the antidepressant venlafaxine by a novel electrocatalytic ozonation process, electro-peroxone (E-peroxone), was studied. The E-peroxone treatment involves sparging ozone generator effluent (O 2 and O 3 gas mixture) into an electrolysis reactor that is equipped with a carbon-polytetrafluoroethylene cathode to electrocatalytically transform O 2 in the bubbled gas to H 2 O 2 . The in-situ generate H 2 O 2 then reacts with the bubbled O 3 to yield ·OH, which can non-selectively degrade organic compounds rapidly in the solution. Thanks to the significant ·OH production, the E-peroxone treatment greatly enhanced both venlafaxine degradation and total organic carbon (TOC) removal as compared to ozonation and electrolysis alone. Under optimal reaction conditions, complete venlafaxine degradation and TOC elimination could be achieved within 3 and 120 min of E-peroxone process, respectively. Based on the by-products (e.g., hydroxylated venlafaxine, phenolics, and carboxylic acids) identified by UPLC–UV and UPLC/Q-TOF-mass spectrometry, plausible reaction pathways were proposed for venlafaxine mineralization by the E-peroxone process. The results of this study suggest that the E-peroxone treatment may provide a promising way to treat venlafaxine contaminated water.

  12. Transformation and fate of natural estrogens and their conjugates in wastewater treatment plants: Influence of operational parameters and removal pathways.

    Science.gov (United States)

    Ben, Weiwei; Zhu, Bing; Yuan, Xiangjuan; Zhang, Yu; Yang, Min; Qiang, Zhimin

    2017-11-01

    Natural estrogens (NEs) discharged from wastewater treatment plants (WWTPs) have drawn great attention because of their potential risks to aquatic ecosystems. However, neglect of the conjugated natural estrogens (C-NEs) has caused large discrepancies among different studies on the removal of NEs in WWTPs. The present work investigated the transformation and fate of three NEs and six corresponding C-NEs along wastewater treatment processes. The removal efficiencies of the target estrogens (i.e., NEs and C-NEs) and their correlations with the operational parameters were determined over a twelve-month monitoring period at a typical WWTP adopting a combined bio-treatment process (i.e., anaerobic/anoxic/oxic process followed by a moving-bed biofilm reactor). The concentration variations of the target estrogens along the treatment processes were examined to differentiate the transformation and fate of NEs and C-NEs. Moreover, lab-scale experiments were conducted to clarify the removal pathways of C-NEs in the bio-treatment process. Results indicate that both NEs and C-NEs could pass through the treatment processes, thus being frequently detected in the effluent and excess sludge. The aqueous removal efficiencies of NEs and C-NEs were significantly correlated with the sludge retention time and temperature, respectively. C-NEs were more persistent than NEs, so considerably high conjugated ratios (13.5-100.0%) were detected in the effluent. Sulfate conjugates presented a lower adsorption affinity to sludge and a slower hydrolysis rate than glucuronide conjugates, which makes the former more recalcitrant to biodegradation. This study highlights the challenge on the elimination of NEs, particularly their conjugates, by wastewater treatment processes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Stomal construction: Technical tricks for difficult situations, prevention and treatment of post-operative complications.

    Science.gov (United States)

    Sabbagh, C; Rebibo, L; Hariz, H; Regimbeau, J M

    2018-02-21

    The creation of a digestive stoma, whether it is a lateral stoma or a terminal stoma, is an essential gesture in colorectal surgery, but that may result in post-operative complications in 35% of patients. Surgeons are aware of the situations at the origin of complications, although there is little factual data in the literature to discriminate them. They are related to patient-specific factors (obesity, cirrhosis, portal hypertension) or to the underlying pathology (colon obstruction) or the conditions under which the intervention is performed (emergency). The aim of this review is to describe these different situations and the data from the literature that may allow reduction of the risk of an unsatisfactory or even complicated stoma. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Two years of the operation of a domestic MBR wastewater treatment plant

    Science.gov (United States)

    Pikorová, Tina

    2012-06-01

    The paper evaluates the results of data obtained from two years of observing an actual domestic wastewater treatment plant (WWTP) with an immersed membrane module. The domestic MBR (membrane bioreactor) WWTP was linked to a dwelling with four residents. Two different commercial flat sheet membrane modules were investigated. The membrane modules, as well as the whole WWTP, were tested with different fluxes as well as the response of the membrane and activated sludge to different conditions, such as actual peak wastewater flows, extremes temperatures (a winter below 5 °C), and high pH values.

  15. Psychological barriers in long term non-operative treatment of retroperitoneal hematoma

    Directory of Open Access Journals (Sweden)

    Bogdan Socea

    2015-04-01

    Full Text Available The retroperitoneal hematoma can have, mainly, a traumatic etiology - blunt abdominal trauma (falls from height, road accidents, aggression of any kind, etc., or open (incised wounds, puncture, penetration or gunshot wounds. Ruptured arterial aneurysms can cause hemorrhage in the retroperitoneal space. There is also spontaneous retroperitoneal trauma in patients with chronic treatment with anticoagulant or antiaggregant drugs (1. Hemorrhage in the retroperitoneal space can be iatrogenic, after surgical, open or laparoscopic, interventions (2, 3. A particular type of retroperitoneal hematoma is the psoas muscle hematoma in patients with chronic oral anticoagulant treatment (Acenocumarol, Warfarin. The management of the retroperitoneal hematoma, whatever the cause may be, is, for most of the time, difficult. In case of traumatic etiology, the retroperitoneal hematoma is not the only lesion, being frequently associated with severe hollow or parenchymal organs injury or vascular lesions, which highlights the importance of a complete and precise clinical inventory of the lesions. The decision between an aggressive, surgical or interventional attitude and a conservative one, with monitoring, is often taken under pressure. Especially difficult are the cases in which the imaging results of the lesions is uncertain, when the patient presents hemodynamic instability, when other lesions can not be excluded, or when the parietal peritoneum is ruptured and the retroperitoneal hematoma gets into the peritoneal cavity, the patient presenting haemoperitoneum. For most of the time, these cases have indication for exploratory laparotomy, for a diagnostic, not therapeutic, goal.

  16. Comparing efficacy of preemptively used dexketoprofen and tramadol for postoperative pain in patients underwent laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Süreyya Özkan

    2015-03-01

    Full Text Available Objective: In our study, we aimed to compare effects of preoperative dexketoprofen and tramadol administered by intravenous route on intraoperative and postoperative analgesic consumption, postoperative pain, durations of hospital stay and patient satisfaction in patients, undergoing laparoscopic cholecystectomy. Methods:After approval of ethic committee and written consent of patients were obtained, 60 patients between 18-70 years old with ASA I-II were included in the study. After routine monitorization and 20 minutes before induction of anesthesia, dexketoprofen 50 mg in 100 cc 0.9% NaCl was administered in Dexketoprofen Group and tramadol 100 mg in 100 cc 0.9% NaCl in Tramadol Group as intravenous infusion during 20 minutes. Intraoperative hemodynamic parameters, analgesic-anesthetic consumptions and complications of patients, on whom standard general anesthesia was applied, were recorded. Pain severity, degree of sedation, morphine consumptions and hemodynamic parameters were recorded at postoperative 30 th minute, and 4 th, 8th, 12th and 24 th hours. Additional analgesia requirement, times for requiring first analgesia, duration of hospital stay, postoperative complications and patient satisfactions were recorded. Results: Intraoperative analgesic-anesthetic consumptions, postoperative visual analogue scale (VAS scores, sedation degrees, intravenous patient controlled analgesia (PCA and morphine consumptions, times for requiring first analgesic, durations of hospital stay, intraoperative-postoperative complications developed and patient satisfactions were similar in both groups. Consequently, postoperative analgesic efficacy of pre-emptive dexketoprofen intravenous 50 mg and tramadol intravenous 100 mg administered was found to be similar in cases, who had laparoscopic cholecystectomy operation. Conclusion:Because VAS scores were low in our patients, morphine consumptions with intravenous PCA were similar in both groups, and there wasn

  17. Non-operative treatment of neglected bilateral posterior four-part fracture- dislocation of the shoulders--a case report.

    Science.gov (United States)

    Ifesanya, A O; Ogundele, O J; Anejukwo, A A

    2015-09-01

    Bilateral posterior dislocation of the shoulders is rare and may result from a seizure. A 48 year-old HIV-positive man who presented eight weeks after bilateral posterior shoulder dislocation and bilateral fractures of the surgical necks of both humeri is reviewed. He was treated with an algesics and physiotherapy and was able to return to work after 9 months. The rarity of this lesion, its late presentation, the importance of a high index of suspicion in making the diagnosis and the fair outcome of non-operative treatment informed this report.

  18. The role of the Fontan operation in the treatment of congenitally corrected transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    Tom R Karl

    2011-01-01

    Full Text Available Congenitally corrected transposition of the great arteries (ccTGA is a complex cardiac anomaly with an unfavorable natural history. Surgical treatment has been available for over 50 years. Initial procedures used for ccTGA did not correct atrio-ventricular discordance, leaving the right ventricle in systemic position. In the past two decades anatomic repair has been considered to be a better option. Many cases subjected to anatomic repairs would also be suitable for the Fontan strategy, which probably has a lower initial risk. The rationale for use of the Fontan operation in management of congenitally corrected transposition is discussed in this review, with comparisons to other strategies.

  19. Long-term results after operative treatment of osteochondritis dissecans of the knee joint—30 year results

    OpenAIRE

    Michael, J. W.P.; Wurth, A.; Eysel, P.; König, D. P.

    2007-01-01

    Osteochondritis dissecans (OD) mostly appears at the knee joint on the weight-bearing part of the medial femoral condyle. A multi-factorial event is most likely responsible for the triggering of OD. The aim of this retrospective study was to carry out long-term assessment of the results of operative treatment. Between 1959 and 1976, 148 patients were treated for OD by an open technique. For this purpose, a total number of 38 patients were analysed after approximately 30 years. Twenty-six pati...

  20. LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE, IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT, HANFORD SITE

    International Nuclear Information System (INIS)

    BYRNES ME

    2008-01-01

    This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU

  1. Design, construction and operation of a new filter approach for treatment of surface waters in Southeast Asia

    Science.gov (United States)

    Frankel, R. J.

    1981-05-01

    A simple, inexpensive, and efficient method of water treatment for rural communities in Southeast Asia was developed using local materials as filter media. The filter utilizes coconut fiber and burnt rice husks in a two-stage filtering process designed as a gravityfed system without the need for backwashing, and eliminates in most cases the need of any chemicals. The first-stage filter with coconut fiber acts essentially as a substitute for the coagulation and sedimentation phases of conventional water-treatment plants. The second-stage filter, using burnt rice husks, is similar to slow sand filtration with the additional benefits of taste, color and odor removals through the absorption properties of the activated carbon in the medium. This paper reports on the design, construction costs, and operating results of several village size units in Thailand and in the Philippines.

  2. LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    BYRNES ME

    2008-06-05

    This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU.

  3. General design, construction, and operation guidelines: Constructed wetlands wastewater treatment systems for small users including individual residences. Second edition

    Energy Technology Data Exchange (ETDEWEB)

    Steiner, G.R.; Watson, J.T.

    1993-05-01

    One of the Tennessee Valley Authority`s (TVA`s) major goals is cleanup and protection of the waters of the Tennessee River system. Although great strides have been made, point source and nonpoint source pollution still affect the surface water and groundwater quality in the Tennessee Valley and nationally. Causes of this pollution are poorly operating wastewater treatment systems or the lack of them. Practical solutions are needed, and there is great interest and desire to abate water pollution with effective, simple, reliable and affordable wastewater treatment processes. In recognition of this need, TVA began demonstration of the constructed wetlands technology in 1986 as an alternative to conventional, mechanical processes, especially for small communities. Constructed wetlands can be downsized from municipal systems to small systems, such as for schools, camps and even individual homes.

  4. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Directory of Open Access Journals (Sweden)

    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  5. Periodical assessment of genitourinary and gastrointestinal toxicity in patients who underwent prostate low-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Nobumichi; Asakawa, Isao; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2013-01-01

    To compare the periodical incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicity in patients who underwent prostate low-dose-rate brachytherapy between the monotherapy group (seed implantation alone) and the boost group (in combination with external beam radiation therapy (EBRT)). A total of 218 patients with a median follow-up of 42.5 months were enrolled. The patients were divided into 2 groups by treatment modality, namely, the monotherapy group (155 patients) and the boost group (63 patients). The periodical incidence rates of GU and GI toxicity were separately evaluated and compared between the monotherapy group and the boost group using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. To elucidate an independent factor among clinical and postdosimetric parameters to predict grade 2 or higher GU and GI toxicity in the acute and late phases, univariate and multivariate logistic regression analyses were carried out. Of all patients, 78.0% showed acute GU toxicity, and 7.8% showed acute GI toxicity, while 63.8% showed late GU toxicity, and 21.1% showed late GI toxicity. The incidence rates of late GU and GI toxicity were significantly higher in the boost group. Multivariate analysis showed that the International Prostate Symptom Score (IPSS) before seed implantation was a significant parameter to predict acute GU toxicity, while there were no significant predictive parameters for acute GI toxicity. On the other hand, combination with EBRT was a significant predictive parameter for late GU toxicity, and rectal volume (mL) receiving 100% of the prescribed dose (R100) was a significant predictive parameter for late GI toxicity. The boost group showed higher incidence rates of both GU and GI toxicity. Higher IPSS before seed implantation, combination with EBRT and a higher R100 were significant predictors for acute GU, late GU and late GI toxicity

  6. Digital video image processing from dental operating microscope in endodontic treatment.

    Science.gov (United States)

    Suehara, Masataka; Nakagawa, Kan-Ichi; Aida, Natsuko; Ushikubo, Toshihiro; Morinaga, Kazuki

    2012-01-01

    Recently, optical microscopes have been used in endodontic treatment, as they offer advantages in terms of magnification, illumination, and documentation. Documentation is particularly important in presenting images to patients, and can take the form of both still images and motion video. Although high-quality still images can be obtained using a 35-mm film or CCD camera, the quality of still images produced by a video camera is significantly lower. The purpose of this study was to determine the potential of RegiStax in obtaining high-quality still images from a continuous video stream from an optical microscope. Video was captured continuously and sections with the highest luminosity chosen for frame alignment and stacking using the RegiStax program. The resulting stacked images were subjected to wavelet transformation. The results indicate that high-quality images with a large depth of field could be obtained using this method.

  7. Non-Operative Treatment Versus Steroid Injections in the Management of Unicameral Bone Cysts

    Directory of Open Access Journals (Sweden)

    WI Faisham

    2011-07-01

    Full Text Available The cases of nine patients with unicameral bone cysts were reviewed from two orthopaedic centres. In one hospital, five patients received serial steroid injections, and at the other hospital four patients were treated conservatively following fractures. In the steroid injection group, three cases were in the proximal femur and two in the proximal humerus. The five steroid injection patients showed radiological evidence of cyst healing within six months of treatment. Subsequently four of the patients showed a satisfactory radiological outcome after a year and complete resolution after 2 years. In the conservative group, all four cases were in the proximal humerus. Persistent cystic lesions were observed in all four patients and two was complicated by another fracture within six months.

  8. The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

    Directory of Open Access Journals (Sweden)

    Onder Kara

    2017-01-01

    Full Text Available Aim: To evaluate the role of hyperbaric oxygen therapy (HBO2T with buccal mucosal tube urethroplasty in adult patients with hypospadias. Material and Method: Sixteen adult patients with hypospadias were included in our study. Patients with a short urethra and penile curvature were treated in two stages (orthoplasty buccal mucosal tube urethroplasty. Buccal mucosa was taken and prepared for tube urethroplasty around a 16 French (Fr nelaton catheter and the urethral tube was introduced between the urethral meatus and glans penis. Beginning the 1st postoperative day (HBO2T was applied for 10 sessions during weekdays in 13 patients. Results: The mean age was 21 (±1.23 years and mean follow-up time was 10.1 (±2.1 months. In the group who received HBO2T postoperatively (n=13, a two-stage (orthoplasty buccal mucosal tube urethroplasty procedure was performed in 6 (46%, and the mean length of graft was 5.4 (±1.23 cm. In this group of 13 the success rate without any additional manipulations (urethrotomy intern, fistula repair was 54% (7/13. After additional manipulations, complete healing was achieved in 11 out of 13 patients (84.6%. In the group who did not receive HBO2T postoperatively (n=3, a two-stage procedure was performed in 1 patient (33%, and the mean length of graft was 8 (±5 cm. In this group of 3, complete healing was not achieved in any of these patients as a result of the hypospadias surgery. However, after the additional manipulations, complete healing was achieved in 1 patient (33%. Discussion: Given the promising rates of surgical success, postoperative HBO2T might be considered as a supportive treatment modality for adult patients with hypospadias who undergo buccal mucosal tube urethroplasty. Randomized controlled studies are needed.

  9. Engineering aspects of fluidized bed reactor operation applied to lactase treatment of whole whey

    Energy Technology Data Exchange (ETDEWEB)

    Metzdorf, C.; Fauquex, P.F.; Flaschel, E.; Renken, A.

    1985-01-01

    An interesting possibility for the use of lactoserum in human nutrition is the hydrolysis of lactose to glucose and galactose, sugars which exhibit a better digestibility, a higher solubility, and which have a greater sweetening power than lactose. The hydrolysis is catalyzed by an enzyme, the ..beta..-galactosidase which, due to its high price, must be used continuously, preferentially in immobilized form. The enzyme used for these studies has been immobilized on silica gel precoated with chitosan. When whole whey or partially deproteinized whey is treated, a fluidized bed reactor seems to be the most appropriate to circumvent problems with protein adsorption and reactor plugging. However the fluidization of fine particles with a small density difference between the solid and the liquid may give rise to stability problems. In order to prevent unstable operation of the fluidized bed, the reactor has been equipped with special internals. They impose a radial distribution of the liquid and the solid phase and increase the linear velocity required to achieve a given expansion by a factor of five. Besides the resulting high solids content, the back-mixing of the liquid decreases significantly when static mixer-packings are used.

  10. Association of perioperative blood transfusion and adverse events after operative treatment of proximal humerus fractures.

    Science.gov (United States)

    Kozanek, Michal; Menendez, Mariano E; Ring, David

    2015-02-01

    The purpose of this study was to assess the relationship between perioperative blood transfusion for proximal humerus fracture and inpatient mortality, adverse events, prolonged hospital stay, and nonroutine disposition. Among the >55,000 patients with an operatively treated proximal humerus fracture identified in the Nationwide Inpatient Sample between 2008 and 2011, 17% received a perioperative blood transfusion. Multivariable logistic regression analyses addressed the association of blood transfusion with inpatient mortality, adverse events, hospital stay, and nonroutine discharge, accounting for comorbidities and other known confounders. Perioperative blood transfusion for fracture of the proximal humerus was not associated with inhospital death, but it was independently associated with inpatient adverse events (odds ratio (OR) 4.4, 95% confidence interval (CI) 4.2-4.6), prolonged hospital stay (OR 2.8, 95% CI 2.7-2.9), and increased nonroutine discharge (OR 1.8, 95% CI 1.7-1.9). Inpatients with fracture of the proximal humerus who receive transfusion are not more likely to die in hospital, but they do stay longer, experience more adverse events, and are less likely to be discharged home. Additional study is merited to determine if the judicious use of blood transfusion in the perioperative period can decrease inpatient morbidity and health-care resource utilisation. Level II, Retrospective Design, Prognosis Study. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. ALTERNATIVE REMEDIATION TECHNOLOGY STUDY FOR GROUNDWATER TREATMENT AT 200-PO-1 OPERABLE UNIT AT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    DADO MA

    2008-07-31

    This study focuses on the remediation methods and technologies applicable for use at 200-PO-I Groundwater Operable Unit (OU) at the Hanford Site. The 200-PO-I Groundwater au requires groundwater remediation because of the existence of contaminants of potential concern (COPC). A screening was conducted on alternative technologies and methods of remediation to determine which show the most potential for remediation of groundwater contaminants. The possible technologies were screened to determine which would be suggested for further study and which were not applicable for groundwater remediation. COPCs determined by the Hanford Site groundwater monitoring were grouped into categories based on properties linking them by remediation methods applicable to each COPC group. The screening considered the following criteria. (1) Determine if the suggested method or technology can be used for the specific contaminants found in groundwater and if the technology can be applied at the 200-PO-I Groundwater au, based on physical characteristics such as geology and depth to groundwater. (2) Evaluate screened technologies based on testing and development stages, effectiveness, implementability, cost, and time. This report documents the results of an intern research project conducted by Mathew Dado for Central Plateau Remediation in the Soil and Groundwater Remediation Project. The study was conducted under the technical supervision of Gloria Cummins and management supervision of Theresa Bergman and Becky Austin.

