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Sample records for underwent surgical closure

  1. The unnatural history of the ventricular septal defect: outcome up to 40 years after surgical closure

    NARCIS (Netherlands)

    Menting, Myrthe E.; Cuypers, Judith A. A. E.; Opić, Petra; Utens, Elisabeth M. W. J.; Witsenburg, Maarten; van den Bosch, Annemien E.; van Domburg, Ron T.; Meijboom, Folkert J.; Boersma, Eric; Bogers, Ad J. J. C.; Roos-Hesselink, Jolien W.

    2015-01-01

    Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD). The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure. Patients who underwent surgical VSD closure during childhood between 1968

  2. The unnatural history of the ventricular septal defect : outcome up to 40 years after surgical closure

    NARCIS (Netherlands)

    Menting, Myrthe E; Cuypers, Judith A A E; Opić, Petra; Utens, Elisabeth M W J; Witsenburg, Maarten; van den Bosch, Annemien E; van Domburg, Ron T; Meijboom, Folkert J; Boersma, Eric; Bogers, Ad J J C; Roos-Hesselink, Jolien W

    2015-01-01

    BACKGROUND: Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD). OBJECTIVES: The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure. METHODS: Patients who underwent surgical VSD

  3. The unnatural history of the ventricular septal defect: Outcome up to 40 years after surgical closure

    NARCIS (Netherlands)

    M.E. Menting (Myrthe); J.A.A.E. Cuypers (Judith); P. Opic (Petra); E.M.W.J. Utens (Elisabeth); M. Witsenburg (Maarten); A.E. van den Bosch (Annemien); R.T. van Domburg (Ron); F.J. Meijboom (Folkert); H. Boersma (Eric); A.J.J.C. Bogers (Ad); J.W. Roos-Hesselink (Jolien)

    2015-01-01

    textabstractBackground Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD). Objectives The objective of this study was to investigate clinical outcomes >30 years after surgical VSD closure. Methods Patients who underwent

  4. [A Distal Bile Duct Carcinoma Patient Who Underwent Surgical Resection for Liver Metastasis].

    Science.gov (United States)

    Komiyama, Sosuke; Izumiya, Yasuhito; Kimura, Yu; Nakashima, Shingo; Kin, Syuichi; Kawakami, Sadao

    2018-03-01

    A 70-year-old man with distal bile duct carcinoma underwent a subtotal stomach-preserving pancreaticoduodenectomy without adjuvant chemotherapy. One and a half years after the surgery, elevated levels of serum SPan-1(38.1 U/mL)were observed and CT scans demonstrated a solitary metastasis, 25mm in size, in segment 8 of the liver. The patient received 2 courses of gemcitabine-cisplatin combination chemotherapy. No new lesions were detected after chemotherapy and the patient underwent a partial liver resection of segment 8. The pathological examination revealed a metachronous distant metastasis originating from the bile duct carcinoma. Subsequently, the patient received S-1 adjuvant chemotherapy for 6 months. Following completion of all therapies, the patient survived without tumor recurrence for 3 years and 10 months after the initial operation. Thus, surgical interventions might be effective in improving prognosis among selected patients with postoperative liver metastasis of bile duct carcinoma.

  5. Suction Cup Induced Palatal Fistula: Surgical Closure by Palatal ...

    African Journals Online (AJOL)

    1Department of Pediatrics, Pragna Children's Hospital, Hyderabad, ... Eluru, 4Department of Conservative Dentistry and Endodontics, KIMS Dental College and ... The surgical closure of palatal fistula planned under general anesthesia.

  6. Transcatheter closure of re-canalized patent ductus arteriosus after surgical ligation

    International Nuclear Information System (INIS)

    Zhang Qingqiao; Jiang Shiliang; Huang Lianjun; Zhao Shihua; Zheng Hong; Ling Jian; Jin Jinglin; Xu Zhongying; Xie Ruolan; Dai Ruping

    2002-01-01

    Objective: To evaluate the effectiveness of transcatheter closure of re-canalized patent ductus arteriosus (PDA) after surgical ligation. Methods: Between June 1995 and November 2000, 14 patients (5 male, 9 female) with re-canalized PDA after surgical ligation underwent transcatheter closure, their median age was 13 years (range 4 to 48 years). The time between surgical ligation and the interventional procedure ranged from one month to twenty-two years. Implantations of Amplatzer duct occluder and Rashkind occluder were performed trans-venously. Cook coil occlusions was performed trans-arterially. Follow-up with X-ray radiograph and echocardiography was made 24 hours, 1, 3, 6 months, and more than 1 year after the procedure. Results: Twelve PDAs were of funnel shape, and the remaining two PDAs were of tubular shape. The median minimum diameter of re-canalized PDA after ligation was 4 mm (range 1 to 8 mm). Aortograms ten minutes after closure showed complete closure and trivial residual shunt in 11 and 3 patients, respectively. The technical success rate was 100%, and there were no complications. Echocardiography showed complete closure in all patients within 24 hours. All patients were discharged in one to two days after the procedure. At a follow-up of one to eighteen months in ten patients, there were no migration of devices and residual PDA. Conclusion: Transcatheter closure using Amplatzer duct occluder, coil (Cook company or Pfm company) and Rashkind occluder was an effective method for patients with re-canalized PDA after surgical ligation. It may be an alternative to second surgery owing to its safety, reliability, min-invasiveness, and short hospitalization

  7. Transcatheter closure of re-canalized patent ductus arteriosus after surgical ligation

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    Qingqiao, Zhang; Shiliang, Jiang; Lianjun, Huang; Shihua, Zhao; Hong, Zheng; Jian, Ling; Jinglin, Jin; Zhongying, Xu; Ruolan, Xie; Ruping, Dai [Chinese Academy of Medical Science, Beijing Union Medical College, Beijing (China). Cardiovascular Inst. and Fuwai Hospital, Dept. of Radiology

    2002-02-01

    Objective: To evaluate the effectiveness of transcatheter closure of re-canalized patent ductus arteriosus (PDA) after surgical ligation. Methods: Between June 1995 and November 2000, 14 patients (5 male, 9 female) with re-canalized PDA after surgical ligation underwent transcatheter closure, their median age was 13 years (range 4 to 48 years). The time between surgical ligation and the interventional procedure ranged from one month to twenty-two years. Implantations of Amplatzer duct occluder and Rashkind occluder were performed trans-venously. Cook coil occlusions was performed trans-arterially. Follow-up with X-ray radiograph and echocardiography was made 24 hours, 1, 3, 6 months, and more than 1 year after the procedure. Results: Twelve PDAs were of funnel shape, and the remaining two PDAs were of tubular shape. The median minimum diameter of re-canalized PDA after ligation was 4 mm (range 1 to 8 mm). Aortograms ten minutes after closure showed complete closure and trivial residual shunt in 11 and 3 patients, respectively. The technical success rate was 100%, and there were no complications. Echocardiography showed complete closure in all patients within 24 hours. All patients were discharged in one to two days after the procedure. At a follow-up of one to eighteen months in ten patients, there were no migration of devices and residual PDA. Conclusion: Transcatheter closure using Amplatzer duct occluder, coil (Cook company or Pfm company) and Rashkind occluder was an effective method for patients with re-canalized PDA after surgical ligation. It may be an alternative to second surgery owing to its safety, reliability, min-invasiveness, and short hospitalization.

  8. Circulatory Arrest: A Surgical Option for Adult Window Ductus Closure

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    Vithalkumar Malleshi Betigeri

    2012-03-01

    Full Text Available The window ductus , an atypical type of patent ductus arteriosus(PDA is a characteristically large in size(>2cm with no recognizable length, characteristic continuation of main pulmonary artery with aortic arch and absence of internal ductal tissue. Surgical safety and effectiveness of its closure can be increased by using cardiopulmonary bypass (CPB and hypothermic total circulatory arrest (HTCA via median sternotomy.

  9. Lower limb revascularisation preceding surgical wound coverage - an interdisciplinary algorithm for chronic wound closure.

    Science.gov (United States)

    Aust, M C; Spies, M; Guggenheim, M; Gohritz, A; Kall, S; Rosenthal, H; Pichlmaier, M; Oehlert, G; Vogt, P M

    2008-08-01

    Chronic wounds may occur or persist due to arterial insufficiency. Despite the high prevalence of arterial occlusive disease, a search of the literature has yielded a paucity of data on the benefit of interventions to recanalise lower extremity arteries prior to surgical closure of chronic wounds. To investigate the correlation of simple clinical examinations and apparative diagnostics for the detection of arterial occlusive disease of the lower extremity in patients with chronic wounds, and to evaluate the benefit of vascular procedures to optimise wound perfusion before surgical closure. During a 6-year period, 150 patients with chronic lower extremity wounds (no healing for more than 30 days) were included into this prospective study. All patients underwent palpation of foot pulses, Doppler sonography and measurement of occlusive pressures. Positive clinical findings were re-evaluated by angiography. All patients with peripheral extremity vessel occlusions underwent vascular interventions (percutaneous transluminal angioplasty with stenting, open thrombectomy or vascular bypass surgery) prior to surgical wound closure. In all 34 patients (21%) with missing foot pulses, suspicious Doppler signals or pathological occlusive pressure measurements, the clinical diagnosis of arterial occlusion was confirmed by angiography. An arterial pathology had previously been diagnosed in merely two of those patients. Nineteen patients underwent percutaneous transluminal angioplasty and 21 stents were implanted; in 10 cases, open thrombectomy or vascular bypasses were performed. In all 34 patients, sufficient peripheral recanalisation and improved wound perfusion were successfully achieved. For definitive wound closure, microsurgical tissue transplantation was performed in 15 patients. Angiography was performed prior to surgery. In 11 patients, regional or local flaps were used. Six patients received split skin grafting only; two wounds healed conservatively following vascular

  10. The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

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    Burhan Özalp

    2018-06-01

    Full Text Available Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94 years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%, followed by squamous cell carcinoma (n=45, 23.7% and malignant melanoma (n=5, 2.6%. The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%; tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%, showing a significant difference (p<0.001. Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer.

  11. Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases

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    Saatchi Mahesh Kuwelker

    2017-01-01

    Full Text Available Tricuspid valve (TV injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD with Amplatzer ductal occluder I (ADO I, requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.

  12. Surgical treatment of complications associated with the Angio-Seal vascular closure device.

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    Cikirikcioglu, Mustafa; Cherian, Sanjay; Keil, Vera; Manzano, Norman; Gemayel, Gino; Theologou, Thomas; Kalangos, Afksendiyos

    2011-05-01

    Vascular closure devices are used to provide quick hemostasis and early ambulation after percutaneous interventions. The Angio-Seal (AS) vascular closure device forms a mechanical seal by closing the puncture site located between a bioabsorbable anchor within the lumen and a collagen sponge on the adventitia. Although morbidities associated with AS are reportedly infrequent, even the slightest inaccuracy in device implantation may result in displacement of these device components, leading to sudden and severe complications. We report the surgical treatment of complications associated with the use of AS in four patients, including acute limb ischemia, pseudoaneurysm formation, significant hemorrhage, and hypovolemic shock. A common factor in all these cases was that the components of the AS device were displaced from their original site of implantation, stressing the importance of proper device placement. All patients underwent successful surgical vascular repair. Our report highlights the need for exercising extreme care during device implantation, and also the requirement for vigilant inspection for any associated vascular complications commencing immediately after device implantation. It is vital that these device components are actively looked for and removed during surgical exploration so as to prevent future complications. Copyright © 2011. Published by Elsevier Inc.

  13. Patent ductus arteriosus in preterm infants: benefits of early surgical closure.

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    Fonseca, Elizabeth; Georgiev, Stanimir G; Gorenflo, Matthias; Loukanov, Tsvetomir S

    2014-05-01

    Patent ductus arteriosus in preterm neonates leads to significant morbidity. Surgery is indicated when pharmacological treatment fails or is contraindicated, but the optimal timing remains unclear. We retrospectively studied all 41 preterm neonates with symptomatic ductus arteriosus who underwent ligation between 1988 and 2009. We compared early complications rates and late neurological outcomes of patients operated on before 21 days of age with these operated on later. The median gestational age at birth was 26 weeks (range 23-31 weeks) and median weight at birth was 930 g (range 510-1500 g); 34 (82.9%) received pharmacological treatment before surgery. Fourteen (34.1%) patients underwent surgical closure before 21 days of age and 27 (65.9%) after 21 days. The 2 groups did not differ significantly in gestational age and weight at birth, but those operated on after 21 days received significantly more pharmacological treatment cycles. Patients in the early closure group had shorter intubation times: median 23 days (range 13-35 days) vs. 43 days (range 27-84 days; p ductus arteriosus after unsuccessful pharmacological therapy in preterm neonates might lower complication rates and improve neurological outcome. Prospective randomized studies are needed to determine the optimal treatment.

  14. Surgical Closure of Patent Ductus Arteriosus in Premature Neonates Weighing Less Than 1,000 grams: Contemporary Outcomes.

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    Lehenbauer, David G; Fraser, Charles D; Crawford, Todd C; Hibino, Naru; Aucott, Susan; Grimm, Joshua C; Patel, Nishant; Magruder, J Trent; Cameron, Duke E; Vricella, Luca

    2018-07-01

    The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as "rescue" therapy. The objective of this study was to review our institutions' outcomes of surgical PDA ligation. All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.

  15. [Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

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    Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

    2017-05-01

    Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure.

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    Jeong, Young-Hoon; Yun, Tae-Jin; Song, Jong-Min; Park, Jung-Jun; Seo, Dong-Man; Koh, Jae-Kon; Lee, Se-Whan; Kim, Mi-Jeong; Kang, Duk-Hyun; Song, Jae-Kwan

    2007-09-01

    Left ventricular (LV) remodeling and predictors of LV systolic function late after closure of patent ductus arteriosus (PDA) in adults remain to be clearly demonstrated. In 45 patients with PDA, including 28 patients who received successful occlusion using the Amplatzer device (AD group) (AGA, Golden Valley, MN) and 17 patients who received surgical closure (OP group), echocardiography studies were performed before closure and 1 day (AD group) or within 7 days (OP group) after closure, and then were repeated at > or = 6 months (17 +/- 13 months). In both groups, LV ejection fraction (EF) and end-diastolic volume index were significantly decreased immediately after closure, whereas end-systolic volume index did not change. During the long-term follow-up period, end-systolic as well as end-diastolic volume indices decreased significantly in both groups and LV EF recovered compared to the immediate postclosure state. However, LV EF remained low compared to the preclosure state. Five patients (11.1%) including 3 patients in the AD group and 2 patients in the OP group showed persistent late LV systolic dysfunction (EF or = 62% had a sensitivity of 72% and a specificity of 83% for predicting late normal LV EF after closure. Left ventricular EF remains low late after PDA closure compared with preclosure state in adults. Preclosure LV EF is the best index to predict late postclosure LV EF.

  17. Surgical Experience with Closure of an Isolated PDA at Muhimbili ...

    African Journals Online (AJOL)

    Results: A total of 52 patients with clinical diagnosis of PDA, 26 patients in each treatment group of either standard closure or new closure technique. ... string on the ampulla of the PDA followed by a silk ligature has proved to be efficient and reliable technique that leaves no residual lesion with no long term complications.

  18. Comparison of long-term clinical outcome between transcatheter Amplatzer occlusion and surgical closure of isolated patent ductus arteriosus.

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    Chen, Zhao-yang; Wu, Li-ming; Luo, Yu-kun; Lin, Chao-gui; Peng, Ya-fei; Zhen, Xing-chun; Chen, Liang-long

    2009-05-20

    Transcatheter Amplatzer occlusion of patent ductus artertiosus (PDA) has emerged as a minimally invasive alternative to surgical closure. The goal of this study was to compare long-term clinical outcomes between two procedures, especially on chronic residual shunt, late or very late procedure-related complications, and regression of pulmonary hypertension and left ventricular dilation. A total 255 patients having isolated PDA with a minimal diameter of >or= 4 mm treated from January 2000 to July 2003 were included in this study and have been followed up until July 2008. The patients were assigned to either the device or surgical closure group according to the patients' and/or their parents' preference. Baseline physical exams, chest roentgenography, electrocardiography, and echocardiography were performed preprocedure and at each follow-up. Seventy-two patients accepted the transcatheter procedure (Group-TC) and 183 underwent surgical operation (Group-SO) for PDA closure, both groups were similar in their demographics and preoperative clinical characteristics. There were no cardiac deaths and late complications such as infectious endocarditis and Amplatzer duct occluder (ADO) dislodge in either group. More acute procedure-related complications were recorded in Group-SO (13.7%) compared with Group-TC (1.4%) (P = 0.004). The recovery time was (8.7 +/- 2.3) days for the Group-SO and (1.3 +/- 0.5) days for the Group-TC (P ventricular dilation; neither survival freedom from pulmonary hypertension nor abnormal left ventricular end-diastolic volume index were significantly different between the surgical group and the Amplatzer group. Our study confirmed the long-term safety and efficacy of transcatheter Amplatzer occlusion. In comparison to the time-proven surgical closure, transcatheter Amplatzer occlusion was less invasive and associated with fewer complications and residual shunt, and as effective in the regression of pulmonary hypertension and left ventricular

  19. The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts.

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    Saziye, Karaca; Afksendiyos, Kalangos

    2015-04-01

    In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5-10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Risk Analysis of the Long-Term Outcomes of the Surgical Closure of Secundum Atrial Septal Defects

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    Hong Rae Kim

    2017-04-01

    Full Text Available Background: Closure of a secundum atrial septal defect (ASD is possible through surgical intervention or device placement. During surgical intervention, concomitant pathologies are corrected. The present study was conducted to investigate the outcomes of surgical ASD closure, to determine the risk factors of mortality, and establish the effects of concomitant disease correction. Methods: Between October 1989 and October 2009, 693 adults underwent surgery for secundum ASD. Their mean age was 40.9±13.1 years, and 199 (28.7% were male. Preoperatively, atrial fibrillation was noted in 39 patients (5.6% and significant tricuspid regurgitation (TR in 137 patients (19.8%. The mean follow-up duration was 12.4±4.7 years. Results: There was no 30-day mortality. The 1-, 5-, 10-, and 20-year survival rates were 99.4%, 96.8%, 94.5%, and 81.6%, respectively. In multivariate analysis, significant preoperative TR (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.09 to 3.16; p=0.023 and preoperative age (HR, 1.04; 95% CI, 1.01 to 1.06; p=0.001 were independent risk factors for late mortality. The TR grade significantly decreased after ASD closure with tricuspid repair. However, in patients with more than mild TR, repair was not associated with improved long-term survival (p=0.518. Conclusion: Surgical ASD closure is safe. Significant preoperative TR and age showed a strong negative correlation with survival. Our data showed that tricuspid valve repair improved the TR grade effectively. However, no effect on long-term survival was found. Therefore, early surgery before the development of significant TR mat be beneficial for improving postoperative survival.

  1. Transient left ventricular systolic dysfunction following surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac centre, Ethiopia.