  12. Wastewater treatment with submerged fixed bed biofilm reactor systems--design rules, operating experiences and ongoing developments.

    Science.gov (United States)

    Schlegel, S; Koeser, H

    2007-01-01

    Wastewater treatment systems using bio-films that grow attached to a support media are an alternative to the widely used suspended growth activated sludge process. Different fixed growth biofilm reactors are commercially used for the treatment of municipal as well as industrial wastewater. In this paper a fairly new fixed growth biofilm system, the submerged fixed bed biofilm reactor (SFBBR), is discussed. SFBBRs are based on aerated submerged fixed open structured plastic media for the support of the biofilm. They are generally operated without sludge recirculation in order to avoid clogging of the support media and problems with the control of the biofilm. Reactor and process design considerations for these reactors are reviewed. Measures to ensure the development and maintenance of an active biofilm are examined. SFBBRs have been applied successfully to small wastewater treatment plants where complete nitrification but no high degree of denitrification is necessary. For the pre-treatment of industrial wastewater the use of SFBBRs is advantageous, especially in cases of wastewater with high organic loading or high content of compounds with low biodegradability. Performance data from exemplary commercial plants are given. Ongoing research and development efforts aim at achieving a high simultaneous total nitrogen (TN) removal of aerated SFBBRs and at improving the efficiency of TN removal in anoxic SFBBRs.

  13. Polyhydroxyalkanoate Production on Waste Water Treatment Plants: Process Scheme, Operating Conditions and Potential Analysis for German and European Municipal Waste Water Treatment Plants

    Directory of Open Access Journals (Sweden)

    Timo Pittmann

    2017-06-01

    Full Text Available This work describes the production of polyhydroxyalkanoates (PHA as a side stream process on a municipal waste water treatment plant (WWTP and a subsequent analysis of the production potential in Germany and the European Union (EU. Therefore, tests with different types of sludge from a WWTP were investigated regarding their volatile fatty acids (VFA production-potential. Afterwards, primary sludge was used as substrate to test a series of operating conditions (temperature, pH, retention time (RT and withdrawal (WD in order to find suitable settings for a high and stable VFA production. In a second step, various tests regarding a high PHA production and stable PHA composition to determine the influence of substrate concentration, temperature, pH and cycle time of an installed feast/famine-regime were conducted. Experiments with a semi-continuous reactor operation showed that a short RT of 4 days and a small WD of 25% at pH = 6 and around 30 °C is preferable for a high VFA production rate (PR of 1913 mgVFA/(L×d and a stable VFA composition. A high PHA production up to 28.4% of cell dry weight (CDW was reached at lower substrate concentration, 20 °C, neutral pH-value and a 24 h cycle time. A final step a potential analysis, based on the results and detailed data from German waste water treatment plants, showed that the theoretically possible production of biopolymers in Germany amounts to more than 19% of the 2016 worldwide biopolymer production. In addition, a profound estimation regarding the EU showed that in theory about 120% of the worldwide biopolymer production (in 2016 could be produced on European waste water treatment plants.

  14. Polyhydroxyalkanoate Production on Waste Water Treatment Plants: Process Scheme, Operating Conditions and Potential Analysis for German and European Municipal Waste Water Treatment Plants.

    Science.gov (United States)

    Pittmann, Timo; Steinmetz, Heidrun

    2017-06-06

    This work describes the production of polyhydroxyalkanoates (PHA) as a side stream process on a municipal waste water treatment plant (WWTP) and a subsequent analysis of the production potential in Germany and the European Union (EU). Therefore, tests with different types of sludge from a WWTP were investigated regarding their volatile fatty acids (VFA) production-potential. Afterwards, primary sludge was used as substrate to test a series of operating conditions (temperature, pH, retention time (RT) and withdrawal (WD)) in order to find suitable settings for a high and stable VFA production. In a second step, various tests regarding a high PHA production and stable PHA composition to determine the influence of substrate concentration, temperature, pH and cycle time of an installed feast/famine-regime were conducted. Experiments with a semi-continuous reactor operation showed that a short RT of 4 days and a small WD of 25% at pH = 6 and around 30 °C is preferable for a high VFA production rate (PR) of 1913 mgVFA/(L×d) and a stable VFA composition. A high PHA production up to 28.4% of cell dry weight (CDW) was reached at lower substrate concentration, 20 °C, neutral pH-value and a 24 h cycle time. A final step a potential analysis, based on the results and detailed data from German waste water treatment plants, showed that the theoretically possible production of biopolymers in Germany amounts to more than 19% of the 2016 worldwide biopolymer production. In addition, a profound estimation regarding the EU showed that in theory about 120% of the worldwide biopolymer production (in 2016) could be produced on European waste water treatment plants.

  15. Use of wastewater treatment plant biogas for the operation of Solid Oxide Fuel Cells (SOFCs).

    Science.gov (United States)

    Lackey, Jillian; Champagne, Pascale; Peppley, Brant

    2017-12-01

    Solid Oxide Fuel Cells (SOFCs) perform well on light hydrocarbon fuels, and the use of biogas derived from the anaerobic digestion (AD) of municipal wastewater sludges could provide an opportunity for the CH 4 produced to be used as a renewable fuel. Greenhouse gas (GHG), NO x , SO x , and hydrocarbon pollutant emissions would also be reduced. In this study, SOFCs were operated on AD derived biogas. Initially, different H 2 dilutions were tested (N 2 , Ar, CO 2 ) to examine the performance of tubular SOFCs. With inert gases as diluents, a decrease in cell performance was observed, however, the use of CO 2 led to a higher decrease in performance as it promoted the reverse water-gas shift (WGS) reaction, reducing the H 2 partial pressure in the gas mixture. A model was developed to predict system efficiency and GHG emissions. A higher electrical system efficiency was noted for a steam:carbon ratio of 2 compared to 1 due to the increased H 2 partial pressure in the reformate resulting from higher H 2 O concentration. Reductions in GHG emissions were estimated at 2400 tonnes CO 2 , 60 kg CH 4 and 18 kg N 2 O. SOFCs were also tested using a simulated biogas reformate mixture (66.7% H 2 , 16.1% CO, 16.5% CO 2 , 0.7% N 2 , humidified to 2.3 or 20 mol% H 2 O). Higher humidification yielded better performance as the WGS reaction produced more H 2 with additional H 2 O. It was concluded that AD-derived biogas, when cleaned to remove H 2 S, Si compounds, halides and other contaminants, could be reformed to provide a clean, renewable fuel for SOFCs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Paclitaxel-Based Chemoradiotherapy in the Treatment of Patients With Operable Esophageal Cancer

    International Nuclear Information System (INIS)

    Kelsey, Chris R.; Chino, Junzo P.; Willett, Christopher G.; Clough, Robert W.; Hurwitz, Herbert I.; Morse, Michael A.; Bendell, Johanna C.; D'Amico, Thomas A.; Czito, Brian G.

    2007-01-01

    Purpose: To compare a neoadjuvant regimen of cisplatin/5-fluorouracil (5-FU) and concurrent radiation therapy (RT) with paclitaxel-based regimens and RT in the management of operable esophageal (EC)/gastroesophageal junction (GEJ) cancer. Methods and Materials: All patients receiving neoadjuvant chemotherapy (CT) and RT for EC/GEJ cancer at Duke University between January 1995 and December 2004 were included. Clinical end points were compared for patients receiving paclitaxel-based regimens (TAX) vs. alternative regimens (non-TAX). Local control (LC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Chi-square analysis was performed to test the effect of TAX on pathologic complete response (pCR) rates and toxicity. Results: A total of 109 patients received CT-RT followed by esophagectomy (95 M; 14 F). Median RT dose was 45 Gy (range, 36-66 Gy). The TAX and non-TAX groups comprised 47% and 53% of patients, respectively. Most (83%) TAX patients received three drug regimens including platinum and a fluoropyrimidine. In the non-TAX group, 89% of the patients received cisplatin and 5-FU. The remainder received 5-FU or capecitabine alone. Grade 3-4 toxicity occurred in 41% of patients receiving TAX vs. 24% of those receiving non-TAX (p = 0.19). Overall pCR rate was 39% (39% with TAX vs. 40% with non-TAX, p = 0.9). Overall LC, DFS, and OS at 3 years were 80%, 34%, and 37%, respectively. At 3 years, there were no differences in LC (75% vs. 85%, p = 0.33) or OS (37% vs. 37%, p = 0.32) between TAX and non-TAX groups. Conclusions: In this large experience, paclitaxel-containing regimens did not improve pCR rates or clinical end points compared to non-paclitaxel-containing regimens

  17. Thromboembolic Prophylaxis with Heparin in Patients with Blunt Solid Organ Injuries Undergoing Non-operative Treatment.

    Science.gov (United States)

    Khatsilouskaya, Tatsiana; Haltmeier, Tobias; Cathomas, Marionna; Eberle, Barbara; Candinas, Daniel; Schnüriger, Beat

    2017-05-01

    Patients with blunt solid organ injuries (SOI) are at risk for venous thromboembolism (VTE), and VTE prophylaxis is crucial. However, little is known about the safety of early prophylactic administration of heparin in these patients. This is a retrospective study including adult trauma patients with SOI (liver, spleen, kidney) undergoing non-operative management (NOM) from 01/01/2009 to 31/12/2014. Three groups were distinguished: prophylactic heparin (low molecular weight heparin or low-dose unfractionated heparin) ≤72 h after admission ('early heparin group'), >72 h after admission ('late heparin group'), and no heparin ('no heparin group'). Patient and injury characteristics, transfusion requirements, and outcomes (failed NOM, VTE, and mortality) were compared between the three groups. Overall, 179 patients were included; 44.7% in the 'early heparin group,' 34.6% in the 'late heparin group,' and 20.8% in the 'no heparin group.' In the 'late heparin group,' the ISS was significantly higher than in the 'early' and 'no heparin groups' (median 29.0 vs. 17.0 vs. 19.0; p < 0.001). The overall NOM failure rate was 3.9%. Failed NOM was significantly more frequent in the 'no heparin group' compared to the 'early' and 'late heparin groups' (10.8 vs. 3.2 vs. 1.3%; p = 0.043). In the 'early heparin group' 27.5% patients suffered from a high-grade SOI; none of these patients failed NOM. Mortality did not differ significantly. Although not statistically significant, VTE were more frequent in the 'no heparin group' compared to the 'early' and 'late heparin groups' (10.8 vs. 4.8 vs. 1.3%; p = 0.066). In patients with SOI, heparin was administered early in a high percentage of patients and was not associated with an increased NOM failure rate or higher in-hospital mortality.

  18. Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures.

    Science.gov (United States)

    von Rüden, Christian; Hungerer, Sven; Augat, Peter; Trapp, Oliver; Bühren, Volker; Hierholzer, Christian

    2015-02-01

    Mechanical breakage of cephalomedullary nail osteosynthesis is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. The aim of this study was to identify factors that contribute to cephalomedullary nail breakage. In a retrospective case series review between 02/2005 and 12/2013, we analyzed 453 patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with cephalomedullary nail breakage were included (failure rate 2.9 %). Seven patients were women, and six men with a mean age of 72 years (range 35-94). Implant breakage occurred 6 months postoperatively (range 1-19 months). In ten cases, breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, and in two cases due to loss of the lag screw because of missing set screw. In one case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated 6 months after operative revision using Harris hip score in 11 out of 13 patients showing a mean score of 84 %. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 months after revision surgery. Breakage of cephalomedullary nail osteosynthesis of trochanteric fractures is a severe complication. The results of our study demonstrate that revision surgery provides good clinical and radiological short-term results. Predominately, failures of trochanteric fractures are related to lack of surgeon performance. Therefore, application of the implant requires accurate preoperative planning, advanced surgical experience to evaluate the patient and the fracture classification, and precise surgical technique including attention to detail and anatomical

  19. Characterization of an acidification and equalization tank (AET operating as a primary treatment of swine liquid effluent

    Directory of Open Access Journals (Sweden)

    Fabrício Motteran

    2013-06-01

    Full Text Available This work evaluated the potential of the acidification equalization tank (AET used as a primary treatment unit, treating the hog farming wastewater. The treatment system consisted of a degritter with a triangular-notch weir, for measuring the flow, a static sieve, and an acidification and equalization tank (AET, an anaerobic baffled reactor (ABR, an upflow anaerobic sludge blanket (UASB reactor, a settling tank, a greenhouse for fertirrigation and two infiltration ponds. The AET had a net capacity of 8,000 liters, internally covered with asphalt blanket, worked based on surface loading rates application. The unit operated continuously, with its flow varying from 0.1 to 10 L s-1. To determine the efficiency, the following parameters were measured: pH; COD; BOD; volatile and fixed solids; settleable solids; total, intermediate and partial alkalinity and total acidity. The COD removal varied from 5 to 20%. The average pH was 7.3 and the total, intermediate and partial alkalinity in the effluent, were 1919, 846, 1197 mg L-1, respectively. The total acidity in the effluent was 34 mg L-1. The influent and effluent total BOD and oil & grease concentrations were 3436 and 3443 mg L-1, and 415 and 668 mg L-1, respectively. It was found that the AET worked properly concerning the acidification, equalization and sedimentation processes, confirming low cost of implementation and easy operation, when compared to other traditional decanters.

  20. Integrated electrocoagulation-electrooxidation process for the treatment of soluble coffee effluent: Optimization of COD degradation and operation time analysis.

    Science.gov (United States)

    Ibarra-Taquez, Harold N; GilPavas, Edison; Blatchley, Ernest R; Gómez-García, Miguel-Ángel; Dobrosz-Gómez, Izabela

    2017-09-15

    Soluble coffee production generates wastewater containing complex mixtures of organic macromolecules. In this work, a sequential Electrocoagulation-Electrooxidation (EC-EO) process, using aluminum and graphite electrodes, was proposed as an alternative way for the treatment of soluble coffee effluent. Process operational parameters were optimized, achieving total decolorization, as well as 74% and 63.5% of COD and TOC removal, respectively. The integrated EC-EO process yielded a highly oxidized (AOS = 1.629) and biocompatible (BOD 5 /COD ≈ 0.6) effluent. The Molecular Weight Distribution (MWD) analysis showed that during the EC-EO process, EC effectively decomposed contaminants with molecular weight in the range of 10-30 kDa. In contrast, EO was quite efficient in mineralization of contaminants with molecular weight higher than 30 kDa. A kinetic analysis allowed determination of the time required to meet Colombian permissible discharge limits. Finally, a comprehensive operational cost analysis was performed. The integrated EC-EO process was demonstrated as an efficient alternative for the treatment of industrial effluents resulting from soluble coffee production. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Set-up and first operation of a plasma oven for treatment of low level radioactive wastes

    Directory of Open Access Journals (Sweden)

    Nachtrodt Frederik

    2014-01-01

    Full Text Available An experimental device for plasma treatment of low and intermediate level radioactive waste was built and tested in several design variations. The laboratory device is designed with the intention to study the general effects and difficulties in a plasma incineration set-up for the further future development of a larger scale pilot plant. The key part of the device consists of a novel microwave plasma torch driven by 200 W electric power, and operating at atmospheric pressure. It is a specific design characteristic of the torch that a high peak temperature can be reached with a low power input compared to other plasma torches. Experiments have been carried out to analyze the effect of the plasma on materials typical for operational low-level wastes. In some preliminary cold tests the behavior of stable volatile species e. g., caesium was investigated by TXRF measurements of material collected from the oven walls and the filtered off-gas. The results help in improving and scaling up the existing design and in understanding the effects for a pilot plant, especially for the off-gas collection and treatment.

  2. Operating (on) the self: transforming agency through obesity surgery and treatment.

    Science.gov (United States)

    Vogel, Else

    2018-03-01

    In this article, I describe the processes through which patients diagnosed with 'morbid obesity' become active subjects through undergoing obesity surgery and an empowerment lifestyle programme in a Dutch obesity clinic. Following work in actor-network theory and material semiotics that complicates the distinction between active and passive subjects, I trace how agency is configured and re-distributed throughout the treatment trajectory. In the clinic's elaborate care assemblage - consisting of dieticians, exercise coaches and psychologists - the person is not only actively involved in his/her own change, the subject of intervention is the self as 'actor': his/her material constitution, inclinations and feelings. The empirical examples reveal that a self becomes capable of self-care only after a costly and laborious conditioning through which patients are completely transformed. In this work, the changed body, implying a new, potentially disruptive reality that patients must learn to cope with, is pivotal to what the patient can do and become. Rather than striving to be disembodied, self-contained liberal subjects that make sensible decisions for their body, patients become empowered through submission and attachment and by arranging support. © 2017 Foundation for the Sociology of Health & Illness.

  3. Sustainability considerations in the operation of Wastewater Treatment Plant ‘Swarzewo’

    Directory of Open Access Journals (Sweden)

    Dereszewska Alina

    2016-01-01

    Full Text Available The Wastewater Treatment Plant (WWTP ‘Swarzewo’ plays a special role in the protection of coastal waters of the Baltic Sea area and the management of solid wastes in the region. This paper discusses several options implemented in the WWTP area in order to achieve sustainability. The first one was the inclusion of WWTP into municipal waste management plan to increase the biogas production and to reduce volume of organic waste in the region. Nowadays, daily production of about 2000 m3 of biogas is gained. The energy balance shows a considerable benefit from the co-fermentation of sludge with municipal organic wastes. The next goal was to obtain a favorable economical balance of energy and high level of pollution reduction. The last one was the involvement of local communities in a conscious segregation of waste ‘at source’. For the purpose of this paper bio-energy production, nutrient elimination, composting, and research, have been selected as indicators of sustainable development. Furthermore, in this study the methods of nutrient recovery from wastewater were explored. Struvite precipitation and compost production were presented as an example of nutrient elimination with ‘end of waste’ production. Depending on the struvite precipitation conditions, recovery of 4 Mg of phosphorous and 1,8 Mg of nitrogen is possible to obtain annually.

  4. Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

    Science.gov (United States)

    Grau, Luis; Summers, Spencer; Rosas, Samuel; Ong, Alvin; Hernandez, Victor Hugo

    2018-01-01

    Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications. Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population. PMID:29619275

  5. Operational factors and nutrient effects on activated sludge treatment of Pinus radiata kraft mill wastewater.

    Science.gov (United States)

    Diez, M C; Castillo, G; Aguilar, L; Vidal, G; Mora, M L

    2002-06-01

    The biodegradability of Pinus radiata bleached kraft mill wastewater by an activated sludge treatment during a period of 280 days was evaluated. The effect of varying hydraulic retention time (HRT) in the range of 48 to 4.5 h and nitrogen (N) and phosphorus (P) addition on removal of biological oxygen demand (BOD5), chemical oxygen demand (COD), suspended solids (TSS and VSS), total phenolic compounds, tannin and lignin and reduction of toxicity was investigated. Removal of BOD5 was higher than 90% when HRT varied from 16 to 6 h, but decreased when HRT was less than 6 h. Similar performance was observed for COD removal, which was about 60% when HRT was varied from 16 to 6 h. Removal of total phenolic compounds and tannin and lignin was seriously affected by HRT. N and P addition to maintaining a ratio of 100:5:0.3 provided optimal BOD5, COD and suspended solids removal when HRT varied from 16 to 7 h, and no toxicity (using Daphnia) was detected in the treated effluent. When HRT was less than 6 h, the system showed destabilisation and pH, COD, BOD5 and suspended solids removal decreased.

  6. Sorption of Arsenic from Desalination Concentrate onto Drinking Water Treatment Solids: Operating Conditions and Kinetics

    Directory of Open Access Journals (Sweden)

    Xuesong Xu

    2018-01-01

    Full Text Available Selective removal of arsenic from aqueous solutions with high salinity is required for safe disposal of the concentrate and protection of the environment. The use of drinking water treatment solids (DWTS to remove arsenic from reverse osmosis (RO concentrate was studied by batch sorption experiments. The impacts of solution chemistry, contact time, sorbent dosage, and arsenic concentration on sorption were investigated, and arsenic sorption kinetics and isotherms were modeled. The results indicated that DWTS were effective in removing arsenic from RO concentrate. The arsenic sorption process followed a pseudo-second-order kinetic model. Multilayer adsorption was simulated by Freundlich equation. The maximum sorption capacities were calculated to be 170 mg arsenic per gram of DWTS. Arsenic sorption was enhanced by surface precipitation onto the DWTS due to the high amount of calcium in the RO concentrate and the formation of ternary complexes between arsenic and natural organic matter (NOM bound by the polyvalent cations in DWTS. The interactions between arsenic and NOM in the solid phase and aqueous phase exhibited two-sided effects on arsenic sorption onto DWTS. NOM in aqueous solution hindered the arsenic sorption onto DWTS, while the high organic matter content in solid DWTS phase enhanced arsenic sorption.

  7. Complication rates in the operative treatment of mandibular angle fractures: a 10-year retrospective.

    Science.gov (United States)

    Seemann, Rudolf; Schicho, Kurt; Wutzl, Arno; Koinig, Gregor; Poeschl, Wolfgang P; Krennmair, Gerald; Ewers, Rolf; Klug, Clemens

    2010-03-01

    Large-scale studies assessing complication rates and correlation of complications are still missing considering different fracture locations in the mandible. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed. Three hundred twenty-two patients (259 men, 63 women) with 335 surgically treated mandibular angle fractures were included in this study. Fractures were caused by fights (46.6%), falls (19.2%), traffic accidents (14.6%), sports (11.9%), wisdom tooth removal (7.3%), and 0.9% other causes. Successful treatment occurred in 93.69% of fractures with 1 open reduction and in 6.31% with 2 open reductions. Of surgically treated patients, 71.47% (238) were completely free of complications. A detailed complication correlation matrix is given in the text. Ninety-five fractures treated with 1 miniplate, 170 with 2 miniplates, and 70 with other osteosynthesis concepts were compared regarding osteosynthesis failure and pseudarthrosis. Similar osteosynthesis failure rates were shown for 1 miniplate and 2 miniplates. Copyright (c) 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  8. NUTRITIONAL ASPECTS AND THE USE OF NUTRITIONAL SUPPLEMENTS BY WOMEN WHO UNDERWENT GASTRIC BYPASS.

    Science.gov (United States)

    Trindade, Elisangela Mara; Gebara, Telma Souza E Silva; Cambi, Maria Paula Carlini; Baretta, Giorgio Alfredo Pedroso

    2017-01-01

    Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities. Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery. The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used. In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins. After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic. A cirurgia bariátrica é considerada um dos procedimentos mais eficazes para tratamento da obesidade e objetiva a redução e manutenção da perda de peso em longo prazo, assim como, o controle das comorbidades associadas. Quantificar a ocorrência de alterações funcionais do trato gastrointestinal, sinais sugestivos de carências nutricionais e o uso de suplementos em um grupo de mulheres submetidas à cirurgia bariátrica. A amostra foi constituída por mulheres com idades entre 20-65 anos submetidas ao bypass gástrico em Y-de-Roux com seguimento igual ou superior a 24 meses. Para análise qualitativa foi utilizado o Questionário de Frequência Alimentar. No per

  9. Testing fluidized bed incinerators for energy-efficient operation for the Southtowns Sewage Treatment Agency. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-01-01

    Two methods for improving the energy efficiency of fluidized bed sludge incinerators were evaluated. The first method used paper pulp and polymer as conditioning agents for municipal sludge instead of lime and ferric chloride. Automatic control of the incinerator was the second method evaluated for energy savings. To evaluate the use of paper pulp and polymer as conditioning agents, varying quantities of paper pulp were added to the liquid sludge to determine the optimal sludge-to-paper pulp ratio. The effect of the paper pulp and polymer-conditioned sludge on plant operations also was evaluated. When compared to sludge conditioned with lime and ferric chloride, the paper pulp and polymer-conditioned sludge had similar cake release and feed characteristics, higher BTU values for the dry sludge solids, required less auxiliary fuel for incineration, and generated less ash for disposal. The paper pulp and polymer did not have any appreciable negative effects on the operation of the wastewater treatment plant. It was estimated that processing and incinerating the sludge conditioned with paper pulp and polymer resulted in a cost savings of up to $91.73 per dry ton of activated sludge solids. To evaluate the effect of automatic control, all the incinerator operating parameters including air flow rates, fuel oil feed rates, and sludge feed rates, were automatically monitored and controlled to minimize auxiliary fuel oil use and to keep the incinerator running at optimal conditions. Although effective, the estimated cost savings for automatic control of the incinerator were small.

  10. Effect of operating conditions in soil aquifer treatment on the removals of pharmaceuticals and personal care products

    Energy Technology Data Exchange (ETDEWEB)

    He, Kai, E-mail: hekai@urban.env.kyoto-u.ac.jp; Echigo, Shinya; Itoh, Sadahiko

    2016-09-15

    Soil aquifer treatment (SAT) is an alternative advanced treatment for wastewater reclamation, and it has the potential to control micropollutants including pharmaceuticals and personal care products (PPCPs). However, the relationship of operating conditions in SAT and removals of micropollutants was not clear. In this study, the effects of operating conditions on the removals of PPCPs were evaluated by using lab-scale columns and plant pilot-scale reactors under different operating conditions. Firstly, weathered granite soil (WGS), standard sand (SAND) and Toyoura standard sand (TS) have different soil characteristics such as total organic carbon (TOC) and cation exchange capacity (CEC). In the columns with these packing materials, the removals of carboxylic analgesics and antilipidemics were effective regardless packing materials. The removals of antibiotics were more effective in WGS than in TS and SAND, indicating high TOC and CEC enhance the sorption in SAT. Secondly, with the extension of hydraulic retention time (HRT), the removals of sulfamethoxazole, acetaminophen, crotamiton, and antipyrine were improved in WGS columns, and adaptable biodegradation for moderately removable PPCPs was formed. Thirdly, the removal efficiencies of sulfamethoxazole and crotamiton were higher in the WGS column under vadose condition than in the WGS column under saturated condition, because of aerobic condition in WGS column under vadose condition. Though long HRT and vadose condition had positive influence on the removals of several PPCPs such as sulfamethoxazole, WGS column with an HRT of 7 days under saturated condition removed most PPCPs. - Highlights: • Soil organic matter and cation exchange capacity enhanced the removals of antibiotics in SAT. • A hydraulic retention time (HRT) of 7 days was sufficient for the removals of most PPCPs. • The removals of most selected PPCPs were similar under vadose and saturated conditions. • Vadose condition contributed to the

  11. NON - OPERATIVE TREATMENT OF NON - CAVITATED APPROXIMAL CARIOUS LESIONS OF PERMANENT CHIDREN’S TEETH.

    Directory of Open Access Journals (Sweden)

    Rossiza I. Kabakchieva

    2014-10-01

    Full Text Available Aim: To apply and follow up in clinical conditions the success rate of microinvasive technique of infiltration with low viscosity resin ICON® (DMG of non cavitated approximal caries lesions of permanent children's teeth for a period of one year. Material and methods: The study included 18 children aged 7-16 years. They were divided into two groups - children with medium and high caries risk. The survey include 20 teeth with approximal non-cavitated enamel lesions up to the outer third of dentin (E1, E2, D1 – according to the manufacturer’s instructions of ICON®. The size of the lesions was determined using bitewing radiographs and the activity - by Papilla Bleeding Index. The clinical application of the infiltr+ant (ICON® Caries Infiltrant Proximal, DMG was conducted according to the manufacturer's instructions. Bitewing radiographs were made at 6 and 12 months after infiltration in order to evaluate the success of the method. A test of the difference between two relative proportions and alternative test for analysis of the results were used. Results: Our study confirm the hypothesis that this method of infiltration is equally successful for permanent teeth in patients with moderate caries risk as well as those at high caries risk. Conclusion: This study is the first survey regarding the success of the application of ICON® for treatment of non-cavitated approximal carious lesions in permanent dentition of children in the country. Research in this direction should continue in order to increase the conviction that caries can be controlled and arrested in its earliest stages.

  12. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    Science.gov (United States)

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

  13. On the design and operation of primary settling tanks in state of the art wastewater treatment and water resources recovery.

    Science.gov (United States)

    Patziger, Miklos; Günthert, Frank Wolfgang; Jardin, Norbert; Kainz, Harald; Londong, Jörg

    2016-11-01

    In state of the art wastewater treatment, primary settling tanks (PSTs) are considered as an integral part of the biological wastewater and sludge treatment process, as well as of the biogas and electric energy production. Consequently they strongly influence the efficiency of the entire wastewater treatment plant. However, in the last decades the inner physical processes of PSTs, largely determining their efficiency, have been poorly addressed. In common practice PSTs are still solely designed and operated based on the surface overflow rate and the hydraulic retention time (HRT) as a black box. The paper shows the results of a comprehensive investigation programme, including 16 PSTs. Their removal efficiency and inner physical processes (like the settling process of primary sludge), internal flow structures within PSTs and their impact on performance were investigated. The results show that: (1) the removal rates of PSTs are generally often underestimated in current design guidelines, (2) the removal rate of different PSTs shows a strongly fluctuating pattern even in the same range of the HRT, and (3) inlet design of PSTs becomes highly relevant in the removal efficiency at rather high surface overflow rates, above 5 m/h, which is the upper design limit of PSTs for dry weather load.

  14. [Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

    Science.gov (United States)

    Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

    2017-11-01

    We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

  15. Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries

    NARCIS (Netherlands)

    Mulders, M. A. M.; van Eerten, P. V.; Goslings, J. C.; Schep, N. W. L.

    2017-01-01

    Background: Although secondary displacement following closed reduction and plaster immobilisation is high, several guidelines still recommend non-operative treatment for displaced distal radius fractures with an adequate closed reduction. Purpose: The purpose of this study was to evaluate functional

  16. Patterns and Timing of Failure for Diffuse Large B-Cell Lymphoma After Initial Therapy in a Cohort Who Underwent Autologous Bone Marrow Transplantation for Relapse

    Energy Technology Data Exchange (ETDEWEB)

    Dhakal, Sughosh; Bates, James E. [Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States); Casulo, Carla; Friedberg, Jonathan W.; Becker, Michael W.; Liesveld, Jane L. [Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States); Constine, Louis S., E-mail: louis_constine@urmc.rochester.edu [Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States)

    2016-10-01

    Purpose: To evaluate the location and timing of initial recurrence in patients with diffuse large B-cell lymphoma (DLBCL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplant (HDC/ASCT), to direct approaches for disease surveillance, elucidate the patterns of failure of contemporary treatment strategies, and guide adjuvant treatment decisions. Methods and Materials: We analyzed consecutive patients with DLBCL who underwent HDC/ASCT between May 1992 and March 2014 at our institution. Of the 187 evaluable patients, 8 had incomplete data, and 79 underwent HDC/ASCT as a component of initial treatment for de novo or refractory DLBCL and were excluded from further analysis. Results: The median age was 50.8 years; the median time to relapse was 1.3 years. Patients were segregated according to the initial stage at diagnosis, with early stage (ES) defined as stage I/II and advanced stage (AS) defined as stage III/IV. In total, 40.4% of the ES and 75.5% of the AS patients relapsed in sites of initial disease; 68.4% of those with ES disease and 75.0% of those with AS disease relapsed in sites of initial disease only. Extranodal relapses were common (44.7% in ES and 35.9% in AS) and occurred in a variety of organs, although gastrointestinal tract/liver (n=12) was most frequent. Conclusions: Most patients with DLBCL who relapse and subsequently undergo HDC/ASCT initially recur in the previously involved disease site(s). Time to recurrence is brief, suggesting that frequency of screening is most justifiably greatest in the early posttherapy years. © 2016 Elsevier Inc.

  17. Outcome Study of Non-operative Treatment for Knee Osteoarthritis in Middle-aged Patients With Reference to the Body Mass Index—A Randomised Prospective Study

    Directory of Open Access Journals (Sweden)

    Cheong Peng Meng

    2011-06-01

    Full Text Available From the year 2006 to 2008, 69 patients of symptomatic osteoarthritis of the knees were divided randomly and entered into three non-operative treatment protocols. It included 4 weeks of pharmacological treatment followed by 4 weeks of specific treatments (physiotherapy, acupuncture, and combined. The pretreatment and post-treatment physical and functional statuses were evaluated. Their body mass index (BMI was measured. The patients with below-normal BMI did not benefit from all the three treatment protocols. However, all other groups of increased BMI did benefit from all three treatment protocols in terms of pain score, analgesic sparing, and knee scores.

  18. Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy.

    Science.gov (United States)

    Chareancholvanich, Keerati; Pornrattanamaneewong, Chaturong; Narkbunnam, Rapeepat

    2014-06-01

    High tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints. Forty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48). MRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO. Therapeutic study, Level I.

  19. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery ?

    OpenAIRE

    Nunes, Viviane Regina Hernandez; Jacob, Charbel; Cardoso, Igor Machado; Batista, Jos? Lucas; Brazolino, Marcus Alexandre Novo; Maia, Thiago Cardoso

    2016-01-01

    ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, an...

  20. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Science.gov (United States)

    2013-01-01

    Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR) to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS). Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p CA-125 biochemical progression prior to clinically-defined relapse was 31 days (ranging from 1 to 391 days). The median number of the negative imaging studies for the clinical relapse findings in patients with a CA-125 level of CA-125 level at relapse was an independent predictor of overall and progression free survival in patients who had shown CCR to primary therapy (p = 0.04 and 0.02 respectively). The overall and progression free survival durations in patients with a CA-125 level ≤ 1.68 × nadir at relapse (69.4 and 13.8 months) were longer than those with a CA-125 level > 1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively). The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively). Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in

  1. [Operative treatment of traumatic fractures of the thoracic and lumbar spinal column: Part III: Follow up data].

    Science.gov (United States)

    Reinhold, M; Knop, C; Beisse, R; Audigé, L; Kandziora, F; Pizanis, A; Pranzl, R; Gercek, E; Schultheiss, M; Weckbach, A; Bühren, V; Blauth, M

    2009-03-01

    In this third and final part, the Spine Study Group (AG WS) of the German Trauma Association (DGU) presents the follow-up (NU) data of its second, prospective, internet-based multicenter study (MCS II) for the treatment of thoracic and lumbar spinal injuries including 865 patients from 8 trauma centers. Part I described in detail the epidemiologic data of the patient collective and the subgroups, whereas part II analyzed the different methods of treatment and radiologic findings. The study period covered the years 2002 to 2006 including a 30-month follow-up period from 01.01.2004 until 31.05.2006. Follow-up data of 638 (74%) patients were collected with a new internet-based database system and analyzed. Results in part III will be presented on the basis of the same characteristic treatment subgroups (OP, KONS, PLASTIE) and surgical treatment subgroups (Dorsal, Ventral, Kombi) in consideration of the level of injury (thoracic spine, thoracolumbar junction, lumbar spine). After the initial treatment and discharge from hospital, the average duration of subsequent inpatient rehabilitation was 4 weeks, which lasted significantly longer in patients with persistent neurologic deficits (mean 10.9 weeks) or polytraumatized patients (mean 8.6 weeks). Following rehabilitation on an inpatient basis, subsequent outpatient rehabilitation lasted on average 4 months. Physical therapy was administered significantly longer to patients with neurologic deficits (mean 8.7 months) or type C injuries (mean 8.6 months). The level of injury had no influence of the duration of the inpatient or outpatient rehabilitation. A total of 382 (72.2%) patients who were either operated from posterior approach only or in a combined postero-anterior approach had an implant removal after an average 12 months. During the follow-up period 56 (8.8%) patients with complications were registered and of these 18 (2.8%) had to have surgical revision. The most common complications reported were infection, loss

  2. Microbial Community Composition of Polyhydroxyalkanoate-Accumulating Organisms in Full-Scale Wastewater Treatment Plants Operated in Fully Aerobic Mode

    Science.gov (United States)

    Oshiki, Mamoru; Onuki, Motoharu; Satoh, Hiroyasu; Mino, Takashi

    2013-01-01

    The removal of biodegradable organic matter is one of the most important objectives in biological wastewater treatments. Polyhydroxyalkanoate (PHA)-accumulating organisms (PHAAOs) significantly contribute to the removal of biodegradable organic matter; however, their microbial community composition is mostly unknown. In the present study, the microbial community composition of PHAAOs was investigated at 8 full-scale wastewater treatment plants (WWTPs), operated in fully aerobic mode, by fluorescence in situ hybridization (FISH) analysis and post-FISH Nile blue A (NBA) staining techniques. Our results demonstrated that 1) PHAAOs were in the range of 11–18% in the total number of cells, and 2) the microbial community composition of PHAAOs was similar at the bacterial domain/phylum/class/order level among the 8 full-scale WWTPs, and dominant PHAAOs were members of the class Alphaproteobacteria and Betaproteobacteria. The microbial community composition of α- and β-proteobacterial PHAAOs was examined by 16S rRNA gene clone library analysis and further by applying a set of newly designed oligonucleotide probes targeting 16S rRNA gene sequences of α- or β-proteobacterial PHAAOs. The results demonstrated that the microbial community composition of PHAAOs differed in the class Alphaproteobacteria and Betaproteobacteria, which possibly resulted in a different PHA accumulation capacity among the WWTPs (8.5–38.2 mg-C g-VSS−1 h−1). The present study extended the knowledge of the microbial diversity of PHAAOs in full-scale WWTPs operated in fully aerobic mode. PMID:23257912

  3. Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system.

    Science.gov (United States)

    Poyanli, Oguz S; Soylemez, Salih; Ozkut, Afsar T; Uygur, Esat; Kemah, Bahattin; Unal, Omer K

    2015-11-01

    We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head. Deviation values ranged from -11̊ to +15̊ for the 27 cases in group A, with a median absolute deviation of 8̊±6̊. That in the 28 cases after the introduction of the new guide system (group B) ranged from -5̊ to +6̊, with a median absolute deviation of 0.5̊±3̊ (Pfractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results.

    Science.gov (United States)

    Michael, J W P; Wurth, A; Eysel, P; König, D P

    2008-04-01

    Osteochondritis dissecans (OD) mostly appears at the knee joint on the weight-bearing part of the medial femoral condyle. A multi-factorial event is most likely responsible for the triggering of OD. The aim of this retrospective study was to carry out long-term assessment of the results of operative treatment. Between 1959 and 1976, 148 patients were treated for OD by an open technique. For this purpose, a total number of 38 patients were analysed after approximately 30 years. Twenty-six patients were evaluated clinically by means of standardised questionnaires and also radiologically; 12 patients were analysed only by questionnaire. In order to verify the clinical findings and the subjective assessment, radiographs were done and analysed according the Kannus score. The Brückl score was used to evaluate the results of the OD. Twenty-four knee joints were analysed by radiographs. Sixty percent of the operated joints showed poor results in the analysis according to Kannus. Only four patients showed an excellent result by using the clinical scoring system. Nevertheless, we were able to prove a markedly higher rate of osteoarthrosis. The causal explanation for this lies in the patient selection. Most of the patients were above average age, and the OD was discovered quite late, and thus the disease had already progressed to a higher degree. In 74% of all cases, an extirpation of the osteochondral fragment was performed, whereas today there are several operative options. In our view, therefore, the need arises to conduct further follow-up examinations with comparative time spans, as well as to conduct a parallel analysis of corresponding control groups in order to evaluate the aetiology of the increased rate of osteoarthrosis.

  5. Improved Management of the Technical Interfaces Between the Hanford Tank Farm Operator and the Hanford Waste Treatment Plant - 13383

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, Garth M. [Bechtel National Inc., 2435 Stevens Center Place, Richland, Washington, 99352 (United States); Saunders, Scott A. [Washington River Protection Solutions, P.O. Box 850, Richland, Washington, 99352 (United States)

    2013-07-01

    The Department of Energy (DOE) is constructing the Waste Treatment and Immobilization Plant (WTP) at the Hanford site in Washington to treat and immobilize approximately 114 million gallons of high level radioactive waste (after all retrievals are accomplished). In order for the WTP to be designed and operated successfully, close coordination between the WTP engineering, procurement, and construction contractor, Bechtel National, Inc. and the tank farms operating contractor (TOC), Washington River Protection Solutions, LLC, is necessary. To develop optimal solutions for DOE and for the treatment of the waste, it is important to deal with the fact that two different prime contractors, with somewhat differing contracts, are tasked with retrieving and delivering the waste and for treating and immobilizing that waste. The WTP and the TOC have over the years cooperated to manage the technical interface. To manage what is becoming a much more complicated interface as the WTP design progresses and new technical issues have been identified, an organizational change was made by WTP and TOC in November of 2011. This organizational change created a co-located integrated project team (IPT) to deal with mutual and interface issues. The Technical Organization within the One System IPT includes employees from both TOC and WTP. This team has worked on a variety of technical issues of mutual interest and concern. Technical issues currently being addressed include: - The waste acceptance criteria; - Waste feed delivery and the associated data quality objectives (DQO); - Evaluation of the effects of performing a riser cut on a single shell tank on WTP operations; - The disposition of secondary waste from both TOC and WTP; - The close coordination of the TOC double shell tank mixing and sampling program and the Large Scale Integrated Test (LSIT) program for pulse jet mixers at WTP along with the associated responses to the Defense Nuclear Facilities Safety Board (DNFSB) Recommendation

  6. Improved Management of the Technical Interfaces Between the Hanford Tank Farm Operator and the Hanford Waste Treatment Plant - 13383

    International Nuclear Information System (INIS)

    Duncan, Garth M.; Saunders, Scott A.