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    Tilahun, Birkneh; Tefera, Endale

    2013-05-31

    Patent ductus arteriosus (PDA) is one of the commonest congenital heart diseases that require closure within the first few months after birth. The residential area of patients affects the size of the PDA: living in highlands, like most places in Ethiopia, is a risk for having larger sized PDA. Closure of these congenital heart defects is usually performed at an early age in places where capable centers are available. In Ethiopia, closure of these defects is done on mission basis often at an older age. Recently, limited reports came about the occurrence of postoperative left ventricular systolic dysfunction (POLVD) following closure of PDA though full explanation is still lacking. To determine the rate of and time to improvement of POLVD and the factors associated with it in children and adolescents who underwent surgical closure of PDA. All children and adolescents who underwent surgical closure of PDA at the Cardiac Center, Ethiopia (CCE) had postoperative follow up with echocardiography. Serial left ventricular ejection fraction (LVEF) and fiber shortening (FS) values were recorded for all of them. SPSS 20 was used to analyze the data. A total of 36 children and adolescents who underwent surgical closure of PDA from January 2009 to December 2012 and who fulfilled the inclusion criteria were studied. Their mean age at intervention was 8.52 years (SD = 5.23 years), 77.80% were females. The mean duct size as determined by either echocardiography or intra-operative by the surgeon was 10.31 mm (SD = 3.20 mm). They were followed for a mean duration of 24.80 months (SD = 12.36 months) following surgical closure of PDA. The mean LVEF and FS decreased from 65.06% and 35.28% preoperatively to 54.83% and 28.40% post-operatively respectively. Fifteen (42.86%) of the patients had a post-operative LVEF of less than 55%. The mean time to normalization of systolic function was 5.11 weeks (SD = 3.30 weeks). Having an associated cardiac lesion was an independent

  2. 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

  3. Improvement of gastroesophageal reflux disease in Japanese patients with spinal kyphotic deformity who underwent surgical spinal correction.

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    Sugimoto, Mitsushige; Hasegawa, Tomohiko; Nishino, Masafumi; Sahara, Shu; Uotani, Takahiro; Ichikawa, Hitomi; Kagami, Takuma; Sugimoto, Ken; Yamato, Yu; Togawa, Daisuke; Kobayashi, Sho; Hoshino, Hironobu; Matsuyama, Yukihiro; Furuta, Takahisa

    2016-01-01

    Spinal kyphotic deformity occasionally results in gastroesophageal reflux disease (GERD). The effects of acid reflux on the esophagus in kyphotic patients are unclear, however, and it is unknown whether acid reflux, endoscopic GERD, and reflux-related symptoms improve following surgical spinal correction in these patients. Herein, we investigated the characteristics of GERD in kyphotic patients and the improvement in GERD following surgical correction. In 48 patients with severe kyphotic deformity scheduled for surgical spinal correction, we conducted esophagogastroduodenoscopy, 24-h pH monitoring and three questionnaire surveys, including the frequency scale for the symptoms of GERD (FSSG). We repeated these measurements after surgical correction and compared pre- and post-surgery values. Of 48 patients, 70.8% [95% CI: 55.9-83.0%, 34/48] had endoscopically evaluated esophageal mucosal injury. Regarding pH before surgery, 64.9% (CI: 47.5-79.8%, 24/37) had abnormal acid reflux (intraesophageal pH reflux decreased from 66.7% (95% CI: 41.0-86.7%) to 33.3% (95% CI: 13.3-59.0%) (P = 0.045). Surgical spinal correction in kyphosis patients improves not only kyphotic deformity-related disorders but also esophageal mucosal injury, abnormal acid reflux, and reflux-related symptoms. © 2015 Japan Gastroenterological Endoscopy Society.

  4. Comparison of primary and delayed primary closure in dirty abdominal wounds in terms of frequency of surgical site infection

    International Nuclear Information System (INIS)

    Aziz, O.B.A.; Ahmed, N.; Butt, M.W.U.D.; Saleem, M.R.

    2013-01-01

    Objective: Objective of this study was to compare primary and delayed primary wound closure for dirty abdominal wounds in terms of frequency of surgical site infection. Study Design: Randomized Controlled Trial. Place and Duration of Study: Combined Military Hospital, Multan. From 16 Sep 2010 to 15 Mar 2011. Patients and Methods: A total of 110 patients were randomly divided into two groups of 55 patients each using random numbers table. Abdominal wounds of one group were closed primarily and of other group were subjected to delayed primary wound closure. The wounds were then checked for surgical site infection for seven post operative days. Results: A higher frequency of surgical site infection was observed in primary closure group (27.3%) as compared to delayed primary closure group (9.1%) which was statistically significant (p=0.013). Conclusion: Delayed primary closure is superior to primary closure in dirty abdominal wounds in terms of frequency of surgical site infection. (author)

  5. Wound management with vacuum assisted closure in surgical site infection after ankle surgery.

    Science.gov (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

    2015-05-01

    The aim of this study was to compare the efficacy of vacuum assisted closure (VAC) with standard moist wound care (SMWC) in surgical site infection after ankle surgery. A prospective cohort was performed among patients with surgical site infection after ankle surgery between 2012 and 2013. The follow-up period was three month, and the efficacy end point was complete wound closure rate. Ninety-four patients were analyzed, with 61 patients in the VAC group and 33 in the SMWC group. The complete wound closure rate in the VAC group was higher than that in the SMWC group at 3 month follow up (90.2% Vs. 72.7%, p = 0.028). The median time to complete wound closure was 31 days (95% CI 20.2-41.8) for VAC, and 63 days (95% CI 46.9-79.1) for SMWC (χ(2) = 4.023, p = 0.045). In the superficial infection subgroup, the median times to complete wound closure were 20 days (95% CI 14.2-35.1) in the VAC group and 42 days (95% CI 35.4-69.4) in SMWC group (χ(2) = 4.331, p = 0.041). In the deep subgroup, the median times to complete wound closure were 46 days (95% CI 28.2-65.9) in the VAC group and 75 days (95% CI 43.2-79.6) in SMWC group (χ(2) = 6.475, p = 0.026). Our result showed that vacuum assisted closure was more effective than standard moist wound care in surgical site infection after ankle surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  6. Surgical Scales: Primary Closure versus Gastric Resection for ...

    African Journals Online (AJOL)

    Perforated gastric ulcer is one of the most life‑threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59‑year‑old male patient ...

  7. Evaluation of Cosmetic Results of Surgical Wound Closure in Dogs

    Directory of Open Access Journals (Sweden)

    Rachel Williams

    2018-02-01

    Full Text Available Objective: To evaluate the correlation between wound cosmesis and pet owner satisfaction, to determine the agreement among vet surgeons, and pet owners evaluating a surgical wound with a visual assessment score (VAS, and to determine the agreement between the VAS, a semi-quantitative score of wound inflammation, and wound width.Background: Perception of post-surgical cosmesis by human patients has been found to influence their satisfaction and perceived adequacy of vet surgeons. Due to the trend of owners anthropomorphising pets, this logic can be extended to veterinary patients. Also, there is a lack of consistent, reliable methods to evaluate cosmesis have been developed, creating the need for a scoring system that is accurate and reproducible.Evidentiary value: This was a prospective cohort study with one hundred and seven patients. This study may not change day-to-day practices, but it will bring to light for practitioners the discordance between pet owners and vet surgeons concerning attractiveness of an incision as well as overall satisfaction with a procedure.Methods: Photographs of surgical wounds were taken immediately, 2 weeks, and 8 weeks after surgery in dogs. Owners were asked to evaluate satisfaction with the procedure and attractiveness of the incision using the VAS. Photos were evaluated for cosmetic outcome by pet owner and vet surgeon evaluators with different scoring systems. The reliability of the scoring systems was evaluated using intraclass correlations and kappa statistics as appropriate.Results:  Owners’ evaluation of cosmetic outcome correlated with their overall satisfaction. (r2=0.37, where r2 is the coefficient of determination, and can be used to determine what proportion of variance in one variable is predictable from the other variableThere was generally poor reliability of the subjective scoring between both vet surgeons and pet owners, and the less subjective scoring systems.Conclusion: The cosmetic outcome

  8. Prognostic significance of nuclear factor of activated T-cells 5 expression in non-small cell lung cancer patients who underwent surgical resection.

    Science.gov (United States)

    Cho, Hyun Jin; Yun, Hwan-Jung; Yang, Hee Chul; Kim, Soo Jin; Kang, Shin Kwang; Che, Chengri; Lee, Sang Do; Kang, Min-Woong

    2018-06-01

    Nuclear factor of activated T-cells 5 (NFAT5) is known to be correlated with migration or invasion of tumor cells based on previous in vitro studies. The aim of this study was to analyze the relationship between NFAT5 expression and clinical prognosis in non-small cell lung cancer (NSCLC) patients who underwent surgical resection. A total of 92 NSCLC patients who underwent surgical resection were enrolled. The tissue microarray core was obtained from surgically resected tumor specimens. NFAT5 expression was evaluated by immunohistochemistry. Relationships of NFAT5 expression with disease recurrence, overall survival, and disease-free survival (DFS) were analyzed. The mean age of 92 patients was 63.7 y. The median follow-up duration was 63.3 mo. Fifty-one (55%) patients exhibited positive expression of NFAT5. Disease recurrence in the NFAT5-positive group was significantly (P = 0.022) higher than that in the NFAT5-negative group. NFAT5-positive expression (odds ratio: 2.632, 95% confidence interval: 1.071-6.465, P = 0.035) and pathologic N stage (N1-2 versus N0; odds ratio: 3.174, 95% confidence interval: 1.241-8.123, P = 0.016) were independent and significant risk factors for disease recurrence. DFS of the NFAT5-positive group was significantly worse than that of the NFAT5-negative group (89.7 versus 48.7 mo, P = 0.011). A multivariate analysis identified NFAT5 expression (P < 0.029) as a significant independent risk factor for DFS of patients with postoperative pathologic T and N stages (P < 0.001 and P = 0.017, respectively). NFAT5 expression is a useful prognostic biomarker for NSCLC patients who underwent surgical resection. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. The Impact of Surgical Patent Ductus Arteriosus Closure on Autonomic Function in Premature Infants.

    Science.gov (United States)

    Andescavage, Nickie N; Metzler, Marina; Govindan, Vedavalli; Al-Shargabi, Tareq; Nath, Dilip S; Krishnan, Anita; Massaro, An; Wang, Yunfei; duPlessis, Adre J; Govindan, R B

    2017-07-01

    Background  Patent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest risk for neurodevelopmental injury. Autonomic dysfunction has been described in premature infants with PDA. Aim  To interrogate the autonomic nervous system by analysis of advanced heart rate variability (HRV) metrics before and after surgical closure of the PDA. Study Design  Prospective, observational study. Subjects  Twenty-seven infants born before 28 weeks' gestation were included in this study. Methods  Continuous electrocardiogram data were sampled at a rate of 125 Hz for a total of 6 hours before and 6 hours after 30 hours of surgical closure. HRV was determined by detrended fluctuation analysis to calculate the short and long root mean square (RMS L and RMS S ) and α components at two time scales (long and short). Results  Gestational age (GA) was positively associated with RMS L , RMS S , and α S and was negatively associated with α L . There was no difference between RMS s , RMS L , α S , or α L before and after surgery; however, median heart rate was lower after surgery ( p  < 0.01). Conclusion  Advancing GA is highly associated with increasing HRV; however, surgical ligation does not affect HRV in the postoperative period. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. [Vacuum-assisted closure as a treatment modality for surgical site infection in cardiac surgery].

    Science.gov (United States)

    Simek, M; Nemec, P; Zálesák, B; Hájek, R; Kaláb, M; Fluger, I; Kolár, M; Jecmínková, L; Gráfová, P

    2007-08-01

    The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection. From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 +/- 9.7 years and the median BMI was 33.2 +/- 5.0 kg/m2. Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%). Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 +/- 22.6 days. The median number of dressing changes was 4.6 +/- 1.8. The median VAC treatment time until surgical closure was 9.7 +/- 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy. The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

  11. Assessment of MRI issues at 3-Tesla for metallic surgical implants: findings applied to 61 additional skin closure staples and vessel ligation clips.

    Science.gov (United States)

    Gill, Amreeta; Shellock, Frank G

    2012-01-09

    Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC) and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC) that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information) among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants) underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration). Heating was not substantial (highest temperature change, ≤ 1.6°C). Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants.

  12. Assessment of MRI issues at 3-Tesla for metallic surgical implants: findings applied to 61 additional skin closure staples and vessel ligation clips

    Directory of Open Access Journals (Sweden)

    Gill Amreeta

    2012-01-01

    Full Text Available Abstract Purpose Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. Methods A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Results Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration. Heating was not substantial (highest temperature change, ≤ 1.6°C. Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. Conclusions The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants.

  13. Assessment of MRI issues at 3-Tesla for metallic surgical implants: findings applied to 61 additional skin closure staples and vessel ligation clips

    Science.gov (United States)

    2012-01-01

    Purpose Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. Methods A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC) and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC) that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information) among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants) underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Results Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration). Heating was not substantial (highest temperature change, ≤ 1.6°C). Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. Conclusions The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants. PMID:22230200

  14. Comparison between transcatheter and surgical closure of secundum atrial septal defect in patients over 40 years old

    International Nuclear Information System (INIS)

    Wang Cheng; Zhao Shihua; Jiang Shiliang; Huang Lianjun; Xu Zhongying; Ling Jian; Zheng Hong; Zhang Gejun; Lv Bin; Zhang Yan; Jin Jinglin; Yan Chaowu; Dai Ruping

    2007-01-01

    Objective: To compare the safety and efficacy of transcatheter closure of secundum atrial septal defect (ASD) with surgical closure in patients over 40 years old. Methods: A single center, nonrandomized concurrent study was performed in 233 consecutive adults from January, 2004 to December, 2005. The patients were assigned to either the device or surgical closure group according to the patients options. Technical success rate, complications, residual shunt, hospital stay, amount of blood transfusion and cost were compared. Results: A total of 137 patients were in the group undergoing device closure, whereas 96 patients were in the surgical group. There was no differences in age, sex distribution or baseline cardiac function between the two groups. The sizes of the ASD were(18.9±5.4) mm for the device group and (24.9 ± 6.8)mm for the surgical group (P<0.001). The technical success rates were 97.1% for the device group and 100% for the surgical group (P=0.151). The residual shunt rates were 0.7% for the device group and 0% for the surgical group (P=0.583). Mortality was zero for both groups. The complication rates were 16.1% for the device group and 30.2% for the surgical group (P=0.015). The blood transfusion amounts were (273.1 ± 491.5)ml for the surgical group and 0 ml for the device group (P<0.001). The lengths of hospital stay were (4.6 ± 3.3)days for the device group and (12.0 ± 4.0) days for the surgical group (P<0.001). The costs of hospital stay were 39 570.0±5 929.5 RMB for the device group and 29 839.6±7 533.1 RMB for the surgical group (p<0.001). Conclusions: The technical success rates for surgical versus device closure of ASD were of significantly different, however, the complication rate was lower and the length of hospital stay was shorter for device closure than those for surgical repair. Transcatheter closure of secundum ASD is a safe and effective alternative to surgical repair in selected patients. (authors)

  15. Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery.

    Science.gov (United States)

    Yoshimoto, Akihiro; Inoue, Takafumi; Fujisaki, Masayuki; Morizumi, Sei; Suematsu, Yoshihiro

    2016-08-01

    Surgical site infection (SSI) after cardiovascular procedures is a severe complication, potentially leading to high morbidity and mortality. In addition, during the treatment of SSI, rehabilitation is delayed, which can severely impair postoperative recovery. The aim of this study was to assess the effect of vacuum-assisted closure (VAC) therapy on rehabilitation during the treatment of SSI after cardiovascular surgery. From January 2008 to March 2015, 10 patients underwent VAC therapy for SSI after cardiovascular operations. The patient characteristics, duration of VAC therapy, time interval from the implementation of VAC to physical therapy (PT) (T1), ambulation (T2) and walking (T3), functional independent measure (FIM), and maximum consecutive walking capacity (MCWC) were retrospectively analyzed. Nine patients underwent mid-sternal incision and one patient underwent thoraco-abdominal incision. The mean time interval from the beginning of VAC therapy to PT, ambulation, and walking was 0.38 ± 0.50, 0.63 ± 0.71, and 1.38 ± 1.86 days, respectively. The average FIM was 84.5 ± 14.0 at the beginning of VAC therapy and 106.7 ± 18.5 at the end of VAC therapy (P = 0.000494). On average, MCWC was 52.3 ± 54.6 m at the installation of VAC therapy and 189.7 ± 152.8 m at the completion of VAC therapy (P = 0.0169). FIM and MCWC improvement rate was better in VAC group than non-VAC group although these data are not suitable for statistical analysis because of a small sample size. Although further studies are warranted, VAC therapy may have a role in facilitating rehabilitation and improving the prognosis of SSI cases after major cardiovascular operations.

  16. Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures.

    Science.gov (United States)

    Lies, Shelby R; Zhang, Andrew Y

    2015-09-01

    Music is commonly played in operating theaters. Some surgeons believe music reduces stress and operative time, while others think music is a distraction and should be avoided. There is limited published evidence evaluating the effects of music on surgical performance. The goal of this study is to evaluate the effect of music on simple wound closure. Plastic surgery residents were asked to perform layered closures on pigs' feet with and without their preferred music playing. Simple randomization was used to assign residents to the music playing first or music playing second group. The time to complete the repair was measured and repairs were graded by blinded faculty. Results were analyzed to determine significant differences in time to complete the task and quality of repair. Participants were retested in a second session with music played in the opposite order to evaluate consistency. Listening to preferred music decreased repair time by 8% for all plastic surgery residents (p = 0.009). Subgroup analysis demonstrated even more significant improvement in speed for senior residents (PGY 4-6), resulting in a 10% decrease in repair time (p = 0.006). The quality of repair was also better in the music group, at 3.3 versus 3.1 (p = 0.047). Retesting revealed results remained significant whether music was played first or second. Playing preferred music made plastic surgery residents faster in completing wound closure with a 10% improvement in senior residents. Music also improved quality of repair as judged by blinded faculty. Our study showed that music improves efficiency of wound closure, which may translate to healthcare cost savings. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  17. The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair.

    Science.gov (United States)

    Javadian, Pouya; Shobeiri, S Abbas

    2017-09-13

    The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision. Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0-10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States RESULTS: Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0-10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were associated with

  18. Mr-Proanp Rises during Exercise Even after Surgical Closure of the Left Atrial Appendage

    DEFF Research Database (Denmark)

    Hagdrup, Christian; Hansen, Jesper Park; Svendsen, Jesper Hastrup

    2017-01-01

    bicycle exercise test, at least six weeks after the operation. Closure of the LAA was confirmed by Transesophageal Echocardiography (TEE). Venous blood samples were collected before the test, and within the first two minutes of recovery after maximum work-load. Results: Baseline ANP showed (non-closed vs....... closed LAA): 163.3pM (95% CI: 121.9 – 204.8) vs. 137.5 pM (95% CI: 69.5 – 205.6), p=0.4575. Maximum work-load was similar for both groups. MR-proANP concentration rose significantly: Max ANP (non-closed vs. closed LAA): 197.4pM (95% CI: 146.9 - 247.9) vs. 164.3pM (95% CI: 89.1 - 239.6), p=0.4061MR......-proANP increase was not different between the groups. Delta ANP (non-closed vs. closed LAA): 34.1pM (95% CI: 22.1 – 46.1) vs. 26.8pM (95% CI: 15.3 – 38.3), p=0.3352 Conclusion: This study shows that plasma MR-proANP increases during exercise, and that surgical LAA closure did not reduce the increase of MR...

  19. Results of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure

    NARCIS (Netherlands)

    Roolker, W.; Kraaneveld, E.; Been, H. D.; Marti, R. K.