    2013-01-01

    The Department of Energy (DOE) is constructing the Waste Treatment and Immobilization Plant (WTP) at the Hanford site in Washington to treat and immobilize approximately 114 million gallons of high level radioactive waste (after all retrievals are accomplished). In order for the WTP to be designed and operated successfully, close coordination between the WTP engineering, procurement, and construction contractor, Bechtel National, Inc. and the tank farms operating contractor (TOC), Washington River Protection Solutions, LLC, is necessary. To develop optimal solutions for DOE and for the treatment of the waste, it is important to deal with the fact that two different prime contractors, with somewhat differing contracts, are tasked with retrieving and delivering the waste and for treating and immobilizing that waste. The WTP and the TOC have over the years cooperated to manage the technical interface. To manage what is becoming a much more complicated interface as the WTP design progresses and new technical issues have been identified, an organizational change was made by WTP and TOC in November of 2011. This organizational change created a co-located integrated project team (IPT) to deal with mutual and interface issues. The Technical Organization within the One System IPT includes employees from both TOC and WTP. This team has worked on a variety of technical issues of mutual interest and concern. Technical issues currently being addressed include: - The waste acceptance criteria; - Waste feed delivery and the associated data quality objectives (DQO); - Evaluation of the effects of performing a riser cut on a single shell tank on WTP operations; - The disposition of secondary waste from both TOC and WTP; - The close coordination of the TOC double shell tank mixing and sampling program and the Large Scale Integrated Test (LSIT) program for pulse jet mixers at WTP along with the associated responses to the Defense Nuclear Facilities Safety Board (DNFSB) Recommendation

  7. A chemically enhanced biological process for lowering operative costs and solid residues of industrial recalcitrant wastewater treatment.

    Science.gov (United States)

    Di Iaconi, Claudio; Del Moro, Guido; De Sanctis, Marco; Rossetti, Simona

    2010-06-01

    An innovative process based on ozone-enhanced biological degradation, carried out in an aerobic granular biomass system (SBBGR--Sequencing Batch Biofilter Granular Reactor), was tested at pilot scale for tannery wastewater treatment chosen as representative of industrial recalcitrant wastewater. The results have shown that the process was able to meet the current discharge limits when the biologically treated wastewater was recirculated through an adjacent reactor where a specific ozone dose of 120 mg O3/L(influent) was used. The benefits produced by using ozone were appreciable even visually since the final effluent of the process looked like tap water. In comparison with the conventional treatment, the proposed process was able to reduce the sludge production by 25-30 times and to save 60% of operating costs. Molecular in situ detection methods were employed in combination with the traditional measurements (oxygen uptake rate, total protein content, extracellular polymeric substances and hydrophobicity) to evaluate microbial activity and composition, and the structure of the biomass. A stable presence of active bacterial populations was observed in the biomass with the simultaneous occurrence of distinctive functional microbial groups involved in carbon, nitrogen and sulphate removal under different reaction environments established within the large microbial aggregates. The structure and activity of the biomass were not affected by the use of ozone. 2010 Elsevier Ltd. All rights reserved.

  8. Bronchoplastic operations for lung cancer

    International Nuclear Information System (INIS)

    Cicenas, S.; Naujokaitis, P.; Jackevicius, A. and others

    2002-01-01

    Objective of our work was to evaluate efficacy of bronchoplastic operations for lung cancer and time to progression in combined treatment. From 1997 till 2001, 57pts were operated for early I-IIB stages of lung cancer. Operations were: tracheal resections in 3pts (5.2%), window right pneumonectomies in 5pts (8.7%), window left pneumonectomies in 2pts (3.5%), window right upper lobe in 22pts (38.5%), bifurcation resections 2pts (3.5%), sleeve right upper lobe resections 7pts (12.2%), sleeve left upper lobe resections in 11pts (19.2%). We had complications: in 7pts (12.2%) suture failure, 26pts (45.6%) obstructive pneumonia, 3pts (5.2%) kinking of anastomosis, 2pts (3.7%) bronchial bleeding, 6pts (10.5%) covered bronchial fistulas, 5pts (8.7%) died after operations. 32pts (56%) underwent radiation after surgery, 13pts (22.8%) radiation and chemotherapy. Three-year survival was in 82.4% (47pts), in 10pts (17.4%) disease progressed. Bronchoplastic operations are sufficient for early lung cancer treatment. Three-year was in survival 82.7% of pts. Seventeen percent of patients failed after combined treatment. (author)

  9. Assessment of environmental impacts and operational costs of the implementation of an innovative source-separated urine treatment.

    Science.gov (United States)

    Igos, Elorri; Besson, Mathilde; Navarrete Gutiérrez, Tomás; Bisinella de Faria, Ana Barbara; Benetto, Enrico; Barna, Ligia; Ahmadi, Aras; Spérandio, Mathieu

    2017-12-01

    Innovative treatment technologies and management methods are necessary to valorise the constituents of wastewater, in particular nutrients from urine (highly concentrated and can have significant impacts related to artificial fertilizer production). The FP7 project, ValuefromUrine, proposed a new two-step process (called VFU) based on struvite precipitation and microbial electrolysis cell (MEC) to recover ammonia, which is further transformed into ammonium sulphate. The environmental and economic impacts of its prospective implementation in the Netherlands were evaluated based on life cycle assessment (LCA) methodology and operational costs. In order to tackle the lack of stable data from the pilot plant and the complex effects on wastewater treatment plant (WWTP), process simulation was coupled with LCA and costs assessment using the Python programming language. Additionally, particular attention was given to the propagation and analysis of inputs uncertainties. Five scenarios of VFU implementation were compared to the conventional treatment of 1 m 3 of wastewater. Inventory data were obtained from SUMO software for the WWTP operation. LCA was based on Brightway2 software (using ecoinvent database and ReCiPe method). The results, based on 500 iterations sampled from inputs distributions (foreground parameters, ecoinvent background data and market prices), showed a significant advantage of VFU technology, both at a small and decentralized scale and at a large and centralized scale (95% confidence intervals not including zero values). The benefits mainly concern the production of fertilizers, the decreased efforts at the WWTP, the water savings from toilets flushing, as well as the lower infrastructure volumes if the WWTP is redesigned (in case of significant reduction of nutrients load in wastewater). The modelling approach, which could be applied to other case studies, improves the representativeness and the interpretation of results (e.g. complex relationships

  10. Clinical and Radiographic Evaluation of the Operative Treatment of Lateral Humeral Condylar Fracture in Children at Shafa Hospital, Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Davod Jafari

    2016-11-01

    Full Text Available Background The goal of treatment in displaced lateral condylar fracture is to achieve union without residual deformity. However, growth disturbance may occur despite initial anatomic reduction and secure fixation. Objectives The purpose of this study was to evaluate clinical and radiographic results and assess complications associated with the operative treatment of lateral condylar fractures in children. Methods A total of 73 pediatric patients under the age of 13 years, who were diagnosed with displaced lateral condylar fractures of the humerus and were treated with open reduction and internal fixation, were assessed from March 2011 to September 2015. The mean follow-up duration in these patients was 22 months (8 - 48 months. The clinical results were evaluated using the Hardcare scoring system. Also, anteroposterior and lateral radiographic views were assessed to identify the union process and presence of complications. Results The results of evaluation on 48 boys and 25 girls demonstrated that lateral condylar fractures of the humerus were more common in boys, aged 5-8 years (average: 57.1%. There was no significant relationship between complications and sex. However, according to the radiographic evaluation, while fractures in 71 (97.2% patients were completely united without any complications, 2 (2.8% patients experienced overgrowth of the lateral humeral condyle. Clinical evaluation demonstrated excellent and good outcomes in 68 and 5 patients, respectively. Also, evaluation of Hardcare scores revealed no significant relationship between complications and clinical outcomes. Conclusions The present results were in line with previous research regarding the absence of complications such as non-union, avascular necrosis, fishtail deformity, cubitus varus, cubitus valgus, and pain. The findings demonstrated that the acceptable treatment option for displaced and rotated fractures is open reduction and internal fixation. Furthermore, deformity

  11. A web-based remote radiation treatment planning system using the remote desktop function of a computer operating system: a preliminary report.

    Science.gov (United States)

    Suzuki, Keishiro; Hirasawa, Yukinori; Yaegashi, Yuji; Miyamoto, Hideki; Shirato, Hiroki

    2009-01-01

    We developed a web-based, remote radiation treatment planning system which allowed staff at an affiliated hospital to obtain support from a fully staffed central institution. Network security was based on a firewall and a virtual private network (VPN). Client computers were installed at a cancer centre, at a university hospital and at a staff home. We remotely operated the treatment planning computer using the Remote Desktop function built in to the Windows operating system. Except for the initial setup of the VPN router, no special knowledge was needed to operate the remote radiation treatment planning system. There was a time lag that seemed to depend on the volume of data traffic on the Internet, but it did not affect smooth operation. The initial cost and running cost of the system were reasonable.

  12. Bascoms operation for pilonidalcyste

    DEFF Research Database (Denmark)

    Bertelsen, C.A.; Jørgensen, Lars Nannestad

    2008-01-01

    . MATERIALS AND METHODS: 59 patients (53 male) underwent surgery between September 2004 and January 2007. The median age was 27.7 (16-48) years. The indication for surgery was recurrent pilonidal cysts in 17 cases, impaired wound healing after prior surgery in 7 cases and large cysts in 35 cases. RESULTS: All......INTRODUCTION: Treatment of pilonidal fistula often results in impaired wound healing and recurrence. After wide excision of the fistula, impaired healing and recurrence occur in up to 69% and 10-29% of cases, respectively. Based on these facts we decided to implement Bascom's cleft-lift operation...... reoperation due to infection, but none of these patients received postoperative antibiotics. 26 (44%) patients developed minor wound defects. In 22 (85%) of these cases, the wounds healed spontaneously in less than 3 months. 42 patients were followed for more than 6 months with a median follow-up of 19 (8...

  13. Atrioventricular septal defect (AVSD) : A study of 219 patients who underwent surgery for AVSD at Rikshospitalet from 1979 to 1999

    OpenAIRE

    Skraastad, Ingrid Birthe Bendixen; Skraastad, Berit Kristine

    2010-01-01

    Background: The present study evaluates 219 consecutive patients that underwent surgical repair for AVSD in a long term follow-up. Methods: The patients had a surgical correction for AVSD at Rikshospitalet from January 1979 to December 1999. The follow-up was closed in January 2009. AVSD with additional defects and syndromes were included. Results: Forty-two patients died during the observational period. Early mortality was 12.8% and late mortality was 6.4%. Early mortality declined f...

  14. A prospective randomized study of operative treatment for noncomminuted humeral shaft fractures: conventional open plating versus minimal invasive plate osteosynthesis.

    Science.gov (United States)

    Kim, Ji Wan; Oh, Chang-Wug; Byun, Young-Soo; Kim, Jung Jae; Park, Ki Chul

    2015-04-01

    To compare the clinical and radiologic results of conventional open plating (COP) and minimally invasive plate osteosynthesis (MIPO) in the treatment of noncomminuted humeral shaft fractures. Randomized prospective study. Five level 1 trauma centers. Sixty-eight consecutive patients were randomized into 2 study groups: those treated by COP (COP group; n = 32) and those treated by MIPO (MIPO group; n = 36). Simple humeral shaft fractures (AO/OTA classification types A and B) were reduced by open reduction or closed reduction and fixed with a narrow 4.5/5.0 locking compression plate, metaphyseal locking compression plate, or proximal humeral internal locking system plate to the anterior lateral aspect of the humerus. Fracture healing time, operative time, radiation exposure time, and intraoperative nerve injury. To assess shoulder and elbow function, we used the University of California, Los Angeles (UCLA) scoring system and the Mayo elbow performance index, including the range of motion and pain. Radiographic measurements included fracture alignment, delayed union, and nonunion. Thirty-one fractures (97%) healed in the COP group within 16 weeks, whereas 36 fractures (100%) were healed in the MIPO group by 15 weeks. No significant difference was observed in the operative time or complication rates. In both groups, all fractures achieved union without malunion and with excellent functional outcomes by definition of the Mayo elbow performance index and UCLA scoring system. This study confirmed a high overall rate of union and excellent functional outcomes in both MIPO and COP groups. MIPO is equivalent to COP as a safe and effective method for simple types of humeral shaft fractures when surgery is indicated, and the surgeon is experienced in the technique. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  15. Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies.

    Science.gov (United States)

    Kim, K; Cho, S Y; Park, S I; Kim, B J; Kim, M H; Choi, S C; Ryu, S Y; Lee, E D

    2011-09-01

    The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies. The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined. The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%-2% and the 3-year pelvic recurrence rate was 7%-8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies. Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Estimated cumulative radiation dose received by diagnostic imaging during staging and treatment of operable Ewing sarcoma 2005-2012

    Energy Technology Data Exchange (ETDEWEB)

    Johnsen, Boel [Haukeland University Hospital, Centre for Nuclear Medicine and PET, Department of Radiology, P.O. Box 1400, Bergen (Norway); Fasmer, Kristine Eldevik [Haukeland University Hospital, Department of Oncology, Medical Physics Section, Bergen (Norway); Boye, Kjetil [Norwegian Radium Hospital, Oslo University Hospital, Department of Oncology, Oslo (Norway); Rosendahl, Karen; Aukland, Stein Magnus [Haukeland University Hospital, Department of Radiology, Paediatric Section, Bergen (Norway); University of Bergen, Department of Clinical Medicine, Bergen (Norway); Trovik, Clement [University of Bergen, Department of Clinical Medicine, Bergen (Norway); Haukeland University Hospital, Department of Surgery, Orthopaedic Section, Bergen (Norway); Biermann, Martin [Haukeland University Hospital, Centre for Nuclear Medicine and PET, Department of Radiology, P.O. Box 1400, Bergen (Norway); University of Bergen, Department of Clinical Medicine, Bergen (Norway)

    2017-01-15

    Patients with Ewing sarcoma are subject to various diagnostic procedures that incur exposure to ionising radiation. To estimate the radiation doses received from all radiologic and nuclear imaging episodes during diagnosis and treatment, and to determine whether {sup 18}F-fluorodeoxyglucose positron emission tomography - computed tomography ({sup 18}F-FDG PET-CT) is a major contributor of radiation. Twenty Ewing sarcoma patients diagnosed in Norway in 2005-2012 met the inclusion criteria (age <30 years, operable disease, uncomplicated chemotherapy and surgery, no metastasis or residual disease within a year of diagnosis). Radiation doses from all imaging during the first year were calculated for each patient. The mean estimated cumulative radiation dose for all patients was 34 mSv (range: 6-70), radiography accounting for 3 mSv (range: 0.2-12), CT for 13 mSv (range: 2-28) and nuclear medicine for 18 mSv (range: 2-47). For the patients examined with PET-CT, the mean estimated cumulative effective dose was 38 mSv, of which PET-CT accounted for 14 mSv (37%). There was large variation in number and type of examinations performed and also in estimated cumulative radiation dose. The mean radiation dose for patients examined with PET-CT was 23% higher than for patients not examined with PET-CT. (orig.)

  17. Estimated cumulative radiation dose received by diagnostic imaging during staging and treatment of operable Ewing sarcoma 2005-2012

    International Nuclear Information System (INIS)

    Johnsen, Boel; Fasmer, Kristine Eldevik; Boye, Kjetil; Rosendahl, Karen; Aukland, Stein Magnus; Trovik, Clement; Biermann, Martin

    2017-01-01

    Patients with Ewing sarcoma are subject to various diagnostic procedures that incur exposure to ionising radiation. To estimate the radiation doses received from all radiologic and nuclear imaging episodes during diagnosis and treatment, and to determine whether 18 F-fluorodeoxyglucose positron emission tomography - computed tomography ( 18 F-FDG PET-CT) is a major contributor of radiation. Twenty Ewing sarcoma patients diagnosed in Norway in 2005-2012 met the inclusion criteria (age <30 years, operable disease, uncomplicated chemotherapy and surgery, no metastasis or residual disease within a year of diagnosis). Radiation doses from all imaging during the first year were calculated for each patient. The mean estimated cumulative radiation dose for all patients was 34 mSv (range: 6-70), radiography accounting for 3 mSv (range: 0.2-12), CT for 13 mSv (range: 2-28) and nuclear medicine for 18 mSv (range: 2-47). For the patients examined with PET-CT, the mean estimated cumulative effective dose was 38 mSv, of which PET-CT accounted for 14 mSv (37%). There was large variation in number and type of examinations performed and also in estimated cumulative radiation dose. The mean radiation dose for patients examined with PET-CT was 23% higher than for patients not examined with PET-CT. (orig.)

  18. Technical assessment of fuel cell operation on anaerobic digester gas at the Yonkers, NY, wastewater treatment plant.

    Science.gov (United States)

    Spiegel, R J; Preston, J L

    2003-01-01

    This paper summarizes the results of a 2-year field test to assess the performance of a specially modified commercial phosphoric acid 200-kW fuel cell power plant to recover energy from anaerobic digester gas (ADG) which has been cleansed of contaminants (sulfur and halide compounds) using a patented gas pretreatment unit (GPU). Specific project goals include characterization of the fuel cell power plant emissions and verification of the GPU performance for removing sulfur contaminants. To remove halide contaminants from the ADG, a halide guard, consisting of a vessel with a metal oxide supported on alumina, was incorporated into the fuel cell reactant supply. This first-of-a-kind demonstration was conducted at the Yonkers, NY, wastewater treatment plant, a sewage processing facility owned and operated by Westchester County. Results have demonstrated that the ADG fuel cell power plant can produce electrical output levels close to full power (200 kW) with negligible air emissions of CO, NO(x), and SO(2). The GPU removed virtually 100% of H(2)S and 88% of organic sulfur, bringing the overall sulfur removal efficiency of the GPU to over 99%. The halide guard removed up to 96% of the halides exiting the GPU.

  19. Operational strategies and environmental conditions inducing aerobic denitritation in short-cut biological nitrogen removal at side-line treatment.

    Science.gov (United States)

    Erdirencelebi, Dilek; Koyuncu, Serdar

    2017-06-07

    Factors promoting aerobic denitritation in a pilot-scale short-cut biological nitrogen removal (SBNR) process were investigated. The study implemented optimization of nitrogen removal in the anaerobic reject water (ARW) having a low organic C:N ratio ARW was produced in a large-scale municipal wastewater treatment plant (WWTP). Aerobic denitritation occurred consistently during study of a specific period of sequential batch reactor (SBR) where nitrite removal under fully aerobic conditions was obtained with a switch from oxygen to nitrite respiration, creating an aerobic (high oxidation-reduction potential) condition. Specific factors inducing aerobic denitritation were found related to several parameters as ammonium concentration, temperature, feeding mode, duration of the oxic stage and substrate availability due to beta-oxidation of lipid matter. Microbial analyses indicated a higher increase in nitrite reducing than ammonium oxidizing activity, as an evidence for nitrifying denitrifier bacterial dominance in the biomass. The reaction induced a reduction in the inhibitory products of the process as volatile fatty acids (VFAs) and free nitrous oxide (FNA), produced bicarbonate and increased removal efficiency of ammonium and nitrite, thus, total nitrogen. The outcome presents potential ways for further saving on aeration and chemical need via operational means, while taking advantage of the slowly degrading organic matter on SBNR performance.

  20. Anthracycline and concurrent radiotherapy as adjuvant treatment of operable breast cancer: a retrospective cohort study in a single institution

    Directory of Open Access Journals (Sweden)

    El Guddari Brahim

    2010-10-01

    Full Text Available Abstract Background Concurrent chemoradiotherapy (CCRT after breast surgery was investigated by few authors and remains controversial, because of concerns of toxicity with taxanes/anthracyclines and radiation. This treatment is not standard and is more commonly used for locally advanced breast cancer. The aim of our study was to evaluate the efficacy and safety of the concomitant use of anthracycline with radiotherapy (RT. Findings Four hundred women having operable breast cancer, treated by adjuvant chemotherapy (CT and RT in concomitant way between January 2001 and December 2003, were included in this retrospective cohort study. The study compares 2 adjuvant treatments using CCRT, the first with anthracycline (group A and the second with CMF (group B. The CT treatment was repeated every 21 days for 6 courses and the total delivered dose of RT was 50 Gy, divided as 2 Gy daily fractions. Locoregional recurrence free (LRFS, event free (EFS, and overall survivals (OS were estimated by the Kaplan-Meier method. The log-rank test was used to compare survival events. Multivariate Cox-regression was used to evaluate the relationship between patient characteristics, treatment and survival. In the 2 groups (A+B (n = 400; 249 in group A and 151 in group B, the median follow-up period was 74.5 months. At 5 years, the isolated LRFS was significantly higher in group A compared to group B (98.7% vs 95.3%; hazard ratio [HR] = 0.258; 95% CI, 0.067 to 0.997; log-rank P = .034. In addition, the use of anthracycline regimens was associated with a higher rate of 5 years EFS (80.4% vs 75.1%; HR = 0.665; 95% CI, 0.455 to 1.016; log-rank P = .057. The 5 years OS was 83.2% and 79.2% in the anthracycline and CMF groups, respectively (HR = 0.708; 95% CI, 0.455 to 1.128; log-rank P = .143. Multivariate analysis confirmed the positive effect of anthracycline regimens on LRFS (HR = 0.347; 95% CI, 0.114 to 1.053; log-rank P = .062, EFS (HR = 0.539; 95% CI, 0.344 to 0.846; P

  1. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

    Directory of Open Access Journals (Sweden)

    Luciana Takata Pontes

    2015-11-01

    Full Text Available OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  2. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital.

    Science.gov (United States)

    Takata Pontes, Luciana; Fantelli Stelini, Rafael; Cintra, Maria Leticia; Magalhães, Renata Ferreira; Velho, Paulo Eduardo N F; Moraes, Aparecida Machado

    2015-11-01

    Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating "skip areas" and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  3. 26 CFR 1.132-7T - Treatment of employer-operated eating facilities-1985 through 1988 (temporary).

    Science.gov (United States)

    2010-04-01

    ... primarily on the premises of the eating facility. Direct operating costs do not include the cost of labor... in direct operating costs, but the labor cost for a manager of an eating facility whose services... eating facility. Only 40 percent of the total labor cost of the cooks is includible in direct operating...

  4. The prognostic significance of preoperatively assessed AST/ALT (De Ritis) ratio on survival in patients underwent radical cystectomy.

    Science.gov (United States)

    Gorgel, Sacit Nuri; Kose, Osman; Koc, Esra Meltem; Ates, Erhan; Akin, Yigit; Yilmaz, Yuksel

    2017-09-01

    We aimed to evaluate prognostic significance of preoperatively assessed aspartate aminotransaminase (AST)/alanine aminotransferase (ALT) (De Ritis) ratio on survival in bladder cancer (BC) patients underwent radical cystectomy (RC). We, respectively, analysed clinical and pathological data of 153 patients who underwent RC for BC between February 2006 and December 2016 at a tertiary level hospital. The potential prognostic value of De Ritis ratio was assessed by using ROC curve analysis. The effect of the De Ritis ratio was analysed by the Kaplan-Meier method and Cox regression hazard models for patients' disease-specific survival (DSS) and overall survival (OAS). We had 149 BC patients, in total. Mean age was 61.65 ± 9.13 years. One hundred and thirty-nine (93.3%) of the patients were men. According to ROC analysis, optimal threshold of De Ritis ratio for DSS was 1.30. In Kaplan-Meier analyses, the high De Ritis ratio group showed worse progression in DSS and OAS (all parameters, p < 0.001). On Cox regression models of clinical and pathological parameters to predict DSS, De Ritis ratio (HR 5.79, 95% CI 2.25-15.13), pathological T stage (HR 15.89, 95% CI 3.92-64.33, in all p < 0.001); and to predict OAS, De Ritis ratio (HR 2.61, 95% CI 1.49-4.56; p < 0.001), pathological T stage (HR 5.42, 95% CI 2.63-11.64; p < 0.001) and age (HR 1.05, 95% CI 1.02-1.08; p = 0.001) were determined as independent prognostic factors. Preoperative elevated De Ritis ratio could be an independent prognostic factor in BC patients underwent RC. Our results should be confirmed by large and properly designed prospective, randomized trials.

  5. Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy.

    Science.gov (United States)

    Song, Guo-Min; Liu, Xiao-Ling; Bian, Wei; Wu, Jing; Deng, Yong-Hong; Zhang, Hui; Tian, Xu

    2017-04-04

    Optimal enteral immunonutrition (EIN) regime for gastric cancer (GC) patients underwent gastrectomy remains uncertainty. To assess comparative efficacy of different EIN formulas in GC patients underwent gastrectomy, we performed network meta-analysis. We included 11 RCTs enrolling 840 patients. Pairwise meta-analysis indicated that EIN (RR 0.56, 95% CI 0.36-0.86; MD -0.42, 95% CI -0.74-0.10), Arg+RNA+ω-3-FAs (RR 0.37, 95% CI 0.22-0.63; MD -0.42, 95% CI -0.75-0.07), Arg+Gln+ω-3-FAs (RR 0.22, 95% CI 0.05-0.94; MD -0.69, 95% CI -1.22-1.07) reduced ICs and LOS. Network meta-analysis confirmed the potential of Arg+RNA+ω-3-FAs for ICs (OR 0.27, 95% Crl 0.12-0.49) and Arg+Gln+ω-3-FAs for CIs (OR 0.22, 95% Crl 0.02-0.84) and LOS (SMD -0.63, 95% Crl -1.07-0.13), and indicated that Arg+RNA+ω-3-FAs was superior to Arg+RNA and Arg+Gln for ICs as well. We performed direct and network meta-analyses for randomized controlled trials comparing EIN formulas with each other or standard enteral nutrition (SEN) in reducing infectious complications (ICs), noninfectious complications (NICs) and length of hospital stay (LOS), through January 2016. The surface under the cumulative ranking curve (SCURA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to rank regimes and rate qualities of evidences respectively. As for GC patients underwent gastrectomy, Arg+RNA+ω-3-FAs and Arg+Gln+ω-3-FAs are the optimal regimes of reducing ICs and LOS.

  6. Ankle Fractures: The Operative Outcome

    Directory of Open Access Journals (Sweden)

    Ahmad Hafiz Z

    2011-03-01

    Full Text Available Ankle fractures are commonly seen in orthopaedic practice. This retrospective study of patients with ankle fractures who underwent surgical treatment in our institution from January 2000 to December 2003 was undertaken to analyze the common causes and patterns of ankle fractures; and the functional outcome of operative treatment for these fractures. Eighty patients were identified and reviewed. There were 65 male (81.3% and 15 female patients (18.7% with age ranging from 13 to 71 years old (mean, 32.3y. Common causes of ankle fractures were trauma (especially motor vehicle accidents, sports injuries and the osteoporotic bones in the elderly. Weber C (64.0% was the most common pattern of fracture at presentation. The most common operative treatment for ankle fractures was open reduction and internal fixation (73 patients, 91.2%. Excellent and good outcomes were achieved in 93.8% of cases when measured using the Olerud and Molander scoring system for foot and ankle. In conclusion, operative treatment for ankle fractures restores sufficient stability and allowed mobility of the ankle joint.

  7. [Four patients with hepatitis A presenting with fulminant hepatitis and acute renal failure and who underwent liver transplantation].

    Science.gov (United States)

    Oh, Se Hoon; Lee, Joon Hyoek; Hwang, Ji Won; Kim, Hye Young; Lee, Chang Hoon; Gwak, Geum Youn; Choi, Moon Seok; Koh, Kwang Chul; Paik, Seung Woon; Yoo, Byung Chul

    2009-09-01

    Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (>/=39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of submassive hepatic necrosis.

  8. Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

    Directory of Open Access Journals (Sweden)

    Srinivasa Prasad

    2017-07-01

    Conclusion: In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73. Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03. FFR based revascularization decision appears to be a safe strategy in Indian patients.

  9. SU-E-T-785: Using Systems Engineering to Design HDR Skin Treatment Operation for Small Lesions to Enhance Patient Safety

    International Nuclear Information System (INIS)

    Saw, C; Baikadi, M; Peters, C; Brereton, H

    2015-01-01

    Purpose: Using systems engineering to design HDR skin treatment operation for small lesions using shielded applicators to enhance patient safety. Methods: Systems engineering is an interdisciplinary field that offers formal methodologies to study, design, implement, and manage complex engineering systems as a whole over their life-cycles. The methodologies deal with human work-processes, coordination of different team, optimization, and risk management. The V-model of systems engineering emphasize two streams, the specification and the testing streams. The specification stream consists of user requirements, functional requirements, and design specifications while the testing on installation, operational, and performance specifications. In implementing system engineering to this project, the user and functional requirements are (a) HDR unit parameters be downloaded from the treatment planning system, (b) dwell times and positions be generated by treatment planning system, (c) source decay be computer calculated, (d) a double-check system of treatment parameters to comply with the NRC regulation. These requirements are intended to reduce human intervention to improve patient safety. Results: A formal investigation indicated that the user requirements can be satisfied. The treatment operation consists of using the treatment planning system to generate a pseudo plan that is adjusted for different shielded applicators to compute the dwell times. The dwell positions, channel numbers, and the dwell times are verified by the medical physicist and downloaded into the HDR unit. The decayed source strength is transferred to a spreadsheet that computes the dwell times based on the type of applicators and prescribed dose used. Prior to treatment, the source strength, dwell times, dwell positions, and channel numbers are double-checked by the radiation oncologist. No dosimetric parameters are manually calculated. Conclusion: Systems engineering provides methodologies to

  10. SU-E-T-785: Using Systems Engineering to Design HDR Skin Treatment Operation for Small Lesions to Enhance Patient Safety

    Energy Technology Data Exchange (ETDEWEB)

    Saw, C; Baikadi, M; Peters, C; Brereton, H [Northeast Radiation Oncology Centers, Harrisburg, PA (United States)

    2015-06-15

    Purpose: Using systems engineering to design HDR skin treatment operation for small lesions using shielded applicators to enhance patient safety. Methods: Systems engineering is an interdisciplinary field that offers formal methodologies to study, design, implement, and manage complex engineering systems as a whole over their life-cycles. The methodologies deal with human work-processes, coordination of different team, optimization, and risk management. The V-model of systems engineering emphasize two streams, the specification and the testing streams. The specification stream consists of user requirements, functional requirements, and design specifications while the testing on installation, operational, and performance specifications. In implementing system engineering to this project, the user and functional requirements are (a) HDR unit parameters be downloaded from the treatment planning system, (b) dwell times and positions be generated by treatment planning system, (c) source decay be computer calculated, (d) a double-check system of treatment parameters to comply with the NRC regulation. These requirements are intended to reduce human intervention to improve patient safety. Results: A formal investigation indicated that the user requirements can be satisfied. The treatment operation consists of using the treatment planning system to generate a pseudo plan that is adjusted for different shielded applicators to compute the dwell times. The dwell positions, channel numbers, and the dwell times are verified by the medical physicist and downloaded into the HDR unit. The decayed source strength is transferred to a spreadsheet that computes the dwell times based on the type of applicators and prescribed dose used. Prior to treatment, the source strength, dwell times, dwell positions, and channel numbers are double-checked by the radiation oncologist. No dosimetric parameters are manually calculated. Conclusion: Systems engineering provides methodologies to

  11. Clinical Application of Adjuvant Treatment after Operation in Patients with Stage IIIa Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yajie GAO

    2010-04-01

    Full Text Available Background and objective The efficacy of complete resection of the cancer for patients with stage IIIa non-small cell lung cancer (NSCLC is limited. Synthetic therapy is taken the lead in advocating at present. However, the value of post-operative radiotherapy is not still clear. The aim of this study is to evaluate the survival time and side effects of postoperative chemotherapy or chemoradiotherapy in the treatment of stage IIIa NSCLC. Methods Between December 2003 and June 2007, 52 cases that have completed followed-up data with stage IIIa of NSCLC received in the First Affiliated Hospital of Dalian Medical University. Twenty-three patients received postoperative chemoradiotherapy (group A and 29 patients received postoperative chemotherapy combined with radiotherapy (group B. Group A adopted platinum-based combination chemotherapy for 4-6 cycles. The chemotherapeutics included gemcitabine, vinorelbine and docetaxel. Group B used chemotherapy for 2-4 cycles and then received 3-dimensional conformal radiotherapy (3D-CRT. The prescribe dose of target volume was 50 Gy. The chemotherapy was same as for group A and needed 4 cycles in all. The impact of postoperative adjuvant treatment on survival and toxicity was observed in patients with stage IIIa NSCLC and the reason of disease progression was analyzed. Results The median survival was 32.5 months in group A and 31.9 months in group B (P=0.371. Progression-free survival extended about 6 months (P=0.044. The survival rate was 87% at 1 year, 0.1% at 2 year, 33% at 3 year for group A compared with 93%, 69%, 45% for group B. The major side effects were hematological and gastrointestinal toxicities, including nausea, vomiting and neutropenia. There was no significant difference in these toxicities between the two groups (P>0.05. Radioactiv esophageal infection occurred in 17.2% of the patients. Acute and late radioactive lung infection occurred in 13.8% and 27.6% of the patients. All these toxicities

  12. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery.

    Science.gov (United States)

    Nunes, Viviane Regina Hernandez; Jacob, Charbel; Cardoso, Igor Machado; Batista, José Lucas; Brazolino, Marcus Alexandre Novo; Maia, Thiago Cardoso

    2016-01-01

    To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

  13. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery

    Directory of Open Access Journals (Sweden)

    Viviane Regina Hernandez Nunes

    Full Text Available ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. CONCLUSION: This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

  14. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

    Directory of Open Access Journals (Sweden)

    Lirong Zhang

    2018-01-01

    Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  15. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Wada, Hideki; Dohi, Tomotaka; Miyauchi, Katsumi; Doi, Shinichiro; Naito, Ryo; Konishi, Hirokazu; Tsuboi, Shuta; Ogita, Manabu; Kasai, Takatoshi; Hassan, Ahmed; Okazaki, Shinya; Isoda, Kikuo; Suwa, Satoru; Daida, Hiroyuki

    2017-06-01

    Malnutrition has been identified as an important predictor of poor clinical outcomes in patients with heart failure. The aim of this study is to examine the prognostic impact of nutritional status in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). The impact of nutrition, assessed using the geriatric nutritional risk index (GNRI) calculated by serum albumin and body mass index, was evaluated in 2,853 patients with CAD who underwent their first PCI between 2000 and 2011. Patients were assigned to tertiles based on their GNRI levels. The incidences of all-cause death and cardiac death were assessed. The median GNRI values were 101 (interquartile range 95 to 106). Lower GNRI levels were associated with older age and higher prevalence of acute coronary syndrome and chronic kidney disease. During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of mortality among tertiles (GNRI nutritional status was associated with long-term clinical outcomes in CAD patients after PCI. Evaluation of GNRI carries important prognostic information and may guide the therapeutic approach to such patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Continuous treatment of non-sterile hospital wastewater by Trametes versicolor: How to increase fungal viability by means of operational strategies and pretreatments.

    Science.gov (United States)

    Mir-Tutusaus, J A; Sarrà, M; Caminal, G

    2016-11-15

    Hospital wastewaters have a high load of pharmaceutical active compounds (PhACs). Fungal treatments could be appropriate for source treatment of such effluents but the transition to non-sterile conditions proved to be difficult due to competition with indigenous microorganisms, resulting in very short-duration operations. In this article, coagulation-flocculation and UV-radiation processes were studied as pretreatments to a fungal reactor treating non-sterile hospital wastewater in sequential batch operation and continuous operation modes. The influent was spiked with ibuprofen and ketoprofen, and both compounds were successfully degraded by over 80%. UV pretreatment did not extent the fungal activity after coagulation-flocculation measured as laccase production and pellet integrity. Sequential batch operation did not reduce bacteria competition during fungal treatment. The best strategy was the addition of a coagulation-flocculation pretreatment to a continuous reactor, which led to an operation of 28days without biomass renovation. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the monitoring, prevention and treatment of post-operative recurrence in Crohn's disease.

    Science.gov (United States)

    Domènech, Eugeni; López-Sanromán, Antonio; Nos, Pilar; Vera, Maribel; Chaparro, María; Esteve, María; Gisbert, Javier P; Mañosa, Míriam

    Despite the availability of new, powerful drugs for Crohn's disease, a significant proportion of patients will undergo an intestinal resection to control the disease as it develops. In the absence of an effective preventative treatment, the appearance of new intestinal lesions after surgery for Crohn's disease is the norm; this is known as post-operative recurrence and may appear very early on, even a few weeks after the surgical resection. Furthermore, the drugs that are currently available for the prevention of post-operative recurrence have a limited effect; up to 50% of cases present recurrent Crohn's disease activity despite the preventative treatment, which may require further surgery with the consequent loss of intestinal function, leading some patients to suffer from short bowel syndrome as an irreversible complication. The management of Crohn's disease patients who undergo an intestinal resection should thus be geared towards prevention, early detection and, in the worst case scenario, the treatment of post-operative recurrence. This article reviews the natural history, diagnostic measures, monitoring, prevention and treatment of post-operative recurrence, and proposes recommendations based on existing knowledge. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  18. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; Jong, M. de; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; Thiel, T.P. van; Rijcke, P.A. de; Soesman, N.M.; Hagenaars, T.; Boekhoudt, F.D.; Vries, M.R. de; Roukema, G.R.; Tanka, A.F.; Bremer, J. van den; Meulen, H.G. van der; Bronkhorst, M.W.; Dijkman, B.A. van; Zutphen, S.W. van; Vos, Dieuwke; Schep, N.W.; Eversdijk, M.G.; Olden, G.D.J. van; Brand, J.G. van den; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    BACKGROUND: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and

  19. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; de Jong, M.; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; van Thiel, T.P.H.; de Rijcke, P.A.R.; Soesman, N.M.R.; Hagenaars, T.; Boekhoudt, F.D.; de Vries, M.R.; Roukema, G.R.; Tanka, A.F.K.; van den Bremer, J.; van der Meulen, H.G.W.M.; Bronkhorst, M.W.G.A.; van Dijkman, B.A.; van Zutphen, S.W.A.M.; Vos, D.I.; Schep, N.W.L.; Eversdijk, M.G.; van Olden, G.D.J.; van den Brand, J.G.H.; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    Background: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and

  20. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, Sylvia A.; de Jong, Mireille; Sier, Cornelis F. M.; Krijnen, Pieta; Duijff, Jan W.; van Thiel, Tom P. H.; de Rijcke, Piet A. R.; Soesman, Nicolaj M. R.; Hagenaars, Tjebbe; Boekhoudt, Freek D.; de Vries, Mark R.; Roukema, Gert R.; Tanka, Andras F. K.; van den Bremer, Jephta; van der Meulen, Hub G. W. M.; Bronkhorst, Maarten W. G. A.; van Dijkman, Bart A.; van Zutphen, Stephan W. A. M.; Vos, Dagmar I.; Schep, Niels W. L.; Eversdijk, Martin G.; van Olden, Ger D. J.; van den Brand, Johan G. H.; Hillen, Robert Jan; Frölke, Jan Paul M.; Schipper, Inger B.

    2011-01-01

    The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified

  1. Displaced midshaft fractures of the clavicle: Non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    S.A. Stegeman (Sylvia); M. de Jong (Mireille); C.F.M. Sier (Cornelis); P. Krijnen (Pieta); J.W. Duijff (Jan); T.P.H. Thiel (Tom); P.A.R. Rijcke (Piet); N.M.R. Soesman (Nicolaj); T. Hagenaars (Tjebbe); F.D. Boekhoudt (Freek D.); M.R. de Vries (Mark); G.R. Roukema (Gert); A.F.K. Tanka (Andras); J. van den Bremer (Jephta); H.G.W.M. Meulen (Hub); M.W.G.A. Bronkhorst (Maarten); B.A. van Dijkman (Bart); S.W.A.M. van Zutphen (Stephan); D.I. Vos (Dagmar); N.W.L. Schep (Niels); M.G. Eversdijk (Martin); G.D.J. van Olden (Ger); J.G.H. van den Brand (Johan); R. Hillen (Robert); J.P.M. Frölke (Jan Paul); I.B. Schipper (Inger)

    2011-01-01

    textabstractBackground: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of

  2. A Guide for Developing Standard Operating Job Procedures for the Activated Sludge - Aeration & Sedimentation Process Wastewater Treatment Facility. SOJP No. 5.