    2002-01-01

    A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47

  20. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    NARCIS (Netherlands)

    G. Bol-Raap (Goris); A.H.J. Koning (Anton); T.V. Scohy (Thierry); A.D.J. ten Harkel (Arend); F.J. Meijboom (Folkert); A.P. Kappetein (Arie Pieter); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)

    2007-01-01

    textabstractBackground. This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods. 12

  1. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial.

    Science.gov (United States)

    Diener, Markus K; Knebel, Phillip; Kieser, Meinhard; Schüler, Philipp; Schiergens, Tobias S; Atanassov, Vladimir; Neudecker, Jens; Stein, Erwin; Thielemann, Henryk; Kunz, Reiner; von Frankenberg, Moritz; Schernikau, Utz; Bunse, Jörg; Jansen-Winkeln, Boris; Partecke, Lars I; Prechtl, Gerald; Pochhammer, Julius; Bouchard, Ralf; Hodina, René; Beckurts, K Tobias E; Leißner, Lothar; Lemmens, Hans-Peter; Kallinowski, Friedrich; Thomusch, Oliver; Seehofer, Daniel; Simon, Thomas; Hyhlik-Dürr, Alexander; Seiler, Christoph M; Hackert, Thilo; Reissfelder, Christoph; Hennig, René; Doerr-Harim, Colette; Klose, Christina; Ulrich, Alexis; Büchler, Markus W

    2014-07-12

    Postoperative surgical site infections are one of the most frequent complications after open abdominal surgery, and triclosan-coated sutures were developed to reduce their occurrence. The aim of the PROUD trial was to obtain reliable data for the effectiveness of triclosan-coated PDS Plus sutures for abdominal wall closure, compared with non-coated PDS II sutures, in the prevention of surgical site infections. This multicentre, randomised controlled group-sequential superiority trial was done in 24 German hospitals. Adult patients (aged ≥18 years) who underwent elective midline abdominal laparotomy for any reason were eligible for inclusion. Exclusion criteria were impaired mental state, language problems, and participation in another intervention trial that interfered with the intervention or outcome of this trial. A central web-based randomisation tool was used to randomly assign eligible participants by permuted block randomisation with a 1:1 allocation ratio and block size 4 before mass closure to either triclosan-coated sutures (PDS Plus) or uncoated sutures (PDS II) for abdominal fascia closure. The primary endpoint was the occurrence of superficial or deep surgical site infection according to the Centers for Disease Control and Prevention criteria within 30 days after the operation. Patients, surgeons, and the outcome assessors were masked to group assignment. Interim and final analyses were by modified intention to treat. This trial is registered with the German Clinical Trials Register, number DRKS00000390. Between April 7, 2010, and Oct 19, 2012, 1224 patients were randomly assigned to intervention groups (607 to PDS Plus, and 617 to PDS II), of whom 1185 (587 PDS Plus and 598 PDS II) were analysed by intention to treat. The study groups were well balanced in terms of patient and procedure characteristics. The occurrence of surgical site infections did not differ between the PDS Plus group (87 [14·8%] of 587) and the PDS II group (96 [16·1%] of 598

  2. Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Tansarli, Giannoula S; Vardakas, Konstantinos Z; Stratoulias, Constantinos; Peppas, George; Kapaskelis, Anastasios; Falagas, Matthew E

    2014-08-01

    We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

  3. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds.

    Science.gov (United States)

    Toon, Clare D; Lusuku, Charnelle; Ramamoorthy, Rajarajan; Davidson, Brian R; Gurusamy, Kurinchi Selvan

    2015-09-03

    Most surgical procedures involve a cut in the skin that allows the surgeon to gain access to the deeper tissues or organs. Most surgical wounds are closed fully at the end of the procedure (primary closure). The surgeon covers the closed surgical wound with either a dressing or adhesive tape. The dressing can act as a physical barrier to protect the wound until the continuity of the skin is restored (within about 48 hours) and to absorb exudate from the wound, keeping it dry and clean, and preventing bacterial contamination from the external environment. Some studies have found that the moist environment created by some dressings accelerates wound healing, although others believe that the moist environment can be a disadvantage, as excessive exudate can cause maceration (softening and deterioration) of the wound and the surrounding healthy tissue. The utility of dressing surgical wounds beyond 48 hours of surgery is, therefore, controversial. To evaluate the benefits and risks of removing a dressing covering a closed surgical incision site within 48 hours permanently (early dressing removal) or beyond 48 hours of surgery permanently with interim dressing changes allowed (delayed dressing removal), on surgical site infection. In March 2015 we searched the following electronic databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We also searched the references of included trials to identify further potentially-relevant trials. Two review authors independently identified studies for inclusion. We included all randomised clinical trials (RCTs) conducted with people of any age and sex, undergoing a surgical procedure, who had their wound closed and a dressing applied. We included only trials that compared

  4. Development and validation of a laparoscopic hysterectomy cuff closure simulation model for surgical training.

    Science.gov (United States)

    Tunitsky-Bitton, Elena; Propst, Katie; Muffly, Tyler

    2016-03-01

    The number of robotically assisted hysterectomies is increasing, and therefore, the opportunities for trainees to become competent in performing traditional laparoscopic hysterectomy are decreasing. Simulation-based training is ideal for filling this gap in training. The objective of the study was to design a surgical model for training in laparoscopic vaginal cuff closure and to present evidence of its validity and reliability as an assessment and training tool. Participants included gynecology staff and trainees at 2 tertiary care centers. Experienced surgeons were also recruited at the combined International Urogynecologic Association and American Urogynecologic Society scientific meeting. Participants included 19 experts and 21 trainees. All participants were recorded using the laparoscopic hysterectomy cuff closure simulation model. The model was constructed using the an advanced uterine manipulation system with a sacrocolopexy tip/vaginal stent, a vaginal cuff constructed from neoprene material and lined with a swimsuit material (nylon and spandex) secured to the vaginal stent with a plastic cable tie. The uterine manipulation system was attached to the fundamentals of laparoscopic surgery laparoscopic training box trainer using a metal bracket. Performance was evaluated using the Global Operative Assessment of Laparoscopic Skills scale. In addition, needle handling, knot tying, and incorporation of epithelial edge were also evaluated. The Student t test was used to compare the scores and the operating times between the groups. Intrarater reliability between the scores by the 2 masked experts was measured using the interclass correlation coefficient. Total and annual experience with laparoscopic suturing and specifically vaginal cuff closure varied greatly among the participants. For the construct validity, the participants in the expert group received significantly higher scores in each of the domains of the Global Operative Assessment of Laparoscopic Skills

  5. The preoperative plasma fibrinogen level is an independent prognostic factor for overall survival of breast cancer patients who underwent surgical treatment.

    Science.gov (United States)

    Wen, Jiahuai; Yang, Yanning; Ye, Feng; Huang, Xiaojia; Li, Shuaijie; Wang, Qiong; Xie, Xiaoming

    2015-12-01

    Previous studies have suggested that plasma fibrinogen contributes to tumor cell proliferation, progression and metastasis. The current study was performed to evaluate the prognostic relevance of preoperative plasma fibrinogen in breast cancer patients. Data of 2073 consecutive breast cancer patients, who underwent surgery between January 2002 and December 2008 at the Sun Yat-sen University Cancer Center, were retrospectively evaluated. Plasma fibrinogen levels were routinely measured before surgeries. Participants were grouped by the cutoff value estimated by the receiver operating characteristic (ROC) curve analysis. Overall survival (OS) was assessed using Kaplan-Meier analysis, and multivariate Cox proportional hazards regression model was performed to evaluate the independent prognostic value of plasma fibrinogen level. The optimal cutoff value of preoperative plasma fibrinogen was determined to be 2.83 g/L. The Kaplan-Meier analysis showed that patients with high fibrinogen levels had shorter OS than patients with low fibrinogen levels (p factor for OS in breast cancer patients (HR = 1.475, 95% confidence interval (CI): 1.177-1.848, p = 0.001). Subgroup analyses revealed that plasma fibrinogen level was an unfavorable prognostic parameter in stage II-III, Luminal subtypes and triple-negative breast cancer patients. Elevated preoperative plasma fibrinogen was independently associated with poor prognosis in breast cancer patients and may serve as a valuable parameter for risk assessment in breast cancer patients. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set.

    Science.gov (United States)

    Berger, Nicholas G; Chou, Raymond; Toy, Elliot S; Ludwig, Kirk A; Ridolfi, Timothy J; Peterson, Carrie Y

    2017-08-01

    Enhanced recovery pathways have decreased length of stay after colorectal surgery. Loop ileostomy closure remains a challenge, because patients experience high readmission rates, and validation of enhanced recovery pathways has not been demonstrated. This study examined a protocol whereby patients were discharged on the first postoperative day and instructed to advance their diet at home with close telephone follow-up. The hypothesis was that patients can be safely discharged the day after loop closure, leading to shorter length of stay without increased rates of readmission or complications. Patients undergoing loop ileostomy closure were queried from the American College of Surgeons National Surgical Quality Improvement Project and compared with a single institution (2012-2015). Length of stay, 30-day readmission, and 30-day morbidity data were analyzed. The study was conducted at a tertiary university department. The study includes 1602 patients: 1517 from the National Surgical Quality Improvement Project database and 85 from a single institution. Length of stay and readmission rates were measured. Median length of stay was less at the single institution compared with control (2 vs 4 d; p < 0.001). Thirty-day readmission (15.3% vs 10.4%; p = 0.15) and overall 30-day complications (15.3% vs 16.7%; p = 0.73) were similar between cohorts. Estimated adjusted length of stay was less in the single institution (2.93 vs 5.58 d; p < 0.0001). There was no difference in the odds of readmission (p = 0.22). The main limitations of this study include its retrospective nature and limitations of the National Surgical Quality Improvement Program database. Next-day discharge with protocoled diet advancement and telephone follow-up is acceptable after loop ileostomy closure. Patients can benefit from decreased length of stay without an increase in readmission or complications. This has the potential to change the practice of postoperative management of loop ileostomy closure, as

  7. A standardized perioperative surgical site infection care process among children with stoma closure: a before-after study.

    Science.gov (United States)

    Porras-Hernandez, Juan; Bracho-Blanchet, Eduardo; Tovilla-Mercado, Jose; Vilar-Compte, Diana; Nieto-Zermeño, Jaime; Davila-Perez, Roberto; Teyssier-Morales, Gustavo; Lule-Dominguez, Martha

    2008-10-01

    We report on the effectiveness of a standardized perioperative care process for lowering surgical site infection (SSI) rates among children with stoma closure at a tertiary-care public pediatric teaching hospital in Mexico City. All consecutive children with stoma closure operated on between November 2003 and October 2005 were prospectively followed for 30 days postoperatively. We conducted a before-after study to evaluate standardized perioperative bowel- and abdominal-wall care process results on SSI rates. Seventy-one patients were operated on, and all completed follow-up. SSI rates declined from 42.8% (12/28) before to 13.9% (6/43) after the standardization procedure (relative risk (RR) = 3.1; 95% confidence interval (CI) = 1.3-7.2; p = 0.006). SSI independently associated risk factors comprised peristomal skin inflammation >3 mm (odds ratio (OR) = 9.6; 95% CI = 1.8-49.6; p = 0.007) and intraoperative complications (OR = 13.3; 95% CI = 1.4-127.2; p = 0.02). Being operated on during the after-study period was shown to be a protective factor against SSI (OR = 0.2; 95% CI = 0.4-0.97; p = 0.04). Standardization was able to reduce SSI rates threefold in children with stoma closure in a short period of time.

  8. Transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: a protocol for a network meta-analysis.

    Science.gov (United States)

    You, Tao; Yi, Kang; Ding, Zhao-Hong; Hou, Xiao-Dong; Liu, Xing-Guang; Wang, Xin-Kuan; Ge, Long; Tian, Jin-Hui

    2017-06-21

    Both transcatheter device closure and surgical repair are effective treatments with excellent midterm outcomes for perimembranous ventricular septal defects (pmVSDs) in children. The mini-invasive periventricular device occlusion technique has become prevalent in research and application, but evidence is limited for the assessment of transcatheter closure, mini-invasive closure and open-heart surgical repair. This study comprehensively compares the efficacy, safety and costs of transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of pmVSDs in children using Bayesian network meta-analysis. A systematic search will be performed using Chinese Biomedical Literature Database, China National Knowledge Infrastructure, PubMed, EMBASE.com and the Cochrane Central Register of Controlled Trials to include random controlled trials, prospective or retrospective cohort studies comparing the efficacy, safety and costs of transcatheter closure, mini-invasive closure and open-heart surgical repair. The risk of bias for the included prospective or retrospective cohort studies will be evaluated according to the risk of bias in non-randomised studies of interventions (ROBINS-I). For random controlled trials, we will use risk of bias tool from Cochrane Handbook version 5.1.0. A Bayesian network meta-analysis will be conducted using R-3.3.2 software. Ethical approval and patient consent are not required since this study is a network meta-analysis based on published trials. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CRD42016053352. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Technique of Antireflux Procedure without Creating Submucosal Tunnel for Surgical Correction of Vesicoureteric Reflux during Bladder Closure in Exstrophy.

    Science.gov (United States)

    Sunil, Kanoujia; Gupta, Archika; Chaubey, Digamber; Pandey, Anand; Kureel, Shiv Narain; Verma, Ajay Kumar

    2018-01-01

    To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

  10. A case of residual inferior sinus venosus defect after ineffective surgical closure.

    Science.gov (United States)

    Uga, Sayuri; Hidaka, Takayuki; Takasaki, Taiichi; Kihara, Yasuki

    2014-10-03

    A 38-year-old woman presented with cyanosis and heart failure 34 years after patch closure of an atrial septal defect and partial anomalous pulmonary venous connection. CT and cardiac catheterisation showed a residual defect that caused right-to-left shunting. The patch almost blocked the inferior vena cava from the right atrium, resulting in uncommon drainage of the inferior vena cava into the left atrium. Other anomalies included the coronary-to-pulmonary artery fistula and duplicate inferior vena cava with dilated azygos venous system. A second surgery was performed, and we confirmed an inferior sinus venosus defect, which is rare and can be misdiagnosed. The ineffective patch closure had caused a haemodynamic status that rarely occurs. We describe the diagnostic process and emphasise the importance of correctly understanding the entity. 2014 BMJ Publishing Group Ltd.

  11. Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation.

    Science.gov (United States)

    Abu Hazeem, Anas A; Gillespie, Matthew J; Thun, Haley; Munson, David; Schwartz, Matthew C; Dori, Yoav; Rome, Jonathan J; Glatz, Andrew C

    2013-10-01

    To describe our experience with percutaneous closure of patent ductus arteriosus (PDA) in small infants and compare outcomes to matched surgical patients. Ligation via thoracotomy has been used to close PDAs in small infants, but has been associated with respiratory and hemodynamic compromise. We hypothesized that percutaneous closure would offer faster recovery of respiratory function. Patients closure between January 2000 and April 2012 were reviewed and matched to contemporary surgical patients on gestational age (GA), birth weight (BW), procedure weight (WT), and ventilation mode. Patients returned to baseline respiratory status when the product of mean airway pressure and FiO2 returned to pre-procedural levels. Eight matched pairs were included. Median BW, GA, and WT were 1.43 kg (0.52-2.97), 29.8 weeks (24-39), and 2.8 kg (2.2-3.9) for catheter patients and 1.55 kg (0.48-3.04), 29 weeks (23-37), and 2.75 kg (2.3-4.2) for surgical patients. Complete PDA closure occurred in all. The median time to return to baseline respiratory status was significantly shorter in the percutaneous group (17 hr (range 0-113) vs. 53 hr (range 13-219), P closure of PDA in small infants on respiratory support is equivalent in safety and efficacy and may offer shorter recovery time than surgical ligation. Copyright © 2013 Wiley Periodicals, Inc.

  12. Urethrovaginal fistula closure.

    Science.gov (United States)

    Clifton, Marisa M; Goldman, Howard B

    2017-01-01

    In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula. The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair. The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure. Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.

  13. Coil occlusion of residual shunts after surgical closure of patent ductus arteriosus.

    Science.gov (United States)

    Fujii, Yoko; Keene, Bruce W; Mathews, Kyle G; Atkins, Clarke E; Defrancesco, Teresa C; Hardie, Elizabeth M; Wakao, Yoshito

    2006-12-01

    OBJECTIVE; To describe use of coil embolization to occlude residual flow through a patent ductus arteriosus (PDA) after incomplete surgical ligation. Clinical study. Dogs (n=4) with continuous murmur after surgical ligation of PDA. After PDA ligation, residual ductal flow through the PDA was visible on color-flow Doppler examination and left ventricular end-diastolic diameter remained increased. Coil embolization by an arterial approach was performed to achieve complete occlusion of the PDA. Embolization coils were delivered without complications and hemodynamically successful occlusion was achieved. Doppler-visible flow resolved in 2 dogs within 3 months after embolization. Left ventricular end-diastolic diameter indexed to body weight decreased in all dogs. Transcatheter coil embolization appears to be a safe and minimally invasive procedure for complete occlusion of residual PDA flow after incomplete surgical ligation. Transcatheter coil embolization should be considered for correction of hemodynamically significant residual shunts in dogs that have incomplete PDA occlusion after open surgical ligation.

  14. Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure

    International Nuclear Information System (INIS)

    Kareem, Tayeb S.

    2006-01-01

    Objective was to study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A (37 patients) were treated by open method (excision and healing by secondary intention) and Group B (40 patients) for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years (mean 4.16) was through outpatient visits. The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups (p<0.0001). The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference (p=0.0401), while the differences were insignificant for each complication when analyzed separately. Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus. (author)

  15. Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs.

    Science.gov (United States)

    Nutt, Laura K; Wilson, Megan L; Sakals, Sherisse

    2017-12-01

    This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

  16. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Kappetein A Pieter

    2007-02-01

    Full Text Available Abstract Background This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD. Methods 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility. Results All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included. Conclusion This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I

  17. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dharmesh R Agrawal

    2013-01-01

    Full Text Available Acute left ventricular (LV failure has been reported after surgical closure of atrial septal defect (ASD in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5. The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

  18. Surgical closure of persistent arterial duct with minimal invasive anterior thoracotomy: an alternative technique.

    Science.gov (United States)

    Fouilloux, Virginie; Gran, Célia; Kreitmann, Bernard

    2014-10-01

    Surgical approach for persistent ductus arteriosus ligation is typically a left lateral thoracotomy opening the pleural-space with left lung retraction. We describe an alternative approach, with a minimally invasive anterior parasternal incision. This is particularly adapted to preterm infants weighing less than 1.5 kg. This approach ensures a good exposure of vessels. We believe that it is safe, reliable and reproducible. The learning curve should not be an issue for surgeons used to manage low weight patients. Georg Thieme Verlag KG Stuttgart · New York.

  19. Outcomes following surgical repair using layered closure of unrepaired 4th degree perineal tear in rural western Uganda.