    Science.gov (United States)

    Mason, George J.

    This guide for developing standard operating job procedures for wastewater treatment facilities is devoted to the activated sludge aeration and sedimentation process. This process is for conversion of nonsettleable and nonfloatable materials in wastewater to settleable, floculated biological groups and separation of the settleable solids from the…

  3. Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation.

    Science.gov (United States)

    Towe, Christopher T; White, Frances V; Grady, R Mark; Sweet, Stuart C; Eghtesady, Pirooz; Wegner, Daniel J; Sen, Partha; Szafranski, Przemyslaw; Stankiewicz, Pawel; Hamvas, Aaron; Cole, F Sessions; Wambach, Jennifer A

    2018-03-01

    To describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation. We reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital. We compared their histology with infants with classic ACDMPV and compared their outcomes with infants transplanted for other indications. In contrast with neonates with classic ACDPMV who present with severe hypoxemia and refractory pulmonary hypertension within hours of birth, none of the infants with atypical ACDMPV presented with progressive neonatal respiratory failure. Three infants had mild neonatal respiratory distress and received nasal cannula oxygen. Three other infants had no respiratory symptoms at birth and presented with hypoxemia and pulmonary hypertension at 2-3 months of age. Bilateral lung transplantation was performed at 4-20 months of age. Unlike in classic ACDMPV, histopathologic findings were not distributed uniformly and were not diffuse. Three subjects had apparent nonmosaic genetic defects involving FOXF1. Two infants had extrapulmonary anomalies (posterior urethral valves, inguinal hernia). Three transplanted children are alive at 5-16 years of age, similar to outcomes for infants transplanted for other indications. Lung explants from infants with atypical ACDMPV demonstrated diagnostic but nonuniform histopathologic findings. The 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications. Given the clinical and histopathologic spectra, ACDMPV should be considered in infants with hypoxemia and pulmonary hypertension, even beyond the newborn period. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

    Science.gov (United States)

    Punchick, Boris; Freud, Tamar; Press, Yan

    2016-01-01

    Abstract The prevalence of cognitive impairment and orthostatic hypotension (OH) increases with age, but the results of studies that assessed possible associations between them are inconsistent. The aim of this study is to assess possible associations between cognitive impairment and OH in patients ≥65 years of age who underwent a comprehensive geriatric assessment. A retrospective analysis was conducted of the computerized medical records of the study population from 2005 to 2013. Data collected included blood pressure measurements that enabled the calculation of OH, results of the mini-mental state examination (MMSE), results of the Montreal cognitive assessment (MoCA) test, and cognitive diagnoses that were determined over the course of the assessment. The rate of OH in the study population of 571 adults was 32.1%. The mean MMSE score was 22.5 ± 5.2 among participants with OH and 21.6 ± 5.8 among those without OH (P = 0.09). The absence of a significant association between OH and MMSE remained after adjusting the MMSE score for age and education level. The mean MoCA score was 16.4 ± 5.0 among participants with OH and 16.4 ± 4.8 among those without (P = 0.33). The prevalence of OH was 39% among participants without cognitive impairment, 28.9% among those with mild cognitive impairment (MCI), and 30.6% among those with dementia (P = 0.13). There was no association between OH and cognitive impairment in adults who underwent a comprehensive geriatric assessment. PMID:27442658

  5. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention.

    Science.gov (United States)

    Konishi, Hirokazu; Miyauchi, Katsumi; Kasai, Takatoshi; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Katoh, Yoshiteru; Okai, Iwao; Tamura, Hiroshi; Okazaki, Shinya; Daida, Hiroyuki

    2014-09-01

    Limited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. Between 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m(2). The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08-19.1, p=0.04) for young adults. Current smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  6. [Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis].

    Science.gov (United States)

    Aceves-Velázquez, Eduardo; Vieyra-Herrera, Gerardo; Rodríguez-Chávez, Laura; Herrera-Alarcón, Valentín

    2017-07-16

    According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  7. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  8. Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization

    NARCIS (Netherlands)

    Davids, P. H.; Luitse, J. S.; Strating, R. P.; van der Hart, C. P.

    1996-01-01

    Fourteen patients were treated operatively for delayed union and nonunion of midshaft clavicular fractures from 1986 to 1994. Radiographically, nine nonunions were atrophic and five hypertrophic, The operative technique included opening the medullary canal, bone grafting, and fixation with an AO

  9. Treatment results and prognostic analysis of 47 patients with urethral transitional cell carcinoma treated with post-operative adjuvant radiotherapy

    International Nuclear Information System (INIS)

    He Ke; Hou Xiaorong; Shen Jie; Lian Xin; Sun Shuai; Zhang Fuquan

    2010-01-01

    Objective: To evaluate treatment results and prognostic factors of 47 patients with primary urethral transitional cell carcinoma treated with post-operative adjuvant radiotherapy. Methods: From October 1998 to October 2008, 47 patients with primary urethral transitional cell carcinoma received postoperative adjuvant radiotherapy. Thirty-one patients had stage T 3 /T 4 disease, 7 had lymph node metastasis. Thirty-nine patients had G3 tumor, 13 had stump-positive. The median radiotherapy dose was 60 Gy (36-64 Gy). 81% patients (38/47) were treated with regional irradiation. Results: The median follow-up time was 21 months (6 -88 months). The follow-up rate was 92%. The median overall survival time was 35 months (5 -88 months). The 2-and 5-year overall survival rates were 57% and 49%, respectively. In univariate analysis, the median overall survival time was better in patients with stage T 1 or T 2 compared with stage T 3 or T 4 tumor (42 months vs. 19 months, χ 2 =7.28, P=0.007), with age of ≤65 years compared with >65 years (28 mouths vs 18 months,χ 2 =8.23, P =0.004). There was no significant difference in the long term survival in patients with non-radical surgery compared with radical mastectomy (21 months vs. 20 months, χ 2 = 0.90, P = 0.344). In multivariate analysis, the stage T 3 or T 4 (χ 2 = 7.89, P =0.005), >65 years old (χ 2 = 4.85, P = 0.028), renal pelvis involvement (χ 2 = 5.65, P = 0.018), and tumor located in the mid or inferior segment (χ 2 =6.08,P =0.014) were factors associated with poorer prognosis. Conclusions: Postoperative adjuvant radiotherapy can improve the efficacy of patients with locally advanced urethral transitional cell carcinoma. Advanced T stage and > 65 years age are associated with poorer prognosis. (authors)

  10. Operative treatment of acute acromioclavicular dislocations Rockwood III and V-Comparative study between K-wires combined with FiberTape(®) vs. TightRope System(®).

    Science.gov (United States)

    Vrgoč, G; Japjec, M; Jurina, P; Gulan, G; Janković, S; Šebečić, B; Starešinić, M

    2015-11-01

    Acromioclavicular (AC) joint dislocations usually occur in a young active population as a result of a fall on the shoulder. Rockwood divided these dislocations into six types. Optimal treatment is still a matter of discussion. Many operative techniques have been developed, but the main choice is between open and minimally-invasive arthroscopic procedures. The aim of this study was to compare two different surgical methods on two groups of patients to find out which method is superior in terms of benefit to the patient. The methods were evaluated through objective and subjective scores, with a focus on complications and material costs. A retrospective two-centre study was conducted in patients with acute AC joint dislocation Rockwood types III and V. The two methods conducted were an open procedure using K-wires combined with FiberTape(®) (Arthrex, Naples, USA) (Group 1) and an arthroscopic procedure using the TightRope System(®) (Arthrex, Naples, USA) (Group 2). Groups underwent procedures during a two-year period. Diagnosis was based on the clinical and radiographic examination of both AC joints. Surgical treatment and rehabilitation were performed. Sixteen patients were included in this study: Group 1 comprised 10 patients, all male, average age 41.6 years (range 17-64 years), Rockwood type III (eight patients) and Rockwood type V (two patients); Group 2 had six patients, one female and five male, average age 37.8 years (range 18-58 years), Rockwood type III (two patients) and Rockwood type V (four patients). Time from injury to surgery was shorter and patients needed less time to return to daily activities in Group 1. Duration of the surgical procedure was shorter in Group 2 compared with Group 1. Complications of each method were noted. According to the measured scores and operative outcome between dislocation Rockwood type III and V, no significant difference was found. Implant material used in Group 2 was 4.7 times more expensive than that used in Group 1

  11. Operational strategy, economic and environmental performance of sludge treatment reed bed systems - based on 28 years of experience

    DEFF Research Database (Denmark)

    Nielsen, S.; Larsen, Julie Dam

    2016-01-01

    and hazardous organic compounds, qualities that make it suitable for recycling on agricultural land. The upfront capital cost for STRBs are often higher compared to mechanical dewatering devices. However, the operational expenses (OPEX) (including energy, chemicals, bio solid handling) are significantly lower...... compared to conventional mechanical dewatering devices, delivering an economic break-even of about 3-5 years. This paper provides an overview of the operation and maintenance costs and environmental benefits of a typical STRB based on the experiences gained from the operation of a large number of STRBs...

  12. [A new operation in the treatment of refractory glaucoma: limbo-sclerectomy with valvular drainage of supraciliary space].

    Science.gov (United States)

    Lapochkin, V I; Svirin, A V; Korchuganova, E A

    2001-01-01

    A new antiglaucoma operation has been developed: limbosclerectomy with valvular drainage of the supraciliary space. The operation was performed on 82 eyes with artiphakia, pseudophakia, and previously operated primary open-angle glaucoma. The patients were observed for 1.3 +/- 0.6 years after the intervention. Compensation of intraocular pressure and a significant increase in the coefficient of liquid discharge facility were observed in remote periods in all patients: in 95.1% patients without hypotensive therapy and in 4.9% cases instillations of 0.5% thimolol maleate twice a day were needed. Visual acuity and visual field borders did not appreciably change after the intervention. The operation is recommended for practice.

  13. 65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

    Directory of Open Access Journals (Sweden)

    M. Qasem

    2016-07-01

    Full Text Available Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119 case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2% had normal coronary and normal LV function. Twenty cases (17% of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic, ischemic MR (8.4%, LV apical aneurysm (0.8%, significant pericardial effusion (0.80%. Acute pulmonary edema in 17 cases (14.3%: six cases (5.1% developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′  >20, 9 cases (7.6% develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7% develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8% presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7% with severe fibro degenerative MR, 2 cases (1.7% with mild to moderate AR and 2 cases (1.7% with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

  14. Cross-sectional evaluation of post-operative pain and flare-ups in endodontic treatments using a type of rotary instruments.

    Science.gov (United States)

    Tanalp, Jale; Sunay, Hakki; Bayirli, Gündüz

    2013-01-01

    The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. Pulpal necrosis without periapical pathosis was determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). Teeth with pre-operative pain were more prone to developing post-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapical pathosis and post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developing pain and flare-ups compared to those with no periapical involvement (p = 0.0001). Future

  15. The Effects of Functional Knee Brace on Postural Control in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Salehi

    2016-09-01

    Full Text Available Background The current study aimed to evaluate the postural control in patients underwent anterior cruciate ligament reconstruction pre and post wearing functional knee brace. Methods Eighteen athletes undergone unilateral anterior cruciate ligament reconstruction included in the study. They had unilateral anterior cruciate ligament reconstruction at least six months before session test. Postural control was assessed pre and post wearing custom-fit functional knee brace using a posturographic platform prokin 254. The balance tests included: 1 standing on prokin platform with eyes open/closed on anterior cruciate ligament reconstruction limb, 2 standing on prokin platform with eyes open/closed on both limbs. The standard deviation (SD of body sway along the anteroposterior (AP and mediolateral (ML axis, mean velocity of center of pressure (COP along AP/ ML axis and the area ellipse (measured in 2 mm were calculated. Results Results of the paired T-test revealed a significant effect on selected postural control variables for the brace conditions especially in low challengeable conditions (double leg, eyes open test situations (P < 0.05. But in high challengeable conditions this effect was not significant. Conclusions Functional knee brace improved postural control in the simple balancing task in the subjects with anterior cruciate ligament reconstruction. But this improvement in more difficult balancing task was limited.

  16. The Effect of Prazosin and Oxybutynin on the Symptoms Due to Using Double J Catheter in Patients Underwent TUL

    Directory of Open Access Journals (Sweden)

    K. Tavakkoli Tabassi

    2014-01-01

    Full Text Available Background & Aims: Double J catheter has been used for years as an independent practice or a part of other urological practices. Although these catheters have solved many patients’ problems but those can cause symptoms and problems for patients. The aim of this study was the investigation the effect of prazosin and oxybutynin on the degree of symptoms due to using Double J catheter. Methods: In this interventional study, patients who underwent TUL from July 2008 to march 2008 in the lithotripsy ward of Imam Reza hospital were entered to the study and randomly divided in 3 groups randomly. In the first group, placebo, in the second group, oxybutynin, in the third group prazosin were prescribed. Three weeks later standard questionnaire Ureteric Stent Symptom Questionnaire (USSQ was completed. After collecting data, was analyzed using SPSS software. Results: A total of 113 patients (70 men 43 women were included to the study. The mean age was 39 years. There were no significance difference among urinary symptoms score pain of body and physical activity problems in three groups (P>0.05, but there was a significant difference in general health and work problems among them (P<0.05. Conclusion: Oxybutynin caused a low effect on improvement of general health and work problems in patients who were studied. It might Prazosin does not has a sufficient time to affect on urinary symptoms, because of shortness of usage.

  17. Factors associated with late specialized rehabilitation among veterans with lower extremity amputation who underwent immediate postoperative rehabilitation.

    Science.gov (United States)

    Kurichi, Jibby E; Xie, Dawei; Kwong, Pui L; Bates, Barbara E; Vogel, W Bruce; Stineman, Margaret G

    2011-05-01

    The aim of this study was to determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Data were obtained from eight administrative databases for 2,453 patients who underwent lower limb amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazard ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from surgical hospitalization. There were 2304 patients who received only immediate postoperative services, whereas 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared with the Southeast region, and had their surgeries in facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were all more likely to receive late services. The hazard ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt; however, after 3 mos, those who received early specialized rehabilitation were significantly less likely to receive late services. The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding units accredited by the Commission on Accreditation of Rehabilitation Facilities.

  18. Anatomical location of metastatic lymph nodes: an indispensable prognostic factor for gastric cancer patients who underwent curative resection.

    Science.gov (United States)

    Zhao, Bochao; Zhang, Jingting; Zhang, Jiale; Chen, Xiuxiu; Chen, Junqing; Wang, Zhenning; Xu, Huimian; Huang, Baojun

    2018-02-01

    Although the numeric-based lymph node (LN) staging was widely used in the worldwide, it did not represent the anatomical location of metastatic lymph nodes (MLNs) and not reflect extent of LN dissection. Therefore, in the present study, we investigated whether the anatomical location of MLNs was still necessary to evaluate the prognosis of node-positive gastric cancer (GC) patients. We reviewed 1451 GC patients who underwent radical gastrectomy in our institution between January 1986 and January 2008. All patients were reclassified into several groups according to the anatomical location of MLNs and the number of MLNs. The prognostic differences between different patient groups were compared and clinicopathologic features were analyzed. In the present study, both anatomical location of MLNs and the number of MLNs were identified as the independent prognostic factors (p location of MLNs was considered (p location of MLNs had no significant effect on the prognosis of these patients, the higher number of MLNs in the extraperigastric area was correlated with the unfavorable prognosis (p location of MLNs was an important factor influencing the prognostic outcome of GC patients. To provide more accurate prognostic information for GC patients, the anatomical location of MLNs should not be ignored.

  19. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases : a review of the literature and a comparison with operative cases

    NARCIS (Netherlands)

    Groen, R J M

    OBJECTIVE: To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH). METHODS: The literature was reviewed regarding non-operative cases of SSEH (SSEH(cons)). Sixty-two cases from the literature and 2 of our own cases were collected,

  20. [Comparison of Short-Therm Results of Conservative versus Operative Treatment of Distal Ulna Fractures Associated with Distal Radius Fracture Treated by Plate Osteosynthesis].

    Science.gov (United States)

    Meluzinová, P; Kopp, L; Dráč, P; Edelmann, K; Obruba, P

    2017-01-01

    PURPOSE OF THE STUDY The study aims to evaluate and compare the results of conservative and operative treatment of individual types of distal ulna fractures associated with distal radius fracture treated by plate osteosynthesis and to verify the conclusions of the other authors regarding the recommended therapeutic procedures in these fractures. MATERIAL AND METHODS In the period from 08/2013 to 09/2015, a total of 81 patients participated in the prospective randomised study, with the mean follow-up period of 24 months (6-36). All the fractures of distal two thirds of ulnar styloid process were treated conservatively. The patients with the other types of ulnar fractures (fractures of the proximal third of ulnar styloid process, ulnar head fractures, subcapital fractures) were systematically divided into two cohorts, based on which the subsequent (conservative vs. operative) treatment of distal ulna fractures was indicated. The operative treatment of all the types of distal ulna fractures was performed by plate osteosynthesis using LCP Distal Ulna Plate implant so that a uniform method is applied. RESULTS In the post-operative follow-up not a single patient with tip fracture of ulnar styloid process in the cohort showed a posttraumatic instability or disorder of distal radioulnar joint (DRUJ) biomechanics (ROM 96.6% (91-100), MWS 61.3 points (75-100), QDASH 2.9 points (0-6.8)). The patients with a fracture of the proximal third of ulnar styloid process, a fracture of ulnar head and a subcapital fracture, treated operatively, achieved better early radiographic and functional outcome (ROM 95.7% (60-100), MWS 91.2 points (75-100), QDASH 3.5 points (0-11.4)) than patients treated conservatively (ROM 89.6% (64-100), MWS 70.4 points (35-85), QDASH 18.4 points (0-52.3)). DISCUSSION The study confirms the conclusions drawn by the other authors that tip fractures of ulna do not cause posttraumatic DRUJ instability and do not require operative treatment. Conservative

  1. COMPARATIVE RADIOGRAPHIC ANALYSIS OF THE RESULTS OF TREATMENT OF HALLUX VALGUS DEFORMITY ACCORDING TO MITCHELL AND KELLER OPERATIVE METHODS

    Directory of Open Access Journals (Sweden)

    Georgieva Daniela

    2016-03-01

    Full Text Available Introduction: Hallux valgus represents a complex progressive deformity of the front part of the foot, with the most distinguished malformation as lateral deviation of the toe. Radiography is extremely important in the decision of the surgical procedure for the best correction of this deformity. Aim:The aim of this work is to show the significance of radiographic examinations in operated patients with Hallux Valgus deformityaccording to Mitchell and Keller techniques. Material and methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided to two groups. The patients were grouped according their sex, age, the degree of deformity (moderate or severe degree of deformity and according to radiographic findings. The first group (Group 1 was composed of 35 patients who were treated by osteotomy of the 1st metatarsal bone according to Mitchell, while the second group (Group 2 was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Radiographic examinations (Method of Hardy and Clapham, Piggott classification, presence and absence of the secondary arthritic and reactive changes of the first metatarsophalangeal joint were analyzed comparatively during the evaluation. The analyses of the radiographic results were performed pre-operatively and post-operatively for the two groups. Results: According to their sex, the patients were 5 men and 65 women. The average age of the patients in group 1 was 42 years, while for group 2 it was 56 years. There is no significant difference (p>0.05 in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and 1st intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p<0.001. The patients operated by Mitchell’s technique, according to Piggott classification

  2. Use of emission spectroscopy as a tool for optimization of plasma hearth operation for hazardous waste thermal treatment

    International Nuclear Information System (INIS)

    Monts, D.L.; Bauman, L.E.; Lengel, R.K.; Wang, W.; Lin, J.; Cook, R.L.; Shepard, W.S.

    1994-01-01

    Thermal processing of mixed wastes by plasma hearth vitrification requires optimization of and continuous monitoring of plasma hearth operation. A series of investigations utilizing emission spectroscopy has been initiated to characterize the plasma of a 96 kW plasma hearth in order to determine optimum conditions for monitoring and hence controlling plasma hearth performance. The plasma hearth test stand is based upon a 96 kW, transferred arc plasma torch. The torch is mounted in a vacuum vessel through an electrically operated XYZ Gimbal mount. The peak operating power depends on the gas used for the plasma. The operational limits for DC voltage are 180 V to 550 V; and the current is operated at a constant value, selectable in the range from 72 to 200 amps. The plasma arc length can be varied from 2.5 cm to 25 cm, and is dependent on the supply voltage and the process gas used. The arc current and voltage, gas pressure, cooling water flow, and cooling water temperature are monitored and stored by a PC-based data acquisition system. Five optical ports are available for making optical diagnostic measurements

  3. A Retrospective Case-Matched Cost Comparison of Surgical Treatment of Melanoma and Nonmelanoma Skin Cancer in the Outpatient Versus Operating Room Setting.

    Science.gov (United States)

    Johnson, Ryan P; Butala, Niraj; Alam, Murad; Lawrence, Naomi

    2017-07-01

    To date, no study has used authentic billing data in a case-control matched fashion to examine the cost of treating skin cancer in different settings. To compare the cost of surgical treatment of skin cancer in the outpatient versus operating room setting using matched cases based on patient and skin cancer characteristics. ICD-9 diagnosis codes for skin cancers were used to find patients who had a malignant excision current procedural terminology code in the operating room setting during 2010 to 2014. Patient and skin cancer characteristics were used to match cases to those treated as an outpatient. A total of 36 cases (18 operating room and 18 outpatient) had the required information and characteristics to be matched and analyzed for cost. Health status was determined using the American Society of Anesthesiologists anesthesia grading scale. No statistically significant differences were found in the age (p > 0.9) or American Society of Anesthesiologists scores (p > 0.6) of the outpatient and operating room cases. The median cost for outpatient cases was $1,745. For operating room cases, the median cost was $11,323. This was a statistically significant difference (p skin cancer compared with the operating room.

  4. Economical assessment of the design, construction and operation of open-bed biofilters for waste gas treatment.

    Science.gov (United States)

    Prado, O J; Gabriel, D; Lafuente, J

    2009-06-01

    A protocol was developed with the purpose of assessing the main costs implied in the set-up, operation and maintenance of a waste gas-treating conventional biofilter. The main operating parameters considered in the protocol were the empty bed residence time and the gas flow rate. A wide variety of investment and operating costs were considered. In order to check its reliability, the protocol was applied to a number of scenarios, with biofilter volumes ranging from 8.3 to 4000 m(3). Results show that total annualized costs were between 20,000 and 220,000 euro/year and directly dependent, among other factors, on the size of the system. Total investment and operating costs for average-size compost biofilters were around 60,000 euro and 20,000 euro/year, respectively, which are concordant with actual costs. Also, a sensitivity analysis was performed in order to assess the relative influence of a series of selected costs. Results prove that operating costs are those that influence the total annual costs to a higher extent. Also, packing material replacement costs contribute significantly to the total yearly costs in biofilters with a volume higher than 800 m(3). Among operating costs, the electricity consumption is the main influencing factor in biofilters with a gas flow rate above 50,000 m(3)/h, while labor costs are critical at lower gas flow rates. In addition, the use of a variety of packing materials commonly employed in biofiltration was assessed. According to the results obtained, special attention should be paid to the packing material selected, as it is the main parameter influencing the medium replacement costs, and one of the main factors affecting investment costs.

  5. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years.

    Science.gov (United States)

    Wood, Kirkham B; Buttermann, Glenn R; Phukan, Rishabh; Harrod, Christopher C; Mehbod, Amir; Shannon, Brian; Bono, Christopher M; Harris, Mitchel B

    2015-01-07

    Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up. To our knowledge, longer-term outcome data have not before been presented. From 1992 to 1998, forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups: operative treatment (posterior or anterior arthrodesis) or nonoperative treatment (a body cast or orthosis). We previously reported the results of follow-up at an average of forty-four months. The current study presents the results of long-term follow-up, at an average of eighteen years (range, sixteen to twenty-two years). As in the earlier study, patients at long-term follow-up indicated the degree of pain on a visual analog scale and completed the Roland and Morris disability questionnaire, the Oswestry Disability Index (ODI) questionnaire, and the Short Form-36 (SF-36) health survey. Work and health status were obtained, and patients were evaluated radiographically. Of the original operatively treated group of twenty-four patients, follow-up data were obtained for nineteen; one patient had died, and four could not be located. Of the original nonoperatively treated group of twenty-three patients, data were obtained for eighteen; two patients had died, and three could not be located. The average kyphosis was not significantly different between the two groups (13° for those who received operative treatment compared with 19° for those treated nonoperatively). Median scores for pain (4 cm for the operative group and 1.5 cm for the nonoperative group; p = 0.003), ODI scores (20 for the operative group and 2 for the nonoperative group; p years) revealed few significant differences between the two groups, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated

  6. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Science.gov (United States)

    Adibi, Atoosa; Nouri, Shadi; Moradi, Maryam; Shahabi, Javad

    2016-01-01

    Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE) who underwent computed tomography pulmonary angiography (CTPA). Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells’ criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1%) of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05). Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05). Frequency of all criteria of Wells’ criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05). The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05). Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences. PMID:28255326

  7. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

    International Nuclear Information System (INIS)

    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  8. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Directory of Open Access Journals (Sweden)

    Atoosa Adibi

    2016-01-01

    Full Text Available Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE who underwent computed tomography pulmonary angiography (CTPA. Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells' criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1% of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05. Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05. Frequency of all criteria of Wells' criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05. The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05. Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

  9. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  10. Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture.

    Science.gov (United States)

    Tsur, Noga; Defrin, Ruth; Ginzburg, Karni

    Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations. Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain. Although chronic pain was associated with PTSD (0.44 < β < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < β < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (β = 0.41 and 0.42, respectively; p < .017). The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.

  11. Design and operational experience of the centre for the collection treatment and storage of low level radioactive wastes

    International Nuclear Information System (INIS)

    Zorrilla, S.

    1986-01-01

    The activities of the Centre for Collection, Treatment and Storage of Low-Level Radioactive Wastes (CRTADRBN) are presented. The objective of this centre is the final storage of radioactive waste and radiation sources generated by medicine, industry teaching and research. Safety, storage capacity and economy are considered in the design. The types of treatment for liquid wastes are described and the containement system is specified. (M.C.K.) [pt

  12. National facilities for the management of institutional radioactive waste in Romania: 25 years of operation for radioactive waste treatment plant, Bucharest-Magurele, 15 years of operation for national radioactive repository, Baita-Bihor

    International Nuclear Information System (INIS)

    Rotarescu, Gh.; Turcanu, C.; Dragolici, F.; Lungu, L.; Nicu, M.; Cazan, L.; Matei, G.; Guran, V.

    1999-01-01

    The management of the non-fuel cycle radioactive wastes in Romania is centralized at IFIN-HH in the Radioactive Waste Treatment Plant (STDR) Bucharest-Magurele and the National Repository of Radioactive Waste (DNDR) Baita-Bihor. From November 1974 to November 1999 there were treated at STDR nearly 26,000 m 3 LLAW, 2,100 m 3 LLSW and 4,000 spent sources resulting over 5,500 conditioned packages disposed at DNDR. After 25 years of operation for STDR and 15 years of operation for DNDR an updating programme started in 1991. The R and D programme will improve the basic knowledge and waste management practices for the increasing of nuclear safety in the field. (authors)

  13. Operator lattices

    International Nuclear Information System (INIS)

    Bender, C.M.

    1984-01-01

    The finite-element method enables us to convert the operator differential equations of a quantum field theory into operator difference equations. These difference equations are consistent with the requirements of quantum mechanics and they do not exhibit fermion doubling, a problem that frequently plagues lattice treatments of fermions. Guage invariance can also be incorporated into the difference equations. On a finite lattice the operator difference equations can be solved in closed form. For the case of the Schwinger model the anomaly is computed and results in excellent agreement are obtained with the known continuum value

  14. Comparison of NF-RO and RO-NF for the Treatment of Mature Landfill Leachates: A Guide for Landfill Operators.

    Science.gov (United States)

    Ramaswami, Sreenivasan; Behrendt, Joachim; Otterpohl, Ralf

    2018-03-21

    Reverse osmosis (RO) and nanofiltration (NF) are among the state-of-the-art technologies for treating landfill leachates. Due to the complexity and variance in the composition of leachates, numerous combinations of multiple technologies are used for their treatment. One process chain for the treatment of raw leachate is RO followed by further concentration of RO-retentate using NF (RO-NF scheme). The aptness of this process train used by some landfill sites around the world (usually with the aim of volume reduction so as to re-inject the concentrate into the landfill) is questionable. This study investigated two schemes RO-NF and NF-RO (nanofiltration of raw leachate followed by reverse osmosis of NF permeate) to identify their merits/demerits. Experiments were conducted in bench scale using commercial membranes: DOW Filmtec NF270 and SW30HR. Filtration trials were performed at different pressures to compare the water and solute transports in the individual stages of the two schemes. Based on the water fluxes and compositions of retentates and permeates; osmotic pressures, energy demands, and other possible operational advantages were discussed. NF-RO offers some advantages and flexibility for leachate treatment besides being energy efficient compared to RO-NF, wherein osmotic pressure steadily increases during operation in turn increasing operation and maintenance costs.

  15. Hygiene hazards for wastewater treatment plant (wwtp) operators; Riesgos higienicos en operadores de plantas depuradoras de aguas residuales urbanas

    Energy Technology Data Exchange (ETDEWEB)

    Suarez Suarez, C. A.

    1999-06-01

    Are revised in the present article (chemical, physical and biological hazards) and also routes of infection. Referring to the bibliography, biological hazards are the most important for the WWTP operators, but the incidence of occupational illness is comparable to other related professions when workers follow good personal hygiene practices, use protective equipment and clothing and minimise exposure time. (Author) 10 refs.

  16. Ten-year response of a forest bird community to an operational herbicide-shelterwood treatment in Allegheny hardwoods

    Science.gov (United States)

    Scott H. Stoleson; Todd E. Ristau; David S. deCalesta; Stephen B. Horsley

    2011-01-01

    Use of herbicides in forestry to direct successional trajectories has raised concerns over possible direct or indirect effects on non-target organisms. We studied the response of forest birds to an operational application of glyphosate and sulfometuron methyl herbicides, using a randomized block design in which half of each 8 ha block received herbicide and the other...

  17. Pilot-scale comparison of two hybrid-passive landfill leachate treatment systems operated in a cold climate.

    Science.gov (United States)

    Speer, Sean; Champagne, Pascale; Anderson, Bruce

    2012-01-01

    Hybrid-passive landfill leachate treatment systems employ active pretreatment to remove dissolved inorganic constituents and decrease the oxygen demand of the leachate prior to treatment in a passive system. In a 1-year pilot-scale study, two passive treatment systems - a peat and wood shaving biological trickle filter and a sand and gravel constructed wetland - were installed to treat leachate from the Merrick Landfill in North Bay, Ontario, Canada. Leachate was pretreated in a fixed-film aerobic reactor, which provided reductions in COD (26%), and masses of ammonia (21%), Al (69%), Ca (57%), Fe (73%) and Sr (37%). A comparison of the performance of the hybrid-passive treatment systems indicated different extents of heterotrophic nitrification; the peat and wood shaving filter removed 49% of the ammonia and nitrified 29%, while the constructed wetland removed 99% of the ammonia and nitrified 90%. Hybrid-passive landfill leachate treatment was determined to be feasible in cold climates. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  19. Meta-Analysis of Long Thoracic Nerve Decompression and Neurolysis Versus Muscle and Tendon Transfer Operative Treatments of Winging Scapula.

    Science.gov (United States)

    Nath, Rahul K; Somasundaram, Chandra

    2017-08-01

    Injury to long thoracic and the spinal accessory nerves can cause winging scapula as a result of weakness and paralysis of the trapezius and serratus anterior muscles. Although these nerve and muscle operations have been reported to correct winging scapula due to various causes, there is no report on comparing the outcomes of these procedures in peer-reviewed Pubmed-indexed literature. In this article, we compared the improvements in the restoration of shoulder functions in winging scapula patients after long thoracic nerve decompression (LTND) in our present study with outcomes of muscle and tendon transfer operations published in the literature (Aetna cited articles). Twenty-five winging scapula patients met the inclusion criteria, who had LTND and neurolysis at our clinic since 2008. Electromyographic evaluation of the brachial plexus and long thoracic nerve distribution was performed preoperatively for all our patients in this study. Operating surgeon (R.K.N.) examined all patients and measured pre- and postoperative range of motion of the affected shoulder. The mean follow-up was 23 months (range, 13-46 months). Age of our patients in this study at the time of surgery was between 13 and 63 years. These patients had winging scapula between 5 days (tennis injury) and several years before surgery and some were unknown. Shoulder flexion and abduction improved to an average of 163˚ ( P muscle and tendon transfer procedures in the Pubmed-indexed (Aetna cited) literature. This meta-analysis suggests that nerve surgeries such as LTND and neurolysis are effective techniques in correcting winging scapula in comparison with muscle transfer operations.

  20. Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm

    OpenAIRE

    Sharma, Pulak; Swamy, M. K. S.

    2012-01-01

    Background Volkmann’s ischemic contracture is a less common but crippling condition affecting the extremities. Once the condition sets in, the prognosis always remains guarded, even after long and intensive physiotherapy and various restorative surgical techniques. This study was undertaken to evaluate the long-term functional results of the Max Page muscle slide operation in patients with Volkmann’s ischemic contracture of the forearm of moderate degree (Tsuge classification). Materials and ...

  1. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Obstetrics, Paris (France)

    2009-09-15

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  2. A new operational method of functional neurosurgery combining micro-recording and MRI stereotaxy for the treatment of Parkinson's disease

    International Nuclear Information System (INIS)

    Nishimura, Hiroyuki; Hirai, Tatsuo.

    1993-01-01

    We have developed a new operational method for stereotactic functional neurosurgery using MRI stereotaxy combined with microelectrode recording. MRI stereotaxy shows us the individual variations of thalamic configurations. The tentative target points were determined using the MRI stereotaxy assisted software system which revised the distortion of MRI images. Consequently, the accuracy and safety of the microelectrode recording were increased. This, in turn, increased the accuracy and stereotactic thalamotomy while producing encouraging operational outcomes. The effectiveness of stereotactic thalamotomy for Parkinson's disease was confirmed by these excellent operative results. The symptoms improved and the dosage of medications, including L-DOPA, decreased. Furthermore, our results indicate that the distributing area of deep sensory neurons in the thalamus extended more posteriorly and upward than previously expected. Therefore, the functional and anatomical similarity between the human and monkey thalamus was reaffirmed. In this report, based on the above data, we reevaluated the neural mechanism of tremor and the role of stereotactic functional neurosurgery for Parkinson's disease. (author)

  3. Capital and operating costs of full-scale fecal sludge management and wastewater treatment systems in Dakar, Senegal.

    Science.gov (United States)

    Dodane, Pierre-Henri; Mbéguéré, Mbaye; Sow, Ousmane; Strande, Linda

    2012-04-03

    A financial comparison of a parallel sewer based (SB) system with activated sludge, and a fecal sludge management (FSM) system with onsite septic tanks, collection and transport (C&T) trucks, and drying beds was conducted. The annualized capital for the SB ($42.66 capita(-1) year(-1)) was ten times higher than the FSM ($4.05 capita(-1) year(-1)), the annual operating cost for the SB ($11.98 capita(-1) year(-1)) was 1.5 times higher than the FSM ($7.58 capita(-1) year(-1)), and the combined capital and operating for the SB ($54.64 capita(-1) year(-1)) was five times higher than FSM ($11.63 capita(-1) year(-1)). In Dakar, costs for SB are almost entirely borne by the sanitation utility, with only 6% of the annualized cost borne by users of the system. In addition to costing less overall, FSM operates with a different business model, with costs spread among households, private companies, and the utility. Hence, SB was 40 times more expensive to implement for the utility than FSM. However, the majority of FSM costs are borne at the household level and are inequitable. The results of the study illustrate that in low-income countries, vast improvements in sanitation can be affordable when employing FSM, whereas SB systems are prohibitively expensive.

  4. Capital and Operating Costs of Full-Scale Fecal Sludge Management and Wastewater Treatment Systems in Dakar, Senegal

    Science.gov (United States)

    2012-01-01

    A financial comparison of a parallel sewer based (SB) system with activated sludge, and a fecal sludge management (FSM) system with onsite septic tanks, collection and transport (C&T) trucks, and drying beds was conducted. The annualized capital for the SB ($42.66 capita–1 year–1) was ten times higher than the FSM ($4.05 capita–1 year–1), the annual operating cost for the SB ($11.98 capita–1 year–1) was 1.5 times higher than the FSM ($7.58 capita–1 year–1), and the combined capital and operating for the SB ($54.64 capita–1 year–1) was five times higher than FSM ($11.63 capita–1 year–1). In Dakar, costs for SB are almost entirely borne by the sanitation utility, with only 6% of the annualized cost borne by users of the system. In addition to costing less overall, FSM operates with a different business model, with costs spread among households, private companies, and the utility. Hence, SB was 40 times more expensive to implement for the utility than FSM. However, the majority of FSM costs are borne at the household level and are inequitable. The results of the study illustrate that in low-income countries, vast improvements in sanitation can be affordable when employing FSM, whereas SB systems are prohibitively expensive. PMID:22413875

  5. The decision-making process for senior cancer patients: treatment allocation of older women with operable breast cancer in the UK

    International Nuclear Information System (INIS)

    Morgan, Jenna L.; Richards, Paul; Zaman, Osama; Ward, Sue; Collins, Karen; Robinson, Thompson; Cheung, Kwok-Leung; Audisio, Riccardo A.; Reed, Malcolm W.; Wyld, Lynda

    2015-01-01

    Up to 40% of women over 70 years with primary operable breast cancer in the UK are treated with primary endocrine therapy (PET) as an alternative to surgery. A variety of factors are important in determining treatment for older breast cancer patients. This study aimed to identify the patient and tumor factors associated with treatment allocation in this population. Prospectively collected data on treatment received (surgery vs. PET) were analysed with multivariable logistic regression using the variables age, modified Charlson Comorbidity Index (CCI), activities of daily living (ADL) score, Mini-Mental State Examination (MMSE) score, HER2 status, tumour size, grade and nodal status. Data were available for 1,122 cancers in 1,098 patients recruited between February 2013 and June 2015 from 51 UK hospitals. About 78% of the population were treated surgically, with the remainder being treated with PET. Increasing patient age at diagnosis, increasing CCI score, large tumor size (5 cm or more) and dependence in one or more ADL categories were all strongly associated with non-surgical treatment (P<0.05). Increasing comorbidity, large tumor size and reduced functional ability are associated with reduced likelihood of surgical treatment of breast cancer in older patients. However, age itself remains a significant factor for non-surgical treatment; reinforcing the need for evidence-based guidelines

  6. Comparing the Outcomes of Stapled Transanal Rectal Resection, Delorme Operation and Electrotherapy Methods Used for the Treatment of Obstructive Defecation Syndrome

    Directory of Open Access Journals (Sweden)

    Neda Mirabi

    2014-09-01

    Full Text Available Background: Pathophysiology and treatment of obstructive defecation syndrome (ODS remains to be defined clearly. Rectal hidden intussusceptions and voluminous hemorrhoids may be the cause. Where conservative treatment is not effective, ODS can be treated by STARR or Delorme operation. In some patients treatment of advance hemorrhoidal disease may resolve the syndrome. Methods: 81 females out of 183 ODS patients were selected for the treatment by Delorme, STARR or 30 mAmp electrotherapy. Results: The number of patients treated by STARR, Delorme and Electrotherapy were 34, 31 and 16, with mean postoperative pain ranking of 2.5, 3.7 and 1.5 and mean hospital stay of 2.3, and 3.2 and 1 day respectively. Mean ODS score, preoperatively compared with one-year post operation, improved from 14.5 to 5.1 (P=0.005 in STARR, 13.8 to 4.3 (P=0.006 in Delorme and 14.2 to 12.8 (P=0.725 in electrotherapy groups. The mean severity score (SS changed from 14.2, 15.18 and 13.90 preoperatively to 3.8, 4.12 and 11.34 postoperatively in all groups respectively. The mean resting pressures decreased from 82 to 65 in STARR (P=0.006, from 87 to 63 in Delorme (P=0.005 and from 79 to 74 mmHg (P=0.797 in electrotherapy groups. Postoperative defecography showed significant reduction in the intussusception parameter in STARR and Delorme (82.4% and 88% respectively; P<0.0001, but unchanged in electrotherapy group. Conclusion: STARR and Delorme are effective modalities for the treatment of patients with ODS, while STARR is simpler, less invasive and less painful. Although, electrotherapy eradicates the voluminous hemorrhoids but is ineffective in the treatment of ODS.