    Science.gov (United States)

    Goh, Judith T W; Tan, Stephanie B M; Natukunda, Harriet; Singasi, Isaac; Krause, Hannah G

    2016-11-01

    In many rural low-income countries, perineal tears at time of vaginal birth are not repaired at time of delivery. The aims of this study are to describe the surgical technique for management of the unrepaired 4th degree tear, performed without flaps, and short-term follow up on anal incontinence symptoms using a validated questionnaire. Women presenting to fistula camps in western Uganda with unrepaired 4th degree tears were interviewed using the Cleveland Clinic Continence Score. Interviews were undertaken pre-operatively, at 4-6 weeks post-operatively and 12 months following surgery. Repair of the 4th degree tear was performed in layers, with an overlapping anal sphincter repair and reconstruction of the perineal body, without flaps. All women were examined prior to discharge. 68 women completed pre-operative Cleveland Clinic Continence Scores. Prior to surgery, 59 % of women complained of daily incontinence to solid stools. Over 70 % of women complained of restriction to lifestyle due to the unrepaired 4th degree tear. About 50 % of the women are rejected by their husbands because of the condition. Only 1 woman had wound breakdown on Day 2. At 4 to 6 weeks follow-up, 61 women were contacted and all reported perfect continence. This study highlights the hidden problem of unrepaired 4th degree tears in rural areas of low-income countries where most deliveries are undertaken in the village without professional health care workers. These tears have significant impact on quality of life and anal incontinence. Short-term outcomes following surgical repair using a layered closure are promising.

  20. Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.

    Science.gov (United States)

    Fang, Aiwu; Wang, Peijuan; He, Rui; Qu, Jia

    2018-05-18

    To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

  1. Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997).

    Science.gov (United States)

    Weisman, D L; Smeak, D D; Birchard, S J; Zweigart, S L

    1999-05-15

    To describe and compare a simple continuous suture pattern with a simple interrupted pattern for enterotomy closure or end-to-end intestinal anastomosis. Retrospective study. 58 dogs and 25 cats that underwent enterotomy or intestinal resection and anastomosis. Signalment, surgical procedure, suture pattern, suture material, confirmation of dehiscence, and follow-up were reviewed. Groups were compared by procedure (anastomosis or enterotomy) and by suture pattern. 57 animals underwent continuous closure; 26 had interrupted closure. Only polydioxanone or polypropylene suture materials were used. Overall, 81 (98%) animals had no signs of intestinal dehiscence and survived > 2 weeks. Two animals had confirmed dehiscence after foreign body removal, 1 of 57 (2%) after continuous closure, and 1 of 26 (4%) after interrupted closure. The simple continuous closure pattern is an acceptable alternative to simple interrupted closure for small intestinal anastomosis or enterotomy closure.

  2. A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures.

    Science.gov (United States)

    Rubin, J Peter; Hunstad, Joseph P; Polynice, Alain; Gusenoff, Jeffrey A; Schoeller, Thomas; Dunn, Raymond; Walgenbach, Klaus J; Hansen, Juliana E

    2014-02-01

    Barbed sutures were developed to reduce operative time and improve security of wound closure. The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. 1.

  3. Factors affecting closure of a temporary stoma.

    Science.gov (United States)

    Taylor, Claire; Varma, Sarah

    2012-01-01

    The purpose of the study was to examine time to reversal of a temporary ostomy, reasons for delayed closure, and patient satisfaction with the scheduling of their closure and related hospital care. Cross-sectional, descriptive study. The target population comprised patients who underwent creation of a temporary ostomy and reversal surgery within one National Health System Hospital Trust in the United Kingdom. The population served by this Trust are ethnically and socioeconomically diverse, predominantly living in urban areas around Greater London. Sixty-one persons who met inclusion criteria were identified. A two-step analytical process was undertaken. First, a literature review examining incidence and causes of delayed stoma closure was undertaken. Second, a postal survey of all patients who had had their stoma closed in 2009 was conducted. Respondents were allowed 2 weeks to complete and return the questionnaire. The survey instrument was developed locally and subjected to content validation using ostomy patients, surgical and nursing colleagues. It consisted of 9 questions querying time from original surgery to closure, reasons for delaying closure surgery beyond 12 weeks, and satisfaction with care. Twenty-seven patients returned their questionnaires, indicating they consented to participate; a response rate of 44%. Half of the respondents (n = 14 [52%]) underwent closure surgery within 6 months of stoma formation; the remaining 48% waited more than 6 months (median: 6.5 months, range: 1.5-26 months). Thirteen patients (48%) reported a delay in receiving their stoma closure; the main reason cited was the need for a course of adjuvant postoperative chemotherapy. Three quarters of respondents (22 [74%]) were satisfied with the overall care they received. Findings from this study suggest that stoma closure may be associated with fewest complications if performed before 12 weeks.

  4. Late infectious endocarditis of surgical patch closure of atrial septal defects diagnosed by 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT): a case report.

    Science.gov (United States)

    Honnorat, Estelle; Seng, Piseth; Riberi, Alberto; Habib, Gilbert; Stein, Andreas

    2016-08-24

    In contrast to percutaneous atrial septal occluder device, surgical patch closure of atrial defects was known to be no infective endocarditis risk. We herein report the first case of late endocarditis of surgical patch closure of atrial septal defects occurred at 47-year after surgery. On September 2014, a 56-year-old immunocompetent French Caucasian man was admitted into the Emergency Department for 3-week history of headache, acute decrease of psychomotor performance and fever at 40 °C. The diagnosis has been evoked during his admission for the management of a brain abscess and confirmed using 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT). Bacterial cultures of surgical deep samples of brain abscess were positive for Streptococcus intermedius and Aggregatibacter aphrophilus as identified by the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry and confirmed with 16S rRNA gene sequencing. The patient was treated by antibiotics for 8 weeks and surgical patch closure removal. In summary, late endocarditis on surgical patch and on percutaneous atrial septal occluder device of atrial septal defects is rare. Cardiac imaging by the 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT) could improve the diagnosis and care endocarditis on surgical patch closure of atrial septal defects while transthoracic and transesophageal echocardiography remained difficult to interpret.

  5. Transcatheter Device Closure of Patent Ductus Arteriosus

    International Nuclear Information System (INIS)

    Sultan, M.; Ullah, M.; Sadiq, N.; Akhtar, K.; Akbar, H.

    2014-01-01

    Objective: To determine the efficacy, safety and immediate complications encountered during percutaneous device closure of patent ductus arteriosus (PDA). Study Design: Case series. Place and Duration of Study: Department of Paediatric Cardiology, AFIC/NIHD, Rawalpindi, from January 2005 to December 2010. Methodology: Consecutive 500 patients who underwent attempted transcatheter PDA device closure were included in the study. Device type position, success of closure and complications were described as frequency percentage. Results: In 491 cases (98.2%), PDA was successfully occluded including 4 cases (0.8%) where devices were dislodged but retrieved and redeployed in Cath laboratory. PDA occluder devices used in 448 cases (91%) while coils (single or multiple) were used in 42 cases (8.5%) and in one case (0.2%) ASD occluder device was used to occlude the PDA. There were 09 (1.8%) unsuccessful cases, 06 (1.2%) were abandoned as ducts were considered unsuitable for device closure, 02 (0.4%) devices dislodged and needed surgical retrieval and one case (0.2%) was abandoned due to faulty equipment. The narrowest PDA diameter ranged from 0.5 - 14 mm with mean of 4.5 +- 2.4 mm. There was a single (0.2%) mortality. Conclusion: Transcatheter occlusion of PDA by coil or occluder device is an effective therapeutic option with high success rate. Complication rate is low in the hands of skilled operators yet paediatric cardiac surgical back-up cover is mandatory. (author)

  6. 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.

  7. Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

    Science.gov (United States)

    Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

    2014-11-01

    Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

  8. Colostomy closure: how to avoid complications.

    Science.gov (United States)

    Bischoff, Andrea; Levitt, Marc A; Lawal, Taiwo A; Peña, Alberto

    2010-11-01

    Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48-72 h after the operation. The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung's disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Based on

  9. Prevention of Surgical Site Infection After Ankle Surgery Using Vacuum-Assisted Closure Therapy in High-Risk Patients With Diabetes.

    Science.gov (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

    2016-01-01

    Patients with diabetes have a high risk of surgical site infection (SSI) after ankle surgery. The aim of the present study was to investigate the efficacy of vacuum-assisted closure (VAC) in the prevention of SSI after ankle surgery compared with the efficacy of standard moist wound care (SMWC). A retrospective study was performed of unstable ankle fractures for surgical fixation in patients with diabetes from January 2012 to December 2014. VAC and SMWC were used for surgical incision coverage. The primary outcome was the incidence of SSI, and the secondary outcomes were the length of hospital stay and crude hospital costs. The data from 76 patients were analyzed, with 22 (28.95%) in the VAC group and 54 (71.05%) in the SMWC group. The incidence of SSI was 4.6% in the VAC group compared with 27.8% in the SMWC group (chi-square 5.076; p = .024), and the crude odds ratio for SSI in the VAC group was 0.124 (95% confidence interval 0.002 to 0.938). The length of hospital stay was lower in the VAC group than in the SMWC group (12.6 ± 2.7 days and 15.2 ± 3.5 days, respectively; t = 3.122, p = .003). The crude hospital costs were also lower in the VAC group than in the SMWC group (Chinese yuan 8643.2 ± 1195.3 and 9456.2 ± 1106.3, respectively; t = 2.839, p = .006). After logistic regression analysis, the adjusted odds ratio for the total SSI rate comparing VAC and SMWC was 0.324 (95% confidence interval 0.092 to 0.804; p = .021). Compared with SMWC, VAC can decrease the SSI rate after ankle surgery in patients with diabetes. This finding should be confirmed by prospective, randomized controlled clinical trials. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure: is the muscle flap really necessary?

    Science.gov (United States)

    Camargo, José Jesus; Machuca, Tiago Noguchi; Camargo, Spencer Marcantônio; Lobato, Vivalde F; Medina, Carlos Remolina

    2010-03-01

    Nowadays, despite the advances of the low-pressure high-volume cuffs, post-intubation tracheo-oesophageal fistula (TEF) still poses a major challenge to thoracic surgeons. The original technique includes interposition of muscle flaps between suture lines to avoid recurrence. It is not clear if this manoeuvre is indispensable and, in fact, we and others have faced problems with it. Our aim is to present our experience with TEF management in a consecutive group with no muscle interposition. From June 1992 to November 2007, we evaluated 14 patients presenting with TEF, with a mean age of 44 years (from 18 to 79 years). Thirteen patients had a prolonged intubation history. The remaining case was a 40-year-old male with congenital TEF. Three patients had been previously submitted to failed repairs in other institutions. Ten patients had associated tracheal stenosis, which was subglottic in three of them. Regarding surgical technique, in all cases, we performed a single-staged procedure, which consisted of tracheal resection and anastomosis with double-layer oesophageal closure. In none of our cases was a muscle flap interposed between suture lines. All operations were performed through a cervical incision; however, in one case, an extension with partial sternotomy was required. There was no operative mortality. Thirteen patients were extubated in the first 24h after the procedure, while one patient required 48 h of mechanical ventilation. Four complications were recorded: one each of pneumonia and left vocal cord paralysis and two small tracheal dehiscences managed with a T-tube and a tracheostomy tube. After discharge, three patients returned to their native cities and were lost to follow-up. The remaining 11 patients have been followed up by a mean of 32 months (from three to 108 months), with 10 presenting excellent and one good anatomic and functional results. The single-staged repair with tracheal resection and anastomosis with oesophageal closure provides good

  11. Road Closures

    Data.gov (United States)

    Montgomery County of Maryland — This is an up to date map of current road closures in Montgomery County.This dataset is updated every few minutes from the Department of Transportation road closure...

  12. [Comparative description and retrospective analisis of modern methods of surgical wounds closure for intraoperative prophylaxis of development of pathologic cutaneous cicatrices].

    Science.gov (United States)

    Stavyts'kyĭ, S O; Avetikov, D S; Lokes, K P; Rozkolupa, O O; Boĭko, I V

    2014-05-01

    The experience of application of various methods of closure was presented for the head and neck cutaneous wound surfaces after elective operative interventions. The variant of the postoperative results estimation and optimization of the wounds healing by primary closure was proposed.

  13. Complex bladder-exstrophy-epispadias management: Causes of failure of initial bladder closure

    Directory of Open Access Journals (Sweden)

    Kouame Dibi Bertin

    2014-01-01

    Full Text Available The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0, concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0. The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation.

  14. [Right patent ductus arteriosus with an ipsilateral aortic arch: percutaneous closure with amplatzer devices].

    Science.gov (United States)

    Santiago, Justo; Acuña, Manuel; Arispe, Elizabeth; Camargo, Ronaldo; Neves, Juliana; Arnoni, Daniel; Fontes, Valmir F; Pedra, Carlos A

    2007-03-01

    The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon. An Amplatzer duct occluder was used in two patients and an Amplatzer muscular ventricular septal defect occluder, in the other. In all patients, full closure was confirmed in the catheterization laboratory and the patients were discharged on the same day with no complications. Percutaneous closure of a right patent ductus arteriosus associated with a right aortic arch is feasible, safe and effective.

  15. Patent foramen ovale closure using a bioabsorbable closure device: safety and efficacy at 6-month follow-up.

    Science.gov (United States)

    Van den Branden, Ben J; Post, Martijn C; Plokker, Herbert W; ten Berg, Jurriën M; Suttorp, Maarten J

    2010-09-01

    The aim of this study was to assess the mid-term safety and efficacy of percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device (BioSTAR, NMT Medical, Boston, Massachusetts). Closure of PFO in patients with cryptogenic stroke has proven to be safe and effective using different types of permanent devices. All consecutive patients who underwent percutaneous PFO closure with the bioabsorbable closure device between November 2007 and January 2009 were included. Residual shunt was assessed using contrast transthoracic echocardiography. Sixty-two patients (55% women, mean age 47.7 ± 11.8 years) underwent PFO closure. The in-hospital complications were a surgical device retrieval in 2 patients (3.2%), device reposition in 1 (1.6%), and a minimal groin hematoma in 6 patients (9.7%). The short-term complications at 1-month follow-up (n = 60) were a transient ischemic attack in the presence of a residual shunt in 1 patient and new supraventricular tachycardia in 7 patients (11.3%). At 6-month follow-up (n = 60), 1 patient without residual shunt developed a transient ischemic attack and 1 developed atrial fibrillation. A mild or moderate residual shunt was noted in 51.7%, 33.9%, and 23.7% after 1-day, 1-month, and 6-month follow-up, respectively. A large shunt was present in 8.3%, 3.4%, and 0% after 1-day, 1-month, and 6-month follow-up. Closure of PFO using the bioabsorbable device is associated with a low complication rate and a low recurrence rate of embolic events. However, a relatively high percentage of mild or moderate residual shunting is still present at 6-month follow-up. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method

    Science.gov (United States)

    Timmins, Benjamin H.; Hunter, Benjamin N.; Wilson, Kevin F.; Ward, P. Daniel

    2016-01-01

    Background Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized due to its surgical complexity and flap breakdown. Methods Retrospective review of thirteen HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, pre- and post-procedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional three-flap closure and a simplified two-flap nasal closure procedure. Results The average candidate for nasal closure in this series had an ESS of 7.88, Hgb of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the two flap method is 0.92 and mean GBI score is 56.3. Comparison of five patients who underwent the traditional three-flap nasal closure procedure and eight patients receiving the two flap nasal closure showed no significant difference in post-op ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p=0.0001). Mean time to first revision for eight nasal closure patients is 21.5 months. Conclusion In short-term follow-up, the two-flap procedure has shown comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method. PMID:26751606

  17. Closure requirements

    International Nuclear Information System (INIS)

    Hutchinson, I.P.G.; Ellison, R.D.

    1992-01-01

    Closure of a waste management unit can be either permanent or temporary. Permanent closure may be due to: economic factors which make it uneconomical to mine the remaining minerals; depletion of mineral resources; physical site constraints that preclude further mining and beneficiation; environmental, regulatory or other requirements that make it uneconomical to continue to develop the resources. Temporary closure can occur for a period of several months to several years, and may be caused by factors such as: periods of high rainfall or snowfall which prevent mining and waste disposal; economic circumstances which temporarily make it uneconomical to mine the target mineral; labor problems requiring a cessation of operations for a period of time; construction activities that are required to upgrade project components such as the process facilities and waste management units; and mine or process plant failures that require extensive repairs. Permanent closure of a mine waste management unit involves the provision of durable surface containment features to protect the waters of the State in the long-term. Temporary closure may involve activities that range from ongoing maintenance of the existing facilities to the installation of several permanent closure features in order to reduce ongoing maintenance. This paper deals with the permanent closure features

  18. Comparison of effectiveness and cost of patent ductus arteriosus device occlusion versus surgical ligation of patent ductus arteriosus.

    Science.gov (United States)

    Zulqarnain, Arif; Younas, Muhammad; Waqar, Tariq; Beg, Ahsan; Asma, Touseef; Baig, Mirza Ahmad Raza

    2016-01-01

    Comparison of effectiveness and cost of transcatheter occlusion of patent ductus arteriosus (PDA) with surgical ligation of PDA. This retrospective comparative study was conducted in the pediatric cardiology department of Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Data of 250 patients who underwent patent ductus arteriosus (PDA) closure either surgical or trans-catheter closure using SHSMA Occluder having weight >5 kg from April 2012 to October 2015 were included in this study. SPSS version 20 was used for data analysis. Quantitative variables were compared using independent sample t-test. Chi-square test and fishers exact was used for qualitative variables. P-value <0.05 was considered statistically significant. There were one hundred and twenty (120) patients who underwent transcatheter occlusion of PDA using SHSMA occluder (PDA Device Group) and one hundred and thirty (130) patients who underwent surgical ligation of PDA (Surgical Group). Incidence of residual shunting was two (1.5%) in surgical group and 0 (0.0%) in PDA Device group for one month follow up period. There were 4 (3.1%) major complications in surgical group. The rate of blood transfusions were high in surgical group (p-value 0.04). Hospital stay time was significantly less in PDA Device group (P-value <0.001). Total procedural cost was 110695+1054 Pakistani rupees in PDA Device group and 92414+3512 in surgical group (p-value <0.001). The cost of PDA device closure was 16.52% higher than the surgical ligation of PDA. There was no operative mortality. The transcatheter closure of PDA is an effective and less invasive method as compared to the surgical ligation. There is a lower rate of complications and the cost is not much high as compared to surgical PDA ligation.

  19. Colostomy closure: how to avoid complications

    Science.gov (United States)

    Levitt, Marc A.; Lawal, Taiwo A.; Peña, Alberto

    2010-01-01

    Purpose Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. Methods The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48–72 h after the operation. Results The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung’s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic

  20. Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: Surgical modifications for flap pedicle and donor site closure without skin graft.

    Science.gov (United States)

    Chi, Zhenglin; Chen, Yiheng; Chu, Tinggang; Gao, Weiyang; Li, Zhijie; Yan, Hede; Song, Yonghuan

    2018-02-01

    The conventional procedure of the sural neuro-fasciocutaneous flap enables the supply of blood and venous drainage by increasing the width of the adipofascial tissue and preserving tiny venous return routes. Moreover, skin graft is a common method for donor site closure, which may lead to some complications and influence the aesthetic appearance. We report modifications for a distally based sural neuro-fasciocutaneous perforator flap and a relaying flap for donor site closure without skin graft. Twelve patients undergoing the modified flap for foot and ankle reconstruction were included in this study between 2014 and 2016. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A Z-shape skin incision was performed to explore the perforator vessels and a relaying island perforator flap was used to close the donor site. All flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 15 cm. The diameter width of the pedicle ranged from 1.0 to 2.0 cm. A relaying perforator island flap was used in 10 cases for donor site closure and no skin graft was performed. There were no serious donor site complications. All patients were satisfied with the aesthetic outcome postoperatively at the final follow-up. The distally based sural neuro-fasciocutaneous perforator flap is considered a reliable method for foot and ankle reconstruction. The modification for flap pedicle and donor site closure method without skin graft should be recommended. Copyright © 2017. Published by Elsevier Ltd.

  1. Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair

    Directory of Open Access Journals (Sweden)

    Jung-Hwan Shim

    2016-01-01

    Full Text Available BackgroundThe global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution.MethodsPatients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed.ResultsA total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely.ConclusionsMost myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

  2. Megarectumsigma underwent surgery for chronic faecal impact action

    International Nuclear Information System (INIS)

    Canessa, C.; Gomez del Valle, M.; Caraballo, M.

    2002-01-01

    Seven patients with megarectumsigma underwent surgery for chronic faecal impaction,reviewing clinical diagnosis, aetiology and medical and surgical management.It is suggested medical management of chronic faecal impaction trying to achieve elective surgery.The curative surgery should include the resection of all pathologic bowel, but in Duhamel procedure and its modifications distal rectal tran section should be at the peritoneal reflection.Habr-Gama modification has shown to be technically easier and it has been communicated good functional results.Local unfavourable conditions may be resolve by staged surgery,which allows outline definitive bowel reconstruction after functional assessment

  3. Primary closure in colon trauma.

    Science.gov (United States)

    Salinas-Aragón, Luis Enrique; Guevara-Torres, Lorenzo; Vaca-Pérez, Enrique; Belmares-Taboada, Jaime Arístides; Ortiz-Castillo, Fátima de Guadalupe; Sánchez-Aguilar, Martín

    2009-01-01

    Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI colon injury. Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

  4. Early versus conventional stoma closure following bowel surgery: A randomized controlled trial

    Science.gov (United States)

    Nelson, Thirugnanasambandam; Pranavi, Amuda R.; Sureshkumar, Sathasivam; Sreenath, Gubbi S.; Kate, Vikram

    2018-01-01

    Background/Aim: To compare early stoma closure with conventional stoma closure following defunctioning diversion stoma surgery with respect to the frequency of complications, health-related quality of life (QoL), and length of hospitalization (LoH). Patients and Methods: This study was designed as a prospective parallel-arm randomized controlled trial. Patients who underwent temporary stoma following bowel surgery between February 2014 and November 2015 were included. The rate of complications (medical and surgical) following early and conventional stoma closure was assessed. Health-related QoL and LoH were also measured. Results: One hundred patients were included, with 50 cases in each group. Postoperative complications including laparostoma (6% vs. 2%;P = 0.307), wound infection (32% vs. 18%; P = 0.106), intra-abdominal collection (14% vs. 18%; P = 0.585), anastomotic leak (4%vs. 8%;P = 0.400), and medical complications were comparable (22% vs. 32%;P = 0.257). The length of hospital stay, overall mortality and morbidity (64% vs. 44%; P = 0.05) were similar across the two groups. There was a significant reduction in the cost towards stoma care (96% vs. 2%; P = 0.001) in the early stoma closure group. Patients in the early stoma closure group also had a significantly better QoL. Conclusion: Early stoma closure does not carry an increased risk of postoperative complications, reduces cost towards stoma care, and leads to better a QoL. PMID:29451185

  5. Long-term efficacy of transcatheter closure of patent ductus arteriosus with the Rashkind double umbrella

    International Nuclear Information System (INIS)

    Zhang Qingqiao; Jiang Shiliang; Huang Lianjun; Zhao Shihua; Zheng Hong; Ling Jian; Xu Zhongying; Zhang Gejun; Xie Ruolan; Dai Ruping

    2003-01-01

    Objective: To evaluate the long-term efficacy of transcatheter patent ductus arteriosus (PDA) closure with the Rashkind double umbrella. Methods: Between July 1994 and December 1998, forty nine patients (12 male, 37 female) at a mean age of (21 ± 13) years (range 2.4 to 54 years) underwent attempted transcatheter closure of a PDA using the Rashkind double umbrella. The Rashkind double umbrella was implanted through femoral venous route. Aortography was performed to check any residual shunt presence, 10 to 30 minutes after the closure, and at 6-month intervals thereafter. Results: Forty seven of the 49 patients had successful device placement. Two patients underwent surgical therapy. The prevalence of trace, mild, moderate, and large residual shunt was 12.8% (6/47), 27.7%(13/47), 25.5%(12/47), and 14.8% (7/47), respectively, and the prevalence of complete closure was 19.2%(9/47) 10 to 30 minutes after the procedure. Of the 49 patients, 36 completed short-term (≤3 months) follow-up, the prevalence of residual shunt was 44.4%(16/36) at 3 months. 30 patients completed medium-term (>3 months and ≤36 months) follow-up, the prevalence of residual shunt was 13.3% (4/30) at 36 months. For the long-term (>36 months) follow-up (38-96 months, mean 60±12 months) in 25 patients, there were 4 patients with residual shunt across PDA. Two patients with residual shunt at 46 and 48 months, respectively, had complete closure after reocclusion using the Amplatzer duct occluder. Conclusions: The long-term residual shunt after closure of PDA with the Rashkind double umbrella can not disappear spontaneously, thus a second device is sometimes needed to achieve complete closure

  6. Long-term efficacy of transcatheter closure of patent ductus arteriosus with the Rashkind double umbrella

    Energy Technology Data Exchange (ETDEWEB)

    Qingqiao, Zhang; Shiliang, Jiang; Lianjun, Huang; Shihua, Zhao; Hong, Zheng; Jian, Ling; Zhongying, Xu; Gejun, Zhang; Ruolan, Xie; Ruping, Dai [Chinese academy of Medical Science and Beijing Union Medical College, Beijing (China). Cardiovascular Institute and Fuwai Hospital, Dept. of Radiology

    2003-10-01

    Objective: To evaluate the long-term efficacy of transcatheter patent ductus arteriosus (PDA) closure with the Rashkind double umbrella. Methods: Between July 1994 and December 1998, forty nine patients (12 male, 37 female) at a mean age of (21 {+-} 13) years (range 2.4 to 54 years) underwent attempted transcatheter closure of a PDA using the Rashkind double umbrella. The Rashkind double umbrella was implanted through femoral venous route. Aortography was performed to check any residual shunt presence, 10 to 30 minutes after the closure, and at 6-month intervals thereafter. Results: Forty seven of the 49 patients had successful device placement. Two patients underwent surgical therapy. The prevalence of trace, mild, moderate, and large residual shunt was 12.8% (6/47), 27.7%(13/47), 25.5%(12/47), and 14.8% (7/47), respectively, and the prevalence of complete closure was 19.2%(9/47) 10 to 30 minutes after the procedure. Of the 49 patients, 36 completed short-term ({<=}3 months) follow-up, the prevalence of residual shunt was 44.4%(16/36) at 3 months. 30 patients completed medium-term (>3 months and {<=}36 months) follow-up, the prevalence of residual shunt was 13.3% (4/30) at 36 months. For the long-term (>36 months) follow-up (38-96 months, mean 60{+-}12 months) in 25 patients, there were 4 patients with residual shunt across PDA. Two patients with residual shunt at 46 and 48 months, respectively, had complete closure after reocclusion using the Amplatzer duct occluder. Conclusions: The long-term residual shunt after closure of PDA with the Rashkind double umbrella can not disappear spontaneously, thus a second device is sometimes needed to achieve complete closure.

  7. Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    You Na Oh

    2015-08-01

    Full Text Available Background: Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Methods: Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Results: Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578, major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99, minor wound complications (3.6% vs. 2.0%, p=0.279, or mediastinitis (0.8% vs. 1.0%, p=1.00. Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068. Conclusion: The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

  8. Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery.

    Science.gov (United States)

    Oh, You Na; Ha, Keong Jun; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2015-08-01

    Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA) was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578), major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99), minor wound complications (3.6% vs. 2.0%, p=0.279), or mediastinitis (0.8% vs. 1.0%, p=1.00). Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068). The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

  9. Performance Assessment of Bi-Directional Knotless Tissue-Closure Devices in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters, 2009 - Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Woodley, Christa M.; Wagner, Katie A.; Bryson, Amanda J.

    2012-11-09

    The purpose of this report is to assess the performance of bi-directional knotless tissue-closure devices for use in tagging juvenile salmon. This study is part of an ongoing effort at Pacific Northwest National Laboratory (PNNL) to reduce unwanted effects of tags and tagging procedures on the survival and behavior of juvenile salmonids, by assessing and refining suturing techniques, suture materials, and tag burdens. The objective of this study was to compare the performance of the knotless (barbed) suture, using three different suture patterns (treatments: 6-point, Wide “N”, Wide “N” Knot), to the current method of suturing (MonocrylTM monofilament, discontinuous sutures with a 2×2×2×2 knot) used in monitoring and research programs with a novel antiseptic barrier on the wound (“Second Skin”).

  10. Restaurant closures

    CERN Document Server

    Novae Restauration

    2012-01-01

    Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

  11. VACUUM ASSISTED CLOSURE IN DIABETIC FOOT MANAGEMENT

    OpenAIRE

    Moganakannan; `Prema; Arun Sundara Rajan

    2014-01-01

    Comparision of vacuum assisted closure vs conventional dressing in management of diabetic foot patients. 30 patients were taken in that 15 underwent vacuum therapy and remaining 15 underwent conventional dressing.They were analysed by the development of granulation tissue and wound healing.The study showed Vac therapy is the best modality for management of diabetic foot patients.

  12. Vacuum-assisted closure in the treatment of extensive lymphangiomas in children.

    Science.gov (United States)

    Katz, Michael S; Finck, Christine M; Schwartz, Marshall Z; Moront, Matthew L; Prasad, Rajeev; Timmapuri, Shaheen J; Arthur, L Grier

    2012-02-01

    The management of lymphangiomas in children is a complex problem with frequent recurrence and infection. Vacuum-assisted closure (VAC) devices have been shown to accelerate the healing of open wounds. We hypothesized that VAC therapy might decrease complications after resection of lymphangiomas. A retrospective review was performed on 13 children (August 2005 to April 2010) who were patients undergoing lymphangioma resection with postoperative VAC therapy. Patient demographics, size and location of the lymphangioma, VAC duration and number of changes, hospital stay, complications, need for further surgery, and length of follow-up were recorded. Thirteen children (mean age, 8 years; mean weight, 34 kg) underwent 15 operations for lymphangiomas followed by postoperative VAC therapy. Locations included the head and neck, thorax and abdomen, and lower extremity. The mean VAC duration was 19 days, and they underwent a mean of 2.6 VAC changes. Six children had operative closure of the wound at a mean of 15 days postoperative. The remaining patients underwent closure by secondary intention. There were no recurrences. Complications included VAC device malfunctions requiring intervention and wound infections. Mean follow-up was 289 days. Postoperative VAC therapy for the treatment of lymphangiomas can be an effective adjunct to surgical treatment by decreasing risks of recurrence and infection. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Experience with Vacuum-assisted closure of sternal wound infections following cardiac surgery and evaluation of chronic complications associated with its use.

    Science.gov (United States)

    Bapat, Vinayak; El-Muttardi, Naguib; Young, Christopher; Venn, Graham; Roxburgh, James

    2008-01-01

    We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treatment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. Between July 2000 and June 2003, 2706 patients underwent various cardiac procedures via median sternotomy. Forty-nine patients with postoperative sternal wound infection (1.9%) were managed with VAC. Wounds were classified as either superficial sternal wound infection (28 patients) or deep sternal wound infection (21 patients). In the superficial sternal wound infection group, 23 patients had VAC as definitive treatment (GroupA), while five patients (Group B) had VAC followed by surgical closure. Similarly, in the deep sternal wound infection group, 12 patients had VAC as definitive treatment (Group C), while nine patients had VAC followed by surgical closure (Group D). Patients were discharged after satisfactory wound closure. Upon discharge patients were followed up at interval of three to six months. Recurrent sternal problems when identified were investigated and additional surgical procedures were carried out when necessary. There were nine deaths, all due to unrelated causes except in one patient who died of right ventricular rupture (Group C). Nine patients in Group A had recurrent wound problems of which six had VAC system for > 21 days. Three patients underwent extensive debridement due to sternal osteomyelitis. All eight patients in Group B presented with chronic wound-related problems and underwent multiple debridements. Four patients had laparoscopic omental flaps. In contrast 14 patients (Group B and D) who were treated with shorter duration of VAC followed by either a flap or direct surgical closure, did not present with recurrent problems. VAC therapy is a safe and reliable option in the treatment of sternal wound infection. However, prolonged use of VAC system as a replacement for surgical closure of sternal wound appears to be associated

  14. Combined perventricular septal defect closure and patent ductus arteriosus ligation via the lower ministernotomy approach.

    Science.gov (United States)

    Voitov, Alexey; Omelchenko, Alexander; Gorbatykh, Yuriy; Bogachev-Prokophiev, Alexander; Karaskov, Alexander

    2018-02-01

    Over the past decade, minimally invasive approaches have been advocated for surgical correction of congenital defects to reduce costs related to hospitalization and for improved cosmesis. Minimal skin incisions and partial sternotomy reduce surgical trauma, however these techniques might not be successful in treating a number of congenital pathological conditions, particularly for combined congenital defects. We focused on cases with a combined presentation of ventricular septal defect and patent ductus arteriosus. We studied 12 infants who successfully underwent surgical treatment for a combined single-stage ventricular septal defect and patent ductus arteriosus closure through a lower ministernotomy without using cardiopulmonary bypass and X-rays. No intraoperative and early postoperative complications or mortality were noted. Postoperative echocardiography did not reveal residual shunts. The proposed technique is safe and reproducible in infants. © Crown copyright 2017.

  15. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection.

    Science.gov (United States)

    Heal, C F; Banks, J L; Lepper, P; Kontopantelis, E; van Driel, M L

    2017-08-01

    Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82; very low-quality evidence). Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  16. 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

  17. 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

  18. Meconium Ileus–Is a Single Surgical Procedure Adequate?

    Directory of Open Access Journals (Sweden)

    Hagith Nagar

    2006-07-01

    Full Text Available Meconium ileus is one of the gastrointestinal manifestations of cystic fibrosis (CF, and affects 15% of neonates. The condition results from the accumulation of sticky inspissated meconium. Both nonoperative and operative therapies may be effective in relieving obstruction. The treatment of choice for uncomplicated meconium ileus is the use of enteral N-acetylcysteine or Gastrografin enemata. Once such therapy fails, surgery is indicated. A number of operative procedures are in use, including Bishop-Koop enterostomy, T-tube irrigation, resection and primary anastomosis, and enterotomy with irrigation and primary closure. During the period 1991-2003, five newborns required surgical intervention for uncomplicated meconium ileus. None responded to conservative management. All were males, including one set of twins. All underwent laparotomy, enterotomy, appendectomy, irrigation and closure of enterotomy. None required a second surgical procedure. CF was confirmed in all, and in each case, both parents were found to be genetic carriers of a mutational form of CF. A single surgical intervention is preferable in these patients, in view of the high rate of pulmonary involvement in CF patients. Enterotomy, irrigation and primary closure are the treatment of choice for uncomplicated meconium ileus.

  19. Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g.

    Science.gov (United States)

    Semberova, Jana; Sirc, Jan; Miletin, Jan; Kucera, Jachym; Berka, Ivan; Sebkova, Sylva; O'Sullivan, Sinead; Franklin, Orla; Stranak, Zbynek

    2017-08-01

    Patent ductus arteriosus (PDA) remains a challenging issue in very low birth weight (VLBW) infants, and its management varies widely. Our aim in this study was to document the natural course of ductus arteriosus in a cohort of VLBW infants who underwent conservative PDA management with no medical or surgical intervention. A retrospective cohort study conducted in 2 European level-3 neonatal units. A total of 368 VLBW infants were born within the study period. Two hundred and ninety-seven infants were free of congenital malformations or heart defects and survived to hospital discharge. Out of those, 280 infants received truly conservative PDA management. In 237 (85%) of nontreated infants, the PDA closed before hospital discharge. The Kaplan-Meier model was used to document the incidence proportion of PDA closure over time for different gestational age groups. The median time to ductal closure was 71, 13, 8, and 6 days in closure before hospital discharge and neonatal morbidities. The likelihood of PDA spontaneous closure in VLBW infants is extremely high. We provide in our findings a platform for future placebo-controlled trials focused on the smallest and youngest infants. Copyright © 2017 by the American Academy of Pediatrics.

  20. Profile of women with urinary incontinence who underwent surgical procedure in a teaching hospital in the southern Country Perfil de mulheres com incontinência urinária submetidas a procedimento cirúrgico em um hospital de ensino do sul do país

    Directory of Open Access Journals (Sweden)

    Juliana Cristina Frare

    2011-12-01

    Full Text Available Urinary incontinence (UI is defined as any involuntary loss of urine that may characterize a social and/or hygienic problem. The treatment of UI can be performed surgically or by conservative techniques such as physiotherapy, behavioral therapy and drug therapy. The research aim was to identify the sociodemographic and clinical profile of women who performed surgery procedure for correction of UI at the Western University Hospital of Paraná (HUOP. All records of patients treated at the gynecology sector diagnosed with UI undergoing surgery in the years 2008 and 2009 were analyzed. Data was entered into a spreadsheet and analyzed in terms of relative and absolute frequencies. The results demonstratethat the average was observed in 52.41 years (± 12.11, 128 (58.99% patients were aged between 40 and 59 years old. The stress urinary incontinence (UI was the most prevalent disease, observed in 193(88.94% of 217 records analyzed. The surgical techniques used in most cases was pubovaginal sling associated of colpoperineoplastia (CPP, realized in 117 (53.92% patients. Only six (2.76% recordsreported the physiotherapy performance in women with UI submitted to surgery treatment. A incontinência urinária (IU é definida como qualquer perda involuntária de urina pela uretra, possívelde ser caracterizada como um problema social e/ou higiênico. O tratamento da IU pode ser realizado cirurgicamente ou por meio de técnicas conservadoras como a fisioterapia, a terapia comportamental e medicamentosa. O objetivo da pesquisa foi identificar o perfil sociodemográfico e clínico de mulheres que realizaram procedimento cirúrgico para correção de IU no Hospital Universitário do Oeste doParaná (HUOP. Foram analisados todos os prontuários das pacientes atendidas no setor de ginecologia com diagnóstico de IU submetidas a tratamento cirúrgico nos anos de 2008 e 2009. Os dados foramlançados em uma planilha do programa Excel 7.0 (Microsoft®, e

  1. Percutaneous Transcatheter PDA Device Closure in Infancy

    International Nuclear Information System (INIS)

    Ullah, M.; Sultan, M.; Akhtar, K.; Sadiq, N.; Akbar, H.

    2014-01-01

    Objective: To evaluate the results and complications associated with transcatheter closure of patent ductus arteriosus (PDA) in infants. Study Design: Quasi-experimental study. Place and Duration of Study: Paediatric Cardiology Department of Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from December 2010 to June 2012. Methodology: Infants undergoing transcatheter device closure of PDA were included. All patients were evaluated by experienced Paediatric Cardiologists with 2-D echocardiography and Doppler before the procedure. Success of closure and complications were recorded. Results: The age of patients varied from 05 - 12 months and 31 (56.4%) were females. Out of the 55 infants, 3 (5.4%) were not offered device closure after aortogram (two large tubular type ducts and one tiny duct, considered unsuitable for device closure); while in 50 (96.1%) patients out of remaining 52, the duct was successfully closed with transcatheter PDA device or coil. In one infant, device deployment resulted in acquired coarctation, necessitating device retrieval by Snare followed by surgical duct interruption and another patient had non-fatal cardiac arrest during device deployment leading to abandonment of procedure and subsequent successful surgical interruption. Local vascular complications occurred in 12 (21.8%) of cases and all were satisfactorily treated. Conclusion: Transcatheter device closure of PDA in infants was an effective procedure in the majority of cases; however, here were considerable number of local access site vascular complications. (author)

  2. Cyanoacrylate for Intraoral Wound Closure: A Possibility?

    Directory of Open Access Journals (Sweden)

    Parimala Sagar

    2015-01-01

    Full Text Available Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

  3. Full closure strategic analysis.

    Science.gov (United States)

    2014-07-01

    The full closure strategic analysis was conducted to create a decision process whereby full roadway : closures for construction and maintenance activities can be evaluated and approved or denied by CDOT : Traffic personnel. The study reviewed current...