  7. Loblolly pine growth following operational vegetation management treatments compares favorably to that achieved in complete vegetation control research trials

    Science.gov (United States)

    Dwight K. Lauer; Harold E. Quicke

    2010-01-01

    Different combinations of chemical site prep and post-plant herbaceous weed control installed at three Upper Coastal Plain locations were compared in terms of year 3 loblolly (Pinus taeda L.) pine response to determine the better vegetation management regimes. Site prep treatments were different herbicide rates applied in either July or October. Site...

  8. [Second operation more frequent following breast-conserving treatment for invasive lobular than for invasive non-lobular carcinoma

    NARCIS (Netherlands)

    Zeeuw, S. de; Wildenberg, F.; Strobbe, L.; Wobbes, T.

    2009-01-01

    OBJECTIVE: To establish the frequency of re-excision or mastectomy in women who had breast-conserving treatment for invasive lobular mammary carcinoma. DESIGN: Retrospective. METHOD: Data on the number of patients with invasive carcinoma from 1998-2006 were obtained from the national pathology

  9. Effect of design and operational conditions on the performance of subsurface flow treatment wetlands: Emerging organic contaminants as indicators.

    Science.gov (United States)

    Kahl, Stefanie; Nivala, Jaime; van Afferden, Manfred; Müller, Roland A; Reemtsma, Thorsten

    2017-11-15

    Six pilot-scale subsurface flow treatment wetlands loaded with primary treated municipal wastewater were monitored over one year for classical wastewater parameters and a set of emerging organic compounds (EOCs) serving as process indicators for biodegradation: caffeine, ibuprofen, naproxen, benzotriazole, diclofenac, acesulfame, and carbamazepine. The wetland technologies investigated included conventional horizontal flow, unsaturated vertical flow (single and two-stage), horizontal flow with aeration, vertical flow with aeration, and reciprocating. Treatment efficiency for classical wastewater parameters and EOCs generally increased with increasing design complexity and dissolved oxygen concentrations. The two aerated wetlands and the two-stage vertical flow system showed the highest EOC removal, and the best performance in warm season and most robust performance in the cold season. These three systems performed better than the adjacent conventional WWTP with respect to EOC removal. Acesulfame was observed to be removed (>90%) by intensified wetland systems and with use of a tertiary treatment sand filter during the warm season. Elevated temperature and high oxygen content (aerobic conditions) proved beneficial for EOC removal. For EOCs of moderate to low biodegradability, the co-occurrence of aerobic conditions and low content of readily available carbon appears essential for efficient removal. Such conditions occurred in the aerated systems and with use of a tertiary treatment sand filter. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. [Analysis of prevalence and risk factors of pelvic organ prolapse of women underwent gynecologic health care in Peking Union Medical College Hospital].

    Science.gov (United States)

    Zhu, Lan; Wang, Jing-yi; Lang, Jing-he; Xu, Tao; Li, Lin

    2010-07-01

    To investigate prevalence and risk factors of pelvic organ prolapse in women underwent routine gynecologic health care in Peking Union Medical College Hospital (PUMCH). From Jan. 2008 to Aug. 2009, 972 women underwent gynecological health care in PUMCH were enrolled in this study. Questionnaires and pelvic examinations were given. The pelvic organ prolapse quantitive examination (POP-Q) system was used as the assessment tool. (1) Among all participants, the mean ages were (42 ± 10) years (range 22 to 78 years), the mean height were (162 ± 5) cm (range 142 to 180 cm), and the mean weight were (59 ± 8) kg (range 42 to 91 kg). 83.8% (815/972) of women were multipara. The mean total vaginal length (TVL) of 972 women was 8.20 cm. No women met the standard of pelvic organ prolapse, while 35.5% (345/972) of women presented mild posterior vaginal descent and 96.7% (940/972) presented mild anterior vaginal descent, all of them were asymptomatic. (2) The length of genital hiatus (gh), TVL and C, D proximal to the hymen in nullipara were (2.26 ± 0.32), (8.08 ± 0.30), (-7.08 ± 0.24) and (-8.08 ± 0.30) cm, which were significantly less than (2.33 ± 0.39), (8.22 ± 0.35), (-7.14 ± 0.28) and (-8.22 ± 0.35) cm in multipara (P 0.05). However, those in women at group of 22 - 34 years and 35 - 49 years showed statistical difference when compared with women at group of more than 50 years (P < 0.05). When compared with women at group of 22 - 34 years, the incidence of posterior and anterior vaginal wall protrusion were increased (OR = 1.713, 3.765). (4) Menopause status was associated with severities of all kinds of descent (P < 0.05) and presence of posterior vaginal protrusion (OR = 3.354). Mild anterior and posterior vaginal descent by POP-Q were common among women in China. The risk of anterior vaginal descent is relatively higher than posterior vaginal descent. However, most of the women with descent are asymptomatic and need no treatment. The most important factors

  11. Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.

    Science.gov (United States)

    Johnson, Ralph Jay

    2015-01-01

    Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.

  12. [Retrospective analysis of 856 cases with stage 0 to III rectal cancer underwent curative surgery combined modality therapy].

    Science.gov (United States)

    Chen, Pengju; Yao, Yunfeng; Zhao, Jun; Li, Ming; Peng, Yifan; Zhan, Tiancheng; Du, Changzheng; Wang, Lin; Chen, Nan; Gu, Jin

    2015-07-01

    To investigate the survival and prognostic factors of stage 0 to III rectal cancer in 10 years. Clinical data and follow-up of 856 rectal cancer patients with stage 0-III underwent curative surgery from January 2000 to December 2010 were retrospective analyzed. There were 470 male and 386 female patients, with a mean age of (58 ± 12) years. Kaplan-Meier method was used to analyze the overall survival and disease free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to analyze the independent prognostic factors of rectal cancer. The patients in each stage were stage 0 with 18 cases, stage I with 209 cases, stage II with 235 cases, and stage III with 394 cases. All patients received curative surgery. There were 296 patients evaluated as cT3, cT4 and any T with N+ received preoperative radiotherapy. 5.4% patients got pathological complete response (16/296), and the recurrence rate was 4.7% (14/296). After a median time of 41.7 months (range 4.1 to 144.0 months) follow-up, the 5-year overall survival rate in stage 0 to I of was 91.0%, stage II 86.2%, and stage III 60.0%, with a significant difference (P=0.000). The cumulative local recurrence rate was 4.8% (41/856), of which 70.7% (29/41) occurred within 3 years postoperatively, 97.6% (40/41) in 5 years. The cumulative distant metastasis rate was 16.4% (140/856), of which 82.9% (129/140) occurred within 3 years postoperatively, 96.4% (135/140) in 5 years. The incidence of abnormal imaging findings was significantly higher in pulmonary than liver and other sites metastases (75.0% vs. 21.7%, χ² =25.691, P=0.000). The incidence of CEA elevation was significantly higher in liver than lung and other sites metastases (56.8% vs. 37.8%, χ² =25.691, P=0.000). Multivariable analysis showed that age (P=0.015, HR=1.385, 95% CI: 1.066 to 1.801), surgical approach (P=0.029, HR=1.337, 95% CI: 1.030 to 1.733), differentiation (P=0.000, HR=1.535, 95% CI: 1.222 to 1.928), TNM stage (P

  13. The impact of acute post-extraction oroantral communications surgical treatment on patients' quality of life in early post-operative period

    Directory of Open Access Journals (Sweden)

    I. M. Got'

    2017-12-01

    Full Text Available The research objective is to study the impact of plastic surgery different methods of acute post-extraction oroantral communications treatment on patients' quality of life in early post-operative period. Materials and methods. The study included 41 patient aged between 18 and 58 years receiving treatment of maxillary sinus perforation, which was caused by tooth extraction. The patients were divided into 3 groups – 14, 12 and 15 persons respectively. Plastic surgery of the oroantral communication in the first group was done in accordance with the methods suggested by the authors using collagen cone and membrane. The same surgery in the second group was done with PRF (Platelet-rich fibrin. In the third (control group, the communication was closed by the vestibular flap following the Rehrmann method. Results of patients' quality of life evaluation after plastic surgery treatment of acute post-extraction oroantral communication show the decrease of its general indicator in early post-operative period in all groups of patients. The general quality of life indicator (well-being indicator shows a tendency to increase over the first 24 hours after the surgery in both study and control groups. This may mean that a relatively small trauma in a maxillofacial area has a significant influence on patients' perception of their condition and well-being. Absolute numbers of well-being indicator over the first 24 hours after the surgery in the third group were almost 1.5 times higher than those in the groups 1 and2. Ina comparative study of the groups 1 and 3 and then the groups 2 and 3, we observed a significant difference between well-being indicator levels (p < 0.01. The control group demonstrated the return to the pre-operative life quality values on the 7-th day after the surgery. While at the same time, those values in the study groups were equal to the pre-operative ones already on the 4-th day. Conclusions. Operation trauma which was caused by the

  14. SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

    International Nuclear Information System (INIS)

    Acar, H; Altinok, A; Kucukmorkoc, E; Kucuk, N; Caglar, H

    2014-01-01

    Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of the planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is

  15. Reproductive performance of severely symptomatic women with uterine adenomyoma who wanted preservation of the uterus and underwent combined surgical–medical treatment

    Directory of Open Access Journals (Sweden)

    Wen-Hsun Chang

    2013-03-01

    Conclusion: Age was an important factor associated with future successful delivery, therefore, caution should be taken in considering the maintenance of future fertility in older women treated with surgical–medical therapy.

  16. Pilot-scale comparison of constructed wetlands operated under high hydraulic loading rates and attached biofilm reactors for domestic wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Fountoulakis, M.S. [School of Agricultural Technology, Technological Educational Institute of Crete, Heraklion (Greece)], E-mail: mfountoul@teemail.gr; Terzakis, S. [School of Agricultural Technology, Technological Educational Institute of Crete, Heraklion (Greece); Department of Environmental Engineering, Technical University of Crete, Chania (Greece); Chatzinotas, A. [UFZ, Helmholtz Centre for Environmental Research - UFZ, Department of Environmental Microbiology, Permoserstrasse 15, D-04318 Leipzig (Germany); Brix, H. [Department of Biological Sciences, Aarhus University (Denmark); Kalogerakis, N. [Department of Environmental Engineering, Technical University of Crete, Chania (Greece); Manios, T. [School of Agricultural Technology, Technological Educational Institute of Crete, Heraklion (Greece); Greek Open University, School of Science and Technology, Patras (Greece)

    2009-04-01

    Four different pilot-scale treatment units were constructed to compare the feasibility of treating domestic wastewater in the City of Heraklio, Crete, Greece: (a) a free water surface (FWS) wetland system, (b) a horizontal subsurface flow (HSF) wetland system, (c) a rotating biological contactor (RBC), and (d) a packed bed filter (PBF). All units operated in parallel at various hydraulic loading rates (HLR) ranging from 50% to 175% of designed operating HLR. The study was conducted during an 8 month period and showed that COD removal efficiency of HSF was comparable (> 75%) to that of RBC and PBF, whereas that of the FWS system was only 57%. Average nutrient removal efficiencies for FWS, HSF, RBC and PBF were 6%, 21%, 40% and 43%, respectively for total nitrogen and 21%, 39%, 41% and 42%, respectively for total phosphorus. Removals of total coliforms were lowest in FWS and PBF (1.3 log units) and higher in HSF and RBC (2.3 to 2.6 log units). HSF showed slightly lower but comparable effluent quality to that of RBC and PBF systems, but the construction cost and energy requirements for this system are significantly lower. Overall the final decision for the best non-conventional wastewater treatment system depends on the construction and operation cost, the area demand and the required quality of effluent.

  17. The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review.

    Science.gov (United States)

    Alshewaier, Shady; Yeowell, Gillian; Fatoye, Francis

    2017-01-01

    To evaluate the effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury. The following databases were searched: PubMed, Ovid, The Cochrane Library and Web of Science. Studies published between the inception of the databases and December 2015 were sought using appropriate keywords in various combinations. This search was supplemented with a manual search of the references of selected studies. Studies were assessed for methodological quality using the Physiotherapy Evidence Database scale. A total of 500 studies were identified, of which eight studies met the inclusion criteria and were included in the present review. The average Physiotherapy Evidence Database score for the studies included was 5.8, which reflects an overall moderate methodological quality. The eight studies investigated a total of 451 subjects of which 71% ( n=319) were males. The age of the participants in the eight studies ranged from 15 to 57 years. The duration of the intervention in the studies ranged from 3 to 24 weeks. This review found that pre-operative physiotherapy rehabilitation is effective for improving the outcomes of treatment following anterior cruciate ligament injury, including increasing knee-related function and improving muscle strength. However, whilst there was a significant improvement in quality of life from baseline following intervention, no significant difference in quality of life was found between the control and intervention groups. There is evidence to suggest that pre-operative physiotherapy rehabilitation is beneficial to patients with anterior cruciate ligament injury.

  18. Conservative treatment of a proximal full-thickness biceps brachii muscle tear in a special operations soldier.

    Science.gov (United States)

    Helton, Matthew S

    2014-04-01

    A transection of the short head of the biceps brachii muscle is an uncommon injury seen among outpatient sports physical therapy clinics. The highest rate of occurrence and the majority of literature that discusses this specific injury are related to US military parachuting. The purpose of this case report is to outline the episode of care from 2 days after the injury through 6 months of conservative treatment, which consisted of therapeutic exercise, manual therapy, and cryotherapy, within an outpatient sports physical therapy clinic in a military setting. This case report outlines the initial evaluation, diagnostic imaging, treatment, and 6-month follow-up measures for a 23-year-old male patient who sustained a static line injury resulting in a full-thickness tear of his biceps brachii muscle and a partial tear of the coracobrachialis muscle. The individual described in this case report reported having no functional limitations in regard to his job and leisure activities or any pain at his 6-month follow-up, with a score of 0% noted on his Shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH). Isokinetic testing revealed a 39.1% decrease in elbow flexion peak torque and a 60.8% decrease in elbow flexion total work output at this same follow-up interval. In determining the appropriate course of treatment for this injury type, conservative physical therapy intervention should be considered as a viable treatment option, as there have been no decisive studies to suggest superior outcomes with other methods such as surgical correction. It is further recommended that research be conducted in an effort to prevent such injuries from occurring, as this mechanism of injury has proven to be much higher among the US military population compared with other military populations.

  19. Is it necessary to operate on all women with an acute abdomen following medical treatment of tubal ectopic pregnancy?

    Science.gov (United States)

    Dilbaz, S; Guven, E S Guvendag; Yildirim, B Aykan; Gelisen, O; Karcaaltincaba, D; Kurtaran, V; Haberal, A

    2010-01-01

    The main objective of this retrospective study is to evaluate the question of whether it is necessary to perform surgery for patients who develop an acute abdomen after methotrexate administration in cases of tubal ectopic pregnancy. A total of 26 women with tubal ectopic pregnancy who required emergency surgical evaluation after a single dose of methotrexate treatment were included. The surgical findings were tubal abortion (10 cases, 38.4%); tubal rupture (12 cases, 46.2%) and tubal haematoma (4 cases, 15.4%). The average time for initiation of severe abdominal pain following single dose methotrexate treatment was 6.12 +/- 2.10 days (range, 2-10). The most common site of implantation was isthmus (50.0%) and 38.5% (five patients) of the patients had tubal abortion from this part of the tube, while 46.1% of women (six patients) with isthmic localisation had a tubal rupture. Following medical treatment of ectopic pregnancy, surgery may be an option in the presence of symptoms/signs of acute abdomen (in the presence or absence of haemodynamic instability) and free pelvic fluid on sonography for only patients with isthmic tubal ectopic pregnancy, or if the isthmic localisation of tubal ectopic pregnancy is suspected on sonography.

  20. Carcinoma of the throid gland; diagnosis - nonsurgical treatment - follow-up; Schilddruesenkarzinom: Diagnostik - nicht operative Therapie - Nachsorge

    Energy Technology Data Exchange (ETDEWEB)

    Moeller, L.; Saller, B.; Quadbeck, B.; Mann, K. [Universitaetsklinikum Essen (Germany). Abt. fuer Endokrinologie

    2001-01-11

    Thyroid carcinomas may originate in the thyroid cells (follicular and papillary carcinoma, so-called differentiated carcinomas, constituting roughly 80-90% of cases), and the calcitonin-producing parafollicular C cells (medullary carcinoma, roughly 10%). The suspected diagnosis is clarified with the aid of ultrasonography, scintigraphy and fine-needle aspiration cytology. Primarily, carcinomas of the thyroid are treated surgically; in the case of differentiated carcinomas, surgery is followd by radio-iodine treatment, and in the follow-up period I-131 scintigraphy is performed. During this period, physical examination, ultrasonography of the neck, monitoring of the tumor markers, and treatment with levothyroxine are applied (TSH-suppressive in cases of differentiated carcinoma). In the event of a recurrence showing rapid progression, when surgical and nuclear medical treatment modalities have been exhausted, chemotherapy can be given. (orig.) [German] Knotige Veraenderungen der Schilddruese sind immer verdaechtig - da kann ein Malignom dahinterstrecken. Mit gezielter Anamnese, Ultraschall, Szintigraphie und Feinnadelbiopsie lassen sich die operationsbedueftigen Faelle relativ sicher herausfiltern. Unser Autor stellt dar, wie man rationell diagnostisch abklaert und worauf es in der Nachsorge ankommt. (orig.)

  1. Operational and biological analyses of branched water-adjustment and combined treatment of wastewater from a chemical industrial park.

    Science.gov (United States)

    Xu, Ming; Cao, Jiashun; Li, Chao; Tu, Yong; Wu, Haisuo; Liu, Weijing

    2018-01-01

    The combined biological processes of branched water-adjustment, chemical precipitation, hydrolysis acidification, secondary sedimentation, Anoxic/Oxic and activated carbon treatment were used for chemical industrial wastewater treatment in the Taihu Lake Basin. Full-scale treatment resulted in effluent chemical oxygen demand, total nitrogen, NH 3 -N and total phosphorus of 35.1, 5.20, 3.10 and 0.15 mg/L, respectively, with a total removal efficiency of 91.1%, 67.1%, 70.5% and 89.3%, respectively. In this process, short-circuited organic carbon from brewery wastewater was beneficial for denitrification and second-sulfate reduction. The concentration of effluent fluoride was 6.22 mg/L, which also met the primary standard. Gas Chromatography-Mass Spectrometry analysis revealed that many types of refractory compounds were present in the inflow. Microbial community analysis performed in the summer by PCR-denaturing gradient gel electrophoresis and MiSeq demonstrated that certain special functional bacteria, such as denitrificans, phosphorus-accumulating bacteria, sulfate- and perhafnate-reducing bacteria, aromatic compound-degrading bacteria and organic fluoride-degrading bacteria, present in the bio-tanks were responsible for the acceptable specific biological pollutant reduction achieved.

  2. Performance of a passive treatment system for net-acidic coal mine drainage over five years of operation.

    Science.gov (United States)

    Matthies, Romy; Aplin, Andrew C; Jarvis, Adam P

    2010-09-15

    A full-scale passive treatment system (PTS) was commissioned in 2003 to treat two net-acidic coal mine water discharges in the Durham coalfield, UK. The principal aim of the PTS was to decrease concentrations of iron (3.2) and alkalinity (> or =0 mg L(-1) CaCO(3) eq). Secondary objectives were to decrease zinc (treatment, water qualities were improved by 84% in the case of Fe, 87% Al, 83% acidity, 51% Zn, 23% Mn and 29% SO(4)(2)(-). Alkalinity (74%) and pH (95% as H(+)) were increased. Area adjusted removal rates (Fe=1.49+/-0.66 g d(-1) m(-2); acidity=6.7+/-4.9 g d(-1) m(-2)) were low compared to design criteria, mainly due to load limitation. Disregarding seasonality effects, acidity removal and effluent pH were stable over time. A substantial temporal decrease in calcium and alkalinity generation suggests that limestone is increasingly armoured. Once pH is no longer buffered by the carbonate system, metals could be remobilized, putting treatment efficiency at risk. Copyright 2010 Elsevier B.V. All rights reserved.

  3. Benefit of the measurement of mesorectal extension in patients with pT3N1-2 rectal cancer without pre-operative chemoradiotherapy: Post-operative treatment strategy.