  4. Sternal exploration or closure

    Science.gov (United States)

    VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection ... in the wound to look for signs of infection Remove dead or infected ... use a VAC (vacuum-assisted closure) dressing. It is a negative ...

  5. Percutaneous Closure of 2 Paravalvular Leaks and a Gerbode Defect after Mitral Valve Replacement for Infective Endocarditis.

    Science.gov (United States)

    Peñalver, Jorge; Shatila, Wassim; Silva, Guilherme V

    2017-04-01

    Surgical valve replacement after infective endocarditis can result in local destructive paravalvular lesions. A 30-year-old woman with infective endocarditis underwent mitral valve replacement that was complicated postoperatively by 2 paravalvular leaks. During percutaneous closure of the leaks, a Gerbode defect was also found and closed. We discuss our patient's case and its relation to others in the relevant medical literature. To our knowledge, we are the first to describe the use of a percutaneous approach to close concomitant paravalvular leaks and a Gerbode defect.

  6. Post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy

    International Nuclear Information System (INIS)

    Khan, A.W.; Maqsood, R.; Saleem, M.M.

    2017-01-01

    To compare the mean post-operative analgesic requirement in non-closure and closure of peritoneum during open appendectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital Quetta, from 1st August 2014 to 30th April 2015. Material and Methods: A total of 60 patients were included in this study and were divided into two groups of 30 each. Patients in group A underwent open appendectomy with closure of peritoneum while patients in group B had non-closure of peritoneum during the same procedure. Post-operatively, pain severity was assessed on visual analogue scale (VAS) numeric pain distress scale. On presence of VAS numeric pain distress scale between 5 to 7, intramuscular (IM) diclofenac sodium was given and on score >7, intravascular (IV) tramadol was given. The final outcome was measured at day 0 and day 1. Results: Pain score and analgesic requirements were significantly less in non-closure group than closure group on day 0 and day 1, showing statistically significant difference between the two groups. Conclusion: Mean post-operative analgesic requirement is significantly less in non-closure group as compared to closure group during open appendectomy. (author)

  7. A novel surgical management of hypopharyngeal branchial anomalies.

    Science.gov (United States)

    Givens, Daniel J; Buchmann, Luke O; Park, Albert H

    2015-04-01

    To review our experience treating hypopharyngeal branchial anomalies utilizing an open transcervical approach that: (1) includes recurrent laryngeal nerve (RLN) monitoring and identification if needed; (2) resection of tract if present; and (3) a superiorly based sternothyroid muscle flap for closure. A retrospective chart review was performed to identify all patients at a tertiary level children's hospital with branchial anomalies from 2005 to 2014. The clinical presentation, evaluation, treatment and outcome were analyzed for those patients with hypopharyngeal branchial anomalies. Forty-seven patients who underwent excision of branchial anomalies with a known origin were identified. Thirteen patients had hypopharyngeal branchial anomalies. Six of these patients were treated by the authors of this study and are the focus of this analysis. All six underwent an open transcervical procedure with a sternothyroid muscle flap closure of a piriform sinus opening over a nine year period. Definitive surgery included a microlaryngoscopy and an open transcervical approach to close a fistula between the piriform sinus and neck with recurrent laryngeal nerve monitoring or dissection. A superiorly based sternothyroid muscle flap was used to close the sinus opening. There were no recurrences, recurrent laryngeal nerve injuries or other complications from these procedures. This study supports complete surgical extirpation of the fistula tract using an open cervical approach, recurrent laryngeal nerve monitoring or identification, and rotational muscle flap closure to treat patients with hypopharyngeal branchial anomalies. Published by Elsevier Ireland Ltd.

  8. Closure The Definitive Guide

    CERN Document Server

    Bolin, Michael

    2010-01-01

    If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

  9. Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections.

    Science.gov (United States)

    Saadi, Alend; Perentes, Jean Yannis; Gonzalez, Michel; Tempia, Adrien Caliera; Wang, Yabo; Demartines, Nicolas; Ris, Hans-Beat; Krueger, Thorsten

    2011-05-01

    This study is an evaluation of the vacuum-assisted closure (VAC) therapy for the treatment of severe intrathoracic infections complicating lung resection, esophageal surgery, viscera perforation, or necrotizing pleuropulmonary infections. We reviewed the medical records of all patients treated by intrathoracic VAC therapy between January 2005 and December 2008. All patients underwent surgical debridement-decortication and control of the underlying cause of infection such as treatment of bronchus stump insufficiency, resection of necrotic lung, or closure of esophageal or intestinal leaks. Surgery was followed by intrathoracic VAC therapy until the infection was controlled. The VAC dressings were changed under general anesthesia and the chest wall was temporarily closed after each dressing change. All patients received systemic antibiotic therapy. Twenty-seven patients (15 male, median age 64 years) underwent intrathoracic VAC dressings for the management of postresectional empyema (n=8) with and without bronchopleural fistula, necrotizing infections (n=7), and intrathoracic gastrointestinal leaks (n=12). The median length of VAC therapy was 22 days (range 5 to 66) and the median number of VAC changes per patient was 6 (range 2 to 16). In-hospital mortality was 19% (n=5) and was not related to VAC therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in all surviving patients. Vacuum-assisted closure therapy is an efficient and safe adjunct to treat severe intrathoracic infections and may be a good alternative to the open window thoracostomy in selected patients. Long time intervals in between VAC changes and short course of therapy result in good patient acceptance. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications.

    Science.gov (United States)

    Backes, Carl H; Cheatham, Sharon L; Deyo, Grace M; Leopold, Scott; Ball, Molly K; Smith, Charles V; Garg, Vidu; Holzer, Ralf J; Cheatham, John P; Berman, Darren P

    2016-02-12

    Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (closure at weights closure. Twenty-five percent (13/52) of infants were closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, Pclosure at weights closure versus alternative (surgical ligation) management strategies. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  11. Patent ductus arteriosus closure using Occlutech® Duct Occluder, experience in Port Elizabeth, South Africa.

    Science.gov (United States)

    Pepeta, Lungile; Greyling, Adele; Nxele, Mahlubandile Fintan; Makrexeni, Zongezile Masonwabe

    2017-01-01

    Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1-454 months) and the median weight was 8.5 kg (range 2.5-78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12-100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1-7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients.

  12. Surgical Treatment of Pressure Ulcers with a Fibrin Sealant in Patients with Spinal Cord Injury: A Cost-Consequence Analysis.

    Science.gov (United States)

    Velasco, Jose Manuel Arévalo; Lozano, Virginia; Oyagüez, Itziar; Casado, Miguel Angel

    2015-11-01

    A comparative study was performed to evaluate the effectiveness and costs of a fibrin sealant (Tissucol Duo [known as Tisseel in the United States], Baxter International, Deerfield, Illinois) to improve postoperative outcomes in patients with spinal cord injury undergoing surgical treatment for pressure ulcers (PrUs). Between January and June 2011, 27 patients underwent surgical treatment for PrUs with the direct application of Tissucol Duo sprayed before closure. The costs and outcomes obtained in this cohort were compared with those obtained in a previous retrospective study where 71 patients underwent conventional surgery. Lower rates of hematoma-seroma were observed in the study group (3.7% vs 33.8%; P costs. The application of Tissucol Duo during surgical treatment of PrUs in patients with spinal cord injury has been shown to be effective in reducing postoperative complications and in shortening the duration of the hospital stay with a consequent savings in costs.

  13. Transcatheter device closure of ruptured sinus of Valsalva: Immediate results and short term follow up

    Directory of Open Access Journals (Sweden)

    Sen Supratim

    2009-01-01

    Full Text Available This is a retrospective, observational study comprising of eight patients with isolated rupture of the sinus of Valsalva (RSOV who underwent transcatheter device closure. The mean age of presentation was 32.8 ± 10.0 years. New York Heart Association (NYHA class at the time of presentation was II (six patients and III (two patients. The RSOVs were all closed using a patent ductus arteriosus device. The mean procedural time was 42.3 ± 5.4 minutes, while the fluoroscopic time was 24.5 ± 6.9 minutes. All had complete closure of the shunt. The average hospital stay was 2.9 ± 1.1 days. There were no major complications. The patients were followed up for a mean of 11.3 ± 4.1 months. At the time of the last follow up all the patients were in NYHA class I. We conclude that in the short term, transcatheter closure of isolated RSOV is a viable alternative to surgical repair.

  14. Surgical outcome of severe pulmonary arterial hypertension secondary to left-to-right shunt lesions

    Directory of Open Access Journals (Sweden)

    Cha Gon Lee

    2010-02-01

    Full Text Available Purpose : Despite recent advances in pulmonary hypertension management and surgery, appropriate guidelines remain to be developed for operability in congenital heart disease with pulmonary artery hypertension (PAH. Our aim was to evaluate clinical outcomes of patients with severe PAH who underwent surgical closure of left-to-right shunt lesions (LRSL on the basis of pulmonary reactivity. Methods : We retrospectively reviewed 21 patients who underwent surgical closure of LRSL with severe PAH (?#248; Wood unit from January 1995 to April 2009. The median age at operation was 26 years. Atrial septal defect, ventricular septal defect (VSD, VSD and patent ductus arteriosus (PDA, and PDA was present in 11, 4, 4, and 2 patients, respectively. Results : Operability was based on vasoreactivity of PAH. Of the 21 patients, 5 showed response to pulmonary vasodilator therapy and 8 showed vasoreactivity after balloon occlusion of defects. The remaining 8 patients were considered operable because of significant left-to-right shunt (Qp/Qs ?#241;.5. Five patients underwent total closure of defects and 16 were left with small residual shunts. The median follow-up duration was 32 months. There was no significant postoperative mortality or morbidity. Systolic pulmonary artery pressure (PAP decreased in all but 2 patients. All patients except 1 showed improvement of New York Heart Association functional class. Conclusion : Closure of LRSL in patients with severe PAH on the basis of pulmonary vasoreactivity seems reasonable. PAP and clinical symptoms improved in most patients. Further research is needed for the evaluation of long-term results.

  15. Tubular closure device

    International Nuclear Information System (INIS)

    Klahn, F.C.; Nolan, J.H.; Wills, C.

    1982-01-01

    This invention relates to a closure mechanism for closing openings such as the bore of a conduit and for releasably securing members within the bore. More particularly, this invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holders used in nuclear reactors

  16. Angle closure glaucoma in congenital ectropion uvea

    Directory of Open Access Journals (Sweden)

    Grace M. Wang

    2018-06-01

    Full Text Available Purpose: Congenital ectropion uvea is a rare anomaly, which is associated with open, but dysplastic iridocorneal angles that cause childhood glaucoma. Herein, we present 3 cases of angle-closure glaucoma in children with congenital ectropion uvea. Observations: Three children were initially diagnosed with unilateral glaucoma secondary to congenital ectropion uvea at 7, 8 and 13 years of age. The three cases showed 360° of ectropion uvea and iris stromal atrophy in the affected eye. In one case, we have photographic documentation of progression to complete angle closure, which necessitated placement of a glaucoma drainage device 3 years after combined trabeculotomy and trabeculectomy. The 2 other cases, which presented as complete angle closure, also underwent glaucoma drainage device implantation. All three cases had early glaucoma drainage device encapsulation (within 4 months and required additional surgery (cycloablation or trabeculectomy. Conclusions and importance: Congenital ectropion uvea can be associated with angle-closure glaucoma, and placement of glaucoma drainage devices in all 3 of our cases showed early failure due to plate encapsulation. Glaucoma in congenital ectropion uvea requires attention to angle configuration and often requires multiple surgeries to obtain intraocular pressure control. Keywords: Congenital ectropion uvea, Juvenile glaucoma, Angle-closure glaucoma, Glaucoma drainage device

  17. Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure.

    Science.gov (United States)

    Bodur, Serkan; Dede, Murat; Fidan, Ulas; Firatligil, Burcin F; Ulubay, Mustafa; Ozturk, Mustafa; Yenen, Mufit C

    2017-09-01

    The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

  18. Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients.

    Science.gov (United States)

    Raithel, M; Albrecht, H; Scheppach, W; Farnbacher, M; Haupt, W; Hagel, A F; Schellerer, V; Vitali, F; Neurath, M F; Schneider, H T

    2017-06-01

    Acute gastrointestinal (GI) wall defects contain a high risk of morbidity and mortality and may be closed endoscopically by a full-thickness over-the-scope clip (OTSC). Unselected consecutive patients presenting with acute non-surgical perforations or postoperative anastomotic leaks or perforations underwent attempted OTSC placement as primary closure method after interdisciplinary consensus in three tertiary referral centres. Their clinical data and intervention characteristics were evaluated in an intention to treat analysis during a 24-month period to assess closure rates, 30-day mortality, hospitalization and comorbidity. In total, 34 patients (16 females, 18 males, 69.5 years) were included with 22 non-surgical perforations and 12 postoperative anastomotic leaks or perforations. Definitive closure of the perforations and leaks was achieved in 26/34 patients (76.5 %). Successful closure of the GI wall defect resulted in a significantly shorter hospital stay (8 days, p = 0.03) and was significantly correlated with comorbidity (r = 0.56, p = 0.005). In the group with OTSC failure, hospitalization was 18 days and 6 of 8 patients (75 %) required immediate surgery. Three deaths occurred in the group with successful OTSC closure due to comorbidity, while one death in the OTSC failure group was related to a refractory perforation. Favourable indications and locations for a successful OTSC procedure were identified as PEG complications, endoscopic or postoperative leaks of stomach, colon or rectum, respectively. In unselected patients, OTSC was effective for closure of acute GI wall defects in more than 75 % of all patients. Clinical success and short hospitalization were best achieved in patients without comorbidity, but closure of the perforation or the anastomotic leak was found to be not the only parameter relevant for patient outcome and mortality.

  19. Pulmonary artery-to-left atrial fistula discovered after the closure of atrial septal defect: A rare clinical scenario

    Directory of Open Access Journals (Sweden)

    Akshay Chauhan

    2018-01-01

    Full Text Available A case of the right pulmonary artery-to- left atrial fistula with atrial septal defect (ASD is presented. The fistula was detected after the patient developed desaturation following surgical closure of the ASD. It was managed with a transcatheter (trans-RPA route closure of the fistula using a 12-mm Amplatzer ventricular septal defect closure device.

  20. Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

    International Nuclear Information System (INIS)

    Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

    2008-01-01

    Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

  1. Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications

    Science.gov (United States)

    Paul, Malcolm D.

    2009-01-01

    Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings. PMID:24527114

  2. Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities.

    Science.gov (United States)

    Perentes, Jean Yannis; Abdelnour-Berchtold, Etienne; Blatter, Jeannine; Lovis, Alban; Ris, Hans-Beat; Krueger, Thorsten; Gonzalez, Michel

    2015-03-01

    Infected postpneumonectomy chest cavities may be related to chronic postpneumonectomy empyema or arise in rare situations of necrotizing pneumonia with complete lung destruction where pneumonectomy and pleural debridement are required. We evaluated the safety and efficacy of an intrathoracic vacuum-assisted closure device (VAC) for the treatment of infected postpneumonectomy chest cavities. A retrospective single institution review of all patients with infected postpneumonectomy chest cavities treated by VAC between 2005 and 2013. Patients underwent surgical debridement of the thoracic cavity, muscle flap closure of the bronchial stump when a fistula was present, and repeated intrathoracic VAC dressings until granulation tissue covered the entire chest cavity. After this, the cavity was obliterated by a Clagett procedure and closed. Twenty-one patients (14 men and 7 women) underwent VAC treatment of their infected postpneumonectomy chest cavity. Twelve patients presented with a chronic postpneumonectomy empyema (10 of them with a bronchopleural fistula) and 9 patients with an empyema occurring in the context of necrotizing pneumonia treated by pneumonectomy. In-hospital mortality was 23%. The median duration of VAC therapy was 23 days (range, 4-61 days) and the median number of VAC changes per patient was 6 (range, 2-14 days). Infection control and successful chest cavity closure was achieved in all surviving patients. One adverse VAC treatment-related event was identified (5%). The intrathoracic VAC application is a safe and efficient treatment of infected postpneumonectomy chest cavities and allows the preservation of chest wall integrity. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  3. Transcatheter device closure of secundum atrial septal defect (ASD) in young children

    International Nuclear Information System (INIS)

    Sadiq, N.; Ullah, M.; Sultan, M.; Akhtar, K.; Akbar, H.

    2014-01-01

    To analyze the safety and efficacy of device closure of secundum atrial septal defect in children = 5 years of age. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases Rawalpindi, Pakistan from Dec 2010 - Dec 2012. Patients and Method: Forty eight patients = 5 years of age underwent transcatheter closure of secundum ASD during two years. All patients were evaluated with 2-D echocardiography before the procedure. The sizing balloon was used in 6% and general anaesthesia was given in 83% (n=40) of patients. Results: Ninety seven point nine percent (47/48) had successful closure of ASD. The mean age was 4.1 +- 6.8 years (range 2.5-5 years) and 58.4% (28/48) were females. The defect size and occluders used were between 5-20 mm (mean 12 +-- 3.5) and 8-22 mm (mean 15 +- 3.9) respectively, three patients had simultaneous procedures including pulmonary valvuloplasty in two and percutaneous transmitral commissurotomy (PTMC) in one. The major complications remained 2% (1/48) which included device embolization just after release of device while minor complication rate was 12.5%. The median procedure time was 30 min (15-100 min) and median fluoroscopic time was 6 min (1.50-45 min). There was no emergency surgical exploration or death during this period. Conclusion: Transcatheter device closure of suitable secundum atrial septal defect is effective and safe in young children in skilled and professional hands. (author)

  4. Eyelid closure at death

    Directory of Open Access Journals (Sweden)

    A D Macleod

    2009-01-01

    Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

  5. Tracheocutaneous Fistula Closure with Turnover Flap and Polydioxanone Plate

    Directory of Open Access Journals (Sweden)

    Justin R. Bryant, DO, MBA

    2017-10-01

    Full Text Available Summary:. An alternative surgical treatment is proposed for closure of tracheocutaneous fistulas. The authors present a new technique for reconstruction of persistent tracheocutaneous fistula resultant from temporary tracheostomy. The single-stage closure under local anesthesia involves a fistulous tract turnover flap with a perforated 0.15 mm polydioxanone plate between the flap and the subcutaneous closure. This article presents 3 cases of persistent tracheocutaneous fistula treated by this method. At follow-up examination after follow-up, no recurrent fistula formation had occurred, and no respiratory deformity was present.

  6. Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device.

    Science.gov (United States)

    Zannis, John; Angobaldo, Jeff; Marks, Malcolm; DeFranzo, Anthony; David, Lisa; Molnar, Joseph; Argenta, Louis

    2009-04-01

    Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. Once the compartment pressure has been relieved and stabilized, the wound should be closed as quickly and early as possible to avoid later complications. Skin grafting can lead to morbidity and scarring at both the donor and fasciotomy site. Primary closure results in a more functional and esthetic outcome with less morbidity for the patient, but can often be difficult to achieve secondary to edema, skin retraction, and skin edge necrosis. Our objective was to examine fasciotomy wound outcomes, including time to definitive closure, comparing traditional wet-to-dry dressings, and the vacuum-assisted closure (VAC) device. This retrospective chart review included a consecutive series of patients over a 10-year period. This series included 458 patients who underwent 804 fasciotomies. Of these fasciotomy wounds, 438 received exclusively VAC. dressings, 270 received only normal saline wet-to-dry dressings, and 96 were treated with a combination of both. Of the sample, 408 patients were treated with exclusively VAC therapy or wet-to-dry dressings and 50 patients were treated with a combination of both. In comparing all wounds, there was a statistically significant higher rate of primary closure using the VAC versus traditional wet-to-dry dressings (P lower extremities and P extremities). The time to primary closure of wounds was shorter in the VAC. group in comparison with the non-VAC group. This study has shown that the use of the VAC for fasciotomy wound closure results in a higher rate of primary closure versus traditional wet-to-dry dressings. In addition, the time to primary closure of wounds or time to skin grafting is shorter when the VAC was employed. The VAC used in the described settings decreases hospitalization time, allows for earlier rehabilitation, and ultimately leads to increased patient satisfaction.

  7. Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants.

    Science.gov (United States)

    Boghossian, Nansi S; Do, Barbara T; Bell, Edward F; Dagle, John M; Brumbaugh, Jane E; Stoll, Barbara J; Vohr, Betty R; Das, Abhik; Shankaran, Seetha; Sanchez, Pablo J; Wyckoff, Myra H; Bethany Ball, M

    2017-10-01

    Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed. We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment. We studied infants 23-28weeks' gestation born 2006-2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (-0.5) and PDA surgery following pharmacologic treatment. 5606 infants were diagnosed with PDA; 3587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score>-0.5, PDA surgery was increased among infants with z-score -2 to -0.5 (OR=1.23; 95% CI 1.02-1.47) but not among infants with z-score<-2. Infants with birth weight z-score -2 to -0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Percutaneous closure of patent arterial ducts in patients from high altitude: a sub-Saharan experience.

    Science.gov (United States)

    Tefera, Endale; Qureshi, Shakeel A; Bermudez-Cañete, Ramòn; Rubio, Lola

    2015-01-01

    At high altitude, patent arterial ducts tend to be larger and associated with pulmonary hypertension. Patent ductus arteriosus device closure in this background could be challenging. We report our experience with percutaneous closure of patent arterial ducts using a variety of devices in patients residing in a high altitude. This is a retrospective review of the case records of 145 patients (age 9 months-20 years, mean 5.6 ± 3.9 years, and weight 7-54 kg, mean 17.7 ± 9.4) with duct sizes ranging between 2 and 21 mm, (mean, 5.8 ± 2.7) who underwent percutaneous closure of patent arterial ducts. One hundred thirty-six (93.8%) of the patients were from a geographic area of 2100-2800 m above sea level. Successful device closure was achieved in 143 cases. It was difficult to achieve device stability in two patients with expansile ducts. Therefore, they were treated surgically. The devices used were various types of duct occluder devices in 131 patients, while atrial and ventricular septal occluders were used in eight patients. For the group, mean systolic pulmonary artery (PA) pressure decreased from 47.0 ± 16.7 mmHg before occlusion to 29.0 ± 7.4 mmHg after occlusion (P ≤ 0.001)., mean diastolic PA pressure from 25.0 ± 10.9 mmHg to 14.8 ± 6.0 mmHg and the average mean PA pressure decreased from 35.9 ± 13.5 mmHg to 21.1 ± 6.5 mmHg. Complications (4.8%) included device and coil embolization, bleeding, and pulse loss. On follow-up (mean duration of 36.1 ± 12.1 months, range 12-62 months), 137 patients were in functional class 1, 3 had residual shunt, 2 had device migration and one patient had persisting pulse loss. Successful duct closure was achieved in the vast majority of patients, even though the ducts were larger and significant number of them had pulmonary hypertension in this high altitude group. There was a relatively higher incidence of residual shunts and device migration in this series, generally due to the nonavailability of optimal device and

  9. RCRA corrective action and closure

    International Nuclear Information System (INIS)

    1995-02-01

    This information brief explains how RCRA corrective action and closure processes affect one another. It examines the similarities and differences between corrective action and closure, regulators' interests in RCRA facilities undergoing closure, and how the need to perform corrective action affects the closure of DOE's permitted facilities and interim status facilities

  10. Scope and closures

    CERN Document Server

    Simpson, Kyle

    2014-01-01

    No matter how much experience you have with JavaScript, odds are you don’t fully understand the language. This concise yet in-depth guide takes you inside scope and closures, two core concepts you need to know to become a more efficient and effective JavaScript programmer. You’ll learn how and why they work, and how an understanding of closures can be a powerful part of your development skillset.

  11. Temporary abdominal closure in the critically ill patients with an open abdomen.

    Directory of Open Access Journals (Sweden)

    Ghodratollah Maddah

    2014-05-01

    Full Text Available The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag. The study population comprised of 11 (57.9% male and 8 (42.1% female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 (57.9% patients, subjective judgment that the fascia closure is too tight in 6 (31.6% patient's damage control surgery in one patient (5.3% and development of abdominal compartment surgery in one patient (5.3%. Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 (47.4% patients, post operative intestinal fistula in 4 (21.1% patients, post traumatic intra abdominal bleeding in 3 (15.8% patients and intestinal obstructions in 3 (15.8% patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one (10.0% patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 (%21.1 early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 (26.3% late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 (range 2-54 months. Currently 10 patients (52.6% are alive at a follow up of 45 (range 1

  12. Optimisation of Surgical Results in de-Quervain’s Disease

    Directory of Open Access Journals (Sweden)

    B Jagannath Kamath

    2014-11-01

    Full Text Available Background: De Quervain’s disease poses more problems with respect to management than the diagnosis. Surgery is resorted to when the conservative methods fail. There are known complications of the surgical intervention. Surgeon contemplating the surgery should be aware of these and make every attempt to optimize the results and avoid the above mentioned complication. Methods: Sixty symptomatic wrists in 57 individuals suffering from de Quervain’s disease who needed surgery were studied preoperatively with ultrasound. Number of tendons and the sub septae identified in the ultrasound examination preoperatively were confirmed on the table during the surgery. The release was brought about under local anesthesia, with magnification taking care to avoid injury to the cephalic vein and superficial branch of radial nerve, not to violate the anterior margin of the sheath, thus preventing complications. A negative post release finkelstein test was ensured before the wound closure. Results: All 60 patients who underwent release for de Quervain’s disease were symptom free, satisfied and fully functional. Conclusions: De-Quervain's disease not relieved by conservative methods needs surgical release under local anesthesia with a transverse incision with Preoperative ultrasound examination for the number of tendons and subseptae. Avoiding the violation of the volar aspect of the sheath, loupe magnification, tourniquet and post release Finkelstein’s test before wound closure, will ensure optimal results.

  13. Surgical Assisting

    Science.gov (United States)

    ... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

  14. Surgical innovations in canine gonadectomy

    OpenAIRE

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated negative consequences (lengthy placement, impaired wound healing around bulky knots, and the effect of unsightly knots on cosmetics). A study in 9 dogs found that celiotomy closure was easily achiev...

  15. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  16. 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.

  17. Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

    Directory of Open Access Journals (Sweden)

    Azhar Ahmad

    2009-01-01

    Full Text Available Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

  18. Angle closure glaucoma in congenital ectropion uvea.

    Science.gov (United States)

    Wang, Grace M; Thuente, Daniel; Bohnsack, Brenda L

    2018-06-01

    Congenital ectropion uvea is a rare anomaly, which is associated with open, but dysplastic iridocorneal angles that cause childhood glaucoma. Herein, we present 3 cases of angle-closure glaucoma in children with congenital ectropion uvea. Three children were initially diagnosed with unilateral glaucoma secondary to congenital ectropion uvea at 7, 8 and 13 years of age. The three cases showed 360° of ectropion uvea and iris stromal atrophy in the affected eye. In one case, we have photographic documentation of progression to complete angle closure, which necessitated placement of a glaucoma drainage device 3 years after combined trabeculotomy and trabeculectomy. The 2 other cases, which presented as complete angle closure, also underwent glaucoma drainage device implantation. All three cases had early glaucoma drainage device encapsulation (within 4 months) and required additional surgery (cycloablation or trabeculectomy). Congenital ectropion uvea can be associated with angle-closure glaucoma, and placement of glaucoma drainage devices in all 3 of our cases showed early failure due to plate encapsulation. Glaucoma in congenital ectropion uvea requires attention to angle configuration and often requires multiple surgeries to obtain intraocular pressure control.

  19. Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

    OpenAIRE

    R. W. Knackstedt; J. A. Dixon; P. J. O’Neill; F. A. Herrera

    2015-01-01

    Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-ad...

  20. Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure.

    Science.gov (United States)

    Roushdy, Alaa; Abd El Razek, Yasmeen; Mamdouh Tawfik, Ahmed

    2018-01-01

    To determine anatomic and hemodynamic echocardiographic predictors for patent ductus arteriosus (PDA) device vs coil closure. Seventy-six patients who were referred for elective transcatheter PDA closure were enrolled in the study. All patients underwent full echocardiogram including measurement of the PDA pulmonary end diameter, color flow width and extent, peak and end-diastolic Doppler gradients across the duct, diastolic flow reversal, left atrial dimensions and volume, left ventricular sphericity index, and volumes. The study group was subdivided into 2 subgroups based on the mode of PDA closure whether by coil (n = 42) or device (n = 34). Using univariate analysis there was a highly significant difference between the 2 groups as regard the pulmonary end diameter measured in both the suprasternal and parasternal short-axis views as well as the color flow width and color flow extent (P closure group had statistically significant higher end-systolic and end-diastolic volumes indexed, left atrial volume, and diastolic flow reversal. Receiver operating characteristic curve analysis showed a pulmonary end diameter cutoff point from the suprasternal view > 2.5 mm and from parasternal short-axis view > 2.61 mm to have the highest balanced sensitivity and specificity to predict the likelihood for device closure (AUC 0.971 and 0.979 respectively). The pulmonary end diameter measured from the suprasternal view was the most independent predictor of device closure. The selection between PDA coil or device closure can be done on the basis of multiple anatomic and hemodynamic echocardiographic variables. © 2017 Wiley Periodicals, Inc.

  1. Subcostal closure technique for prevention of postthoracotomy pain syndrome.

    Science.gov (United States)

    Hong, Kipyo; Bae, Mikyung; Han, Sora

    2016-09-01

    The purpose of this study was to evaluate the efficacy of our subcostal closure technique in prevention of postthoracotomy pain syndrome. From July 2012 to March 2015, 29 patients in whom a lobectomy was indicated underwent a thoracotomy. The thoracotomy wounds were closed using a subcostal closure technique (subcostal closure group) and outcomes were compared with 31 patients who underwent video-assisted thoracoscopic surgery (thoracoscopy group). The duration of oral opioid consumption was evaluated from medical records, and postoperative pain was evaluated by telephone interview conducted by a trained nurse practitioner who was unaware of the patient's group. Pain scores were higher in the thoracoscopy group compared to the subcostal closure group, reaching statistical significance (Numeric Rating Scale 0.55 ± 0.948 in the subcostal closure group vs. 1.84 ± 1.614 in the thoracoscopy group; p Pain Scale 0.24 ± 0.435 in the subcostal closure group vs. 0.81 ± 0.703 in the thoracoscopy group; p pain syndrome. © The Author(s) 2016.

  2. Laser peripheral iridoplasty for angle-closure.

    Science.gov (United States)

    Ng, Wai Siene; Ang, Ghee Soon; Azuara-Blanco, Augusto

    2012-02-15

    Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.   To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles (PACs), PAC and PACG. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012. We included only randomised controlled trials (RCTs) in this review. Patients with narrow angles, PAC or PACG were eligible. We excluded studies that included only patients with acute presentations

  3. Catheter-based closure of the patent ductus arteriosus in lower weight infants.

    Science.gov (United States)

    Pavlek, Leeann R; Slaughter, Jonathan L; Berman, Darren P; Backes, Carl H

    2018-06-13

    Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight (closure devices; (3) review the technical success (feasibility); (4) review the risks (safety profile); (5) discuss the quality of evidence on procedural efficacy; (6) consider areas for future research. The review provided herein suggests that catheter-based PDA closure is technically feasible, but the lack of comparative trials precludes determination of the optimal strategy for ductal closure in this subgroup of infants. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study.

    Science.gov (United States)

    von Renteln, Daniel; Rudolph, Hans-Ulrich; Schmidt, Arthur; Vassiliou, Melina C; Caca, Karel

    2010-01-01

    Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure. Randomized, controlled animal study. Animal facility laboratory. Domestic pigs (24 females). Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy. One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD +/- 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD +/- 65) for OTSC closures and 143 mm Hg (range, 30-300, SD +/- 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD +/- 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P = .461). Nonsurvival setting. Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  5. Tubular closure mechanism

    International Nuclear Information System (INIS)

    Kalen, D.D.; Mitchem, J.W.

    1982-01-01

    This invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holder used in nuclear reactors. The closure mechanism is composed of a latching member which includes a generally circular chamber with a plurality of elongated latches depending therefrom. The latching member circumscribes part of an actuator member which is disposed within the latching member so as to be axially movable. The axial movement of the actuator actuates positioning of the latches between positions in which the latches are locked and secured within the actuator member. Means, capable of being remotely manipulated, are provided to move the actuator in order to position the latches and load the articles within the tube

  6. Tank closure reducing grout

    International Nuclear Information System (INIS)

    Caldwell, T.B.

    1997-01-01

    A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr 90 , the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel

  7. Intraoperative seizures and seizures outcome in patients underwent awake craniotomy.

    Science.gov (United States)

    Yuan, Yang; Peizhi, Zhou; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shu, Jiang; Qing, Mao

    2016-11-25

    Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general intraoperative seizure(IOS) rate for patients with AC was 8%(fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that awake craniotomy is a safe technique with relatively low intraoperative seizure occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

  8. Limited utility of preoperative studies in preparation for colostomy closure.

    Science.gov (United States)

    Pokorny, R M; Heniford, T; Allen, J W; Tuckson, W B; Galandiuk, S

    1999-04-01

    Numerous diagnostic and therapeutic practices are used in an attempt to reduce the morbidity of colostomy closures. Our principal aim was to evaluate the role of preoperative studies, specifically barium enemas and endoscopic examinations, performed before colostomy closures. Additionally, we wished to identify other practices involved in the perioperative management of patients undergoing colostomy closure that influenced morbidity. The records of 100 consecutive patients who underwent elective colostomy closure at University of Louisville Hospital between January 1989 and July 1995 were reviewed. Wound infection was the most common complication (12%). Various bowel preparations were equivalent in efficacy and did not influence the complication rate. Intermittent wound irrigation with antibiotics for 3 days postoperatively, via subcutaneous drains, was associated with a low incidence of incision infection. Preoperative barium enema or sigmoidoscopy were often performed but rarely useful. Performing these examinations merely increased hospital cost without a corresponding decline in morbidity.

  9. Single-layer closure of typhoid enteric perforation: Our experience ...

    African Journals Online (AJOL)

    Materials and Methods: We retrospectively studied the effects of single versus double layer intestinal closure after typhoid enteric perforation with peritonitis in 902 pediatric patients from September 2007 to April 2012. All the patients underwent laparotomy after resuscitation and antibiotic cover. The patients were divided ...

  10. A simple novel technique [PUIT] for closure of urethrocutaneous fistula after hypospadias repair: Preliminary results

    Directory of Open Access Journals (Sweden)

    Awad M

    2005-01-01

    Full Text Available Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied, the closure of the fistula is a challenging problem. We present a simple surgical procedure, posterior urethral incision technique [PUIT] to close the fistula in our department. Between February 2001 and December 2004 we prospectively evaluated 32 patients, 26 patients with initial hypospadias fistulas and 6 with recurrent fistulas who underwent closure of urethrocutaneous fistula after hypospadias repair. The mean age of patients was 5 years, the operation consisted of trimming the fistula edge after mobilization of the skin all-around then a midline posterior urethral incision was done 2 mm above and 2 mm below the fistula opening then re-approximation of the urethral edges using 6/0 vicryl sutures with loop magnification. The timing of fistula repair was between 6 and 13 months after it was formed, all of these were effectively closed except three cases with stricture and fistula. Of these, two were completely relieved after repeated urethral dilatation, three times a week for 2 weeks. The third failed case will need another sitting after 6 months. The posterior midline urethral incision gives a good opportunity for repair without tension with a good cosmetic outcome. This may be done under local anesthesia in adults. The procedure is considered simple rapid and easy to be done for variable fistulas types whatever of its site and the age.

  11. Professional Closure Beyond State Authorization

    Directory of Open Access Journals (Sweden)

    Gitte Sommer Harrits

    2014-03-01

    Full Text Available For decades, the Weberian approach to the study of professions has been strong, emphasizing state authorization and market monopolies as constituting what is considered a profession. Originally, however, the Weberian conception of closure, or the ways in which a profession is constituted and made separate, was broader. This article suggests a revision of the closure concept, integrating insights from Pierre Bourdieu, and conceptualizing professional closure as the intersection of social, symbolic and legal closure. Based on this revision, this article demonstrates how to apply such a concept in empirical studies. This is done by exploring social, symbolic and legal closure across sixteen professional degree programs. The analyses show a tendency for some overlap between different forms of closure, with a somewhat divergent pattern for legal closure. Results support the argument that we need to study these processes as an intersection of different sources of closure, including capital, lifestyles and discourse

  12. Fetal endoscopic myelomeningocele closure preserves segmental neurological function

    NARCIS (Netherlands)

    Verbeek, Renate J.; Heep, Axel; Maurits, Natalia M.; Cremer, Reinhold; Hoving, Eelco W.; Brouwer, Oebele F.; Van der Hoeven, Johannes H.; Sival, Deborah A.

    AIM:   Our aim was to compare the effect of prenatal endoscopic with postnatal myelomeningocele closure (fetally operated spina bifida aperta [fSBA]) versus neonatally operated spina bifida aperta [nSBA]) on segmental neurological leg condition. METHOD:   Between 2003 and 2009, the fetal surgical

  13. 31. Left ventricular dysfunction after patent ductus arteriosus (PDA closure

    Directory of Open Access Journals (Sweden)

    Rihab Agouba

    2015-10-01

    Conclusions: Depressed LV-SFx may occur after PDA closure with higher incidence after catheter PDA device occlusion. All of preterm babies had surgical PDA occlusion and none of them presented with depressed LV-SFx in the post-operative follow-up. Further prospective studies are needed to investigate these observations.

  14. MNC Subsidiary Closures

    DEFF Research Database (Denmark)

    Sofka, Wolfgang; Torres Preto, Miguel; de Faria, Pedro

    2014-01-01

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. In particular, we examine the extent to which the human capital that these employees acquired while employed by the MNC influences the wages they receive in their new jobs. We propose an employee...

  15. Friction or Closure

    DEFF Research Database (Denmark)

    Lundahl, Mikela

    2014-01-01

    Heritage is a discourse that aims at closure. It fixates the narrative of the past through the celebration of specific material (or sometimes immaterial non-) ob-jects. It organizes temporality and construct events and freezes time. How does this unfold in the case of the UNESCO World Heritage si...

  16. Mail Office annual closure

    CERN Multimedia

    2013-01-01

    On the occasion of the annual closure of CERN, there will be no mail distributed on Friday 20 December 2013 but mail will be collected in the morning. Nevertheless, you will still be able to bring your outgoing mail to Building 555-R-002 until 12 noon.  

  17. Evaluation of left ventricular function by tissue Doppler and speckle-derived strain rate echocardiography after percutaneous ductus closure.

    Science.gov (United States)

    Amoogzar, Hamid; Shakiba, Ali Mohammad; Derakhshan, Dorna; Ajami, Gholamhossein; Cheriki, Sirous; Borzouee, Mohammad; Edraki, Mohammad Reza; Mehdizadegan, Nima

    2015-01-01

    The aim of this study was to evaluate the left ventricular systolic and diastolic function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure. 21 children (age >6 months old) diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler and tissue Doppler imaging and speckled-derived strain rate echocardiography were done at pre-closure, 1 day (early) and 1 month (late) post-closure. Mean age of the patients (female/male: 1.3) was 17.54 ± 24.7 months with the mean PDA diameter of 3.6 ± 0.8 mm. Systolic measures (ejection fraction, shortening fraction) reduced significantly early after PDA closure (P closure status. Early and late diastolic flow velocities of mitral (E M and A M) reduced considerably in early and late post-closure time (P closure. After 1 month, E'M increased considerably. (P = 0.01) but E'M/A'M had an insignificant rise (P > 0.05). E M/E'M ratio did not change in early post-closure but it had a considerable reduction in the subsequent month compared with the pre- and early post-closure (P closure (P closure causes a significant decrease in left ventricular performance early after PDA closure which recovers completely within 1 month. Also PDA size can affect post-closure left ventricular function.

  18. Ring closure in actin polymers

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, Supurna, E-mail: supurna@rri.res.in [Raman Research Institute, Bangalore 560080 (India); Chattopadhyay, Sebanti [Doon University, Dehradun 248001 (India)

    2017-03-18

    We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers. - Highlights: • Ring closure of biopolymers. • Worm like chain model. • Predictions for experiments.

  19. Surgical ablation of ventricular tachycardia secondary to congenital ventricular septal aneurysm.

    Science.gov (United States)

    Graffigna, A; Minzioni, G; Ressia, L; Vigano, M

    1994-04-01

    Three patients underwent surgical ablation for ventricular tachycardia resulting from an aneurysm of the membranous portion of the ventricular septum. Two patients had a definite history of cardiac murmur during infancy, and one of them was found at the time of operation to have a left-to-right shunt through the apex of the aneurysm. The earliest ventricular activation sites were located around the neck of the aneurysm and were ablated in 1 patient by encircling the endocardial ventriculotomy and by cryoablation in the remaining 2. After focus resection had been completed, aneurysm resection and ventricular septal reconstruction were performed. All patients were alive and free of ventricular tachycardia and did not need medication as of 61, 66, and 88 months postoperatively. Spontaneous closure of a ventricular septal defect may lead to the formation of an aneurysm in the ventricular septum that may sustain ventricular tachycardias. Such arrhythmias can be effectively treated using electrically guided surgical techniques.

  20. CIRSE Vascular Closure Device Registry

    NARCIS (Netherlands)

    Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2011-01-01

    Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. The CIRSE registry of closure devices

  1. Crack closure, a literature study

    Science.gov (United States)

    Holmgren, M.

    1993-08-01

    In this report crack closure is treated. The state of the art is reviewed. Different empirical formulas for determining the crack closure are compared with each other, and their benefits are discussed. Experimental techniques for determining the crack closure stress are discussed, and some results from fatigue tests are also reported. Experimental data from the literature are reported.

  2. Urgent surgical management for embolized occluder devices in childhood: single center experience

    Directory of Open Access Journals (Sweden)

    Gokaslan Gokhan

    2012-12-01

    Full Text Available Abstract Background In this study, we sought to analyze our experience in urgent surgical management for embolized cardiac septal and ductal occluder devices resulting from trans-catheter closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus in childhood patient group. Methods We retrospectively reviewed 9 patients (aged 2–15 years who underwent urgent surgery due to cardiac septal and ductal occluder embolization between January 2007 and December 2010. Congenital defects were atrial septal defect (n = 6, ventricular septal defect (n = 1, and patent ductus arteriosus (n = 2. Risk factors for device embolization and urgent surgical management techniques for embolized device removal were discussed. Results Removal of embolized devices in all cases and repair of damaged tricuspid valve in 2 patients were performed. Inevitably, all congenital defects were closed or ligated up to the primary defect. Total circulator arrest necessitated in 1 patient with ascending aortic device embolization. All operations were completed successfully and no hospital mortality or morbidity was encountered. Conclusions Although closure of left to right shunting defects by percutaneous occluder devices has a lot of advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.

  3. 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.

  4. Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

    Directory of Open Access Journals (Sweden)

    Simona Stoicescu

    2013-12-01

    Full Text Available Introduction: Although cleft lip and palate (CLP is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of oronasal fistula rate. Material and methods: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair over a five-year period, from 2008 to 2012. All cleft palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, one- or two-stage cleft palate repair were collected and analyzed. Results: Fifty-three (66% and twenty-seven (34% patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, associating cleft lip to cleft palate. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%. Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the protocol of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery

  5. Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute.

    Science.gov (United States)

    Lapa Pedreira, Denise A; Acacio, Gregório L; Gonçalves, Rodrigo T; Sá, Renato Augusto M; Brandt, Reynaldo A; Chmait, Ramen; Kontopoulos, Eftichia; Quintero, Ruben A

    2018-01-04

    We have previously described our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. We hereby describe a modification of our standard technique using a bilaminar skin substitute to allow closure of such large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large spina bifida defects. Surgeries were performed between 24.0 and 28.9 gestational weeks under general anesthesia, using an entirely percutaneous fetoscopic approach with partial CO2 insufflation of the uterine cavity, as previously described. If there was enough skin to be sutured in the midline, only a biocellulose patch was placed over the placode. In cases where skin approximation was not possible, a bilaminar skin substitute (two layers: one silicone and one dermal matrix) was placed over the biocellulose. The surgical site was assessed at birth, and long-term follow-up was performed. Forty-seven consecutive fetuses underwent percutaneous fetoscopic OSB repair. Premature preterm rupture of membranes (PPROM) occurred in 38 (84%), and the mean gestational age at delivery was 32,8 + 2.5 weeks. A bilaminar skin substitute was required in 13 (29%), of which 5 was associated with myeloschisis. In all cases the skin substitute was found at the surgical site, at birth. In 3 (15%) of these cases, postnatal additional repair was needed. In the other 10 cases, the silicone layer detached spontaneously from the dermal matrix (average 25 days after birth), and the lesion healed by secondary-intention. Operating time was significantly longer in cases requiring the bilaminar skin substitute (additional 42 minutes). The subgroup with bilaminar skin substitute had similar PPROM rate and delivery gestational age compared to the one patch group. Complete reversal of

  6. Pulmonary artery closure in combination with patch technique for treating congenital heart disease combined with large patent ductus arteriosus: A clinical study of 9 cases.

    Science.gov (United States)

    Wen, Bing; Yang, Junya; Liu, Huiruo; Jiao, Zhouyang; Zhao, Wenzeng

    2016-01-01

    To document clinical experience of treating congenital heart disease combined with large patent ductus arteriosus with pulmonary artery closure in combination with patch technique. Thirty-six patients (8 males and 28 females) who suffered from congenital heart disease and underwent hybrid surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to February 2014 were selected for this study. They aged 14 to 39 years and weighed 32.20 to 61.50 kg. Diameter of arterial duct was between 10 mm and 13 mm; 28 cases were tube type, 4 cases were funnel type and four cases were window type. All patients had moderate or severe pulmonary arterial hypertension; besides, there were 28 cases of ventricular septal defect, 16 cases of atrial septal defect, eight cases of aortic insufficiency, four cases of mitral stenosis and insufficiency and four cases of infectious endocarditis. Cardz Pulmonary Bypass (CPB) was established after chest was opened along the middle line. With the help of Transesophageal echocardiography, large patent ductus arteriosus was blocked off through pulmonary artery. Pulmonary artery was cut apart after blocking of heart. Large patent ductus arteriosus on the side of pulmonary artery was strengthened with autologous pericardial patch. Of 36 patients, 32 patients had patent ductus arteriosus closure device and four patients had atrial septal defect closure device. Pulmonary arteries of 36 cases were all successfully closed. Systolic pressure declined after closure ((54.86±19.23) mmHg vs (96.05±23.07) mmHg, pclosure ((39.15±14.83) mmHg vs (72.88±15.76) mmHg, ppatent ductus arteriosus and congenital heart disease, which decreases surgical problems, shortens surgical time and lowers the incidence of complications.

  7. Summer season | Cafeteria closures

    CERN Multimedia

    2013-01-01

    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  8. RELAP-7 Closure Correlations

    Energy Technology Data Exchange (ETDEWEB)

    Zou, Ling [Idaho National Lab. (INL), Idaho Falls, ID (United States); Berry, R. A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, R. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Zhang, H. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hansel, J. E. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, J. P. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Johns, Russell C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-04-01

    The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework, MOOSE (Multi-Physics Object Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty years of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s and TRACE’s capabilities and extends their analysis capabilities for all reactor system simulation scenarios. The RELAP-7 code utilizes the well-posed 7-equation two-phase flow model for compressible two-phase flow. Closure models used in the TRACE code has been reviewed and selected to reflect the progress made during the past decades and provide a basis for the colure correlations implemented in the RELAP-7 code. This document provides a summary on the closure correlations that are currently implemented in the RELAP-7 code. The closure correlations include sub-grid models that describe interactions between the fluids and the flow channel, and interactions between the two phases.

  9. Natural orifice transluminal endoscopic surgery gastrotomy closure with an over-the-endoscope clip: a randomized, controlled porcine study (with videos).

    Science.gov (United States)

    von Renteln, Daniel; Schmidt, Arthur; Vassiliou, Melina C; Gieselmann, Maria; Caca, Karel

    2009-10-01

    Secure endoscopic closure of transgastric natural orifice transluminal endoscopic surgery (NOTES) access is of paramount importance. The over-the-scope clip (OTSC) system has previously been shown to be effective for NOTES gastrotomy closure. To compare OTSC gastrotomy closure with surgical closure. Randomized, controlled animal study. Animal facility laboratory. Thirty-six female domestic pigs. Gastrotomies were created by using a needle-knife and an 18-mm balloon. The animals were subsequently randomized to either open surgical repair with interrupted sutures or endoscopic repair with 12-mm OTSCs. In addition, pressurized leak tests were performed in ex vivo specimens of 18-mm scalpel incisions closed with suture (n = 14) and of intact stomachs (n = 10). The mean time for endoscopic closure was 9.8 minutes (range 3-22, SD 5.5). No complications occurred during either type of gastrotomy closure. At necropsy, examination of all OTSC and surgical closures demonstrated complete sealing of gastrotomy sites without evidence of injury to adjacent organs. Pressurized leak tests showed a mean burst pressure of 83 mm Hg (range 30-140, SD 27) for OTSC closures and 67 mm Hg (range 30-130, SD 27.7) for surgical sutures. Ex vivo hand-sewn sutures of 18-mm gastrotomies (n = 14) exhibited a mean burst pressure of 65 mm Hg (range 20-140, SD 31) and intact ex vivo stomachs (n = 10) had a mean burst pressure of 126 mm Hg (range 90-170, SD 28). The burst pressure of ex vivo intact stomachs was significantly higher compared with OTSC closures (P < .01), in vivo surgical closures (P < .01), and ex vivo hand-sewn closures (P < .01). There was a trend toward higher burst pressures in the OTSC closures compared with surgical closures (P = .063) and ex vivo hand-sewn closures (P = .094). In vivo surgical closures demonstrated similar burst pressures compared with ex vivo hand-sewn closures (P = .848). Nonsurvival setting. Endoscopic closure by using the OTSC system is comparable to

  10. Hybrid closure of atrial septal defect: A modified approach

    Directory of Open Access Journals (Sweden)

    Kshitij Sheth

    2015-01-01

    Full Text Available A 3.5-year-old girl underwent transcatheter closure of patent ductus arteriosus in early infancy during which time her secundum atrial septal defect (ASD was left alone. When she came for elective closure of ASD, she was found to have bilaterally blocked femoral veins. The defect was successfully closed with an Amplatzer septal occluder (ASO; St. Jude Medical, Plymouth, MN, USA using a hybrid approach via a sub-mammary mini-thoracotomy incision without using cardiopulmonary bypass. At the end of 1-year follow-up, the child is asymptomatic with device in a stable position without any residual shunt.

  11. Transcatheter closure of Patent Ductus Arteriosus through only venous route.

    Science.gov (United States)

    Sheikh, Abdul Malik; Duke, Abdul Karim; Sattar, Hina

    2018-03-01

    Patent ductus arteriosus is a common congenital cardiac defect comprising 5-10% of all these defects in term neonates. Although open chest and video-assisted interruption are still in use, transcatheter occlusion has rapidly become the first choice for patent ductus arteriosus closure in the appropriate patient. Percutaneous closure of patent ductus arteriosus is widely done by transvenous approach guided by aortic access. We present the case of a 2 year old girl who underwent patent ductus arteriosus device occlusion with transvenous access only.

  12. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

  13. Anterior Segment Imaging Predicts Incident Gonioscopic Angle Closure.

    Science.gov (United States)

    Baskaran, Mani; Iyer, Jayant V; Narayanaswamy, Arun K; He, Yingke; Sakata, Lisandro M; Wu, Renyi; Liu, Dianna; Nongpiur, Monisha E; Friedman, David S; Aung, Tin

    2015-12-01

    To investigate the incidence of gonioscopic angle closure after 4 years in subjects with gonioscopically open angles but varying degrees of angle closure detected on anterior segment optical coherence tomography (AS OCT; Visante; Carl Zeiss Meditec, Dublin, CA) at baseline. Prospective, observational study. Three hundred forty-two subjects, mostly Chinese, 50 years of age or older, were recruited, of whom 65 were controls with open angles on gonioscopy and AS OCT at baseline, and 277 were cases with baseline open angles on gonioscopy but closed angles (1-4 quadrants) on AS OCT scans. All subjects underwent gonioscopy and AS OCT at baseline (horizontal and vertical single scans) and after 4 years. The examiner performing gonioscopy was masked to the baseline and AS OCT data. Angle closure in a quadrant was defined as nonvisibility of the posterior trabecular meshwork by gonioscopy and visible iridotrabecular contact beyond the scleral spur in AS OCT scans. Gonioscopic angle closure in 2 or 3 quadrants after 4 years. There were no statistically significant differences in age, ethnicity, or gender between cases and controls. None of the control subjects demonstrated gonioscopic angle closure after 4 years. Forty-eight of the 277 subjects (17.3%; 95% confidence interval [CI], 12.8-23; P < 0.0001) with at least 1 quadrant of angle closure on AS OCT at baseline demonstrated gonioscopic angle closure in 2 or more quadrants, whereas 28 subjects (10.1%; 95% CI, 6.7-14.6; P < 0.004) demonstrated gonioscopic angle closure in 3 or more quadrants after 4 years. Individuals with more quadrants of angle closure on baseline AS OCT scans had a greater likelihood of gonioscopic angle closure developing after 4 years (P < 0.0001, chi-square test for trend for both definitions of angle closure). Anterior segment OCT imaging at baseline predicts incident gonioscopic angle closure after 4 years among subjects who have gonioscopically open angles and iridotrabecular contact on AS OCT at

  14. [Surgical coverage technics of pressure sores and their outcomes].

    Science.gov (United States)

    Bilkay, Ufuk; Helvaci, Evren; Tokat, Cenk; Ozek, Cüneyt; Akin, Yalçin

    2006-04-01

    We reviewed the outcome of 66 patients with 100 pressure sores between 1984 and 2002. In the current study, 100 pressure sores in 66 patients (45 male, 21 female; mean age 39.4; range 13 to 80 years) who underwent surgical repair of pressure sores reconstructed using myocutaneous or fasciocutaneous flaps, skin grafts, excision and closure. The risk factors for pressure sores included acute trauma-induced spinal cord injury in 40 (61%) patients with paraplegia and in 5 (7%) patients with quadriplegia; congenital spina bifida and multiple sclerosis in 7 (11%) patients and prolonged immobilization in 14 (21 patients) patients. We achieved an overall pressure sore recurrence rate of 22% and overall patient recurrence of 24% in a-3-year follow-up. The recurrence rates according to anatomic sites; 23% (10 of 43) for the ischial pressure sore, sacral 21% (8 of 37), and trochanteric 20% (4 of 20). Fasciocutaneous and myocutaneous flap reconstructions were the most durable, as they were associated with 17% (6 of 34) and 12% recurrence rates (5 of 39). To reduce the recurrence rates the authors advocate the use of myocutaneous and fasciocutaneous flaps instead of skin grafts or direct closure for the coverage of pressure sores.

  15. Disposable skin staplers for closure of linear gastrointestinal incisions in dogs.

    Science.gov (United States)

    Schwartz, Zeev; Coolman, Bradley R

    2018-02-01

    To report the clinical features and outcomes of linear gastrointestinal incisions closed with skin staples in dogs. Historical cohort study. 333 client-owned dogs. Medical records from 1 private referral hospital were searched for dogs that underwent gastrointestinal surgery between November 1999 and October 2015. Cases were included if skin staplers were used to close linear gastrointestinal incisions. Information regarding preoperative, surgical, and postoperative factors was collected. Complications were diagnosed in 8 of 245 (3.27%) dogs, including 3 of 245 (1.22%) dogs that died or were euthanized, 3 of 245 (1.22%) dogs with incisional dehiscence, and 2 of 245 (0.81%) dogs with attachment of a linear foreign body to the staples at the intestinal lumen. Dehiscence was noted at the enterotomy sites in 3 dogs at a mean time of 44 hours after surgery (SD ± 6.93). Two dogs presented with another linear foreign body that was attached to the staples in the intestinal lumen at postoperative days 24 and 42. The risk factors associated with incisional dehiscence included multiple gastrointestinal incisions performed in 1 surgery (χ 2 , P indication for surgical intervention, surgery location in the gastrointestinal tract, or surgeon experience and incisional dehiscence. Skin staplers provide safe and effective closure of gastrotomies, enterotomies, and colonotomies in dogs. This method is reliable, efficient, and affordable in the hands of veterinary surgeons with varying skill levels. © 2017 The American College of Veterinary Surgeons.

  16. Echocardiography for patent ductus arteriosus including closure in adults.

    Science.gov (United States)

    Chugh, Reema; Salem, Morris M

    2015-01-01

    Patent ductus arteriosus (PDA) represents at least 5-10% of all congenital heart defects (CHDs) making it a very important commonly diagnosed lesion. Although spontaneous closure of the PDA occurs within 24 to 48 hours after birth in the majority, those children who do not have natural or surgical closure may have a persistent PDA into adulthood. The diagnosis is most often confirmed by echocardiography that also guides catheter-based interventions and surgeries. Echocardiography continues to be the most important tool in long-term follow-up of residua and sequelae. © 2014, Wiley Periodicals, Inc.

  17. Vacuum assisted closure in vascular surgery.

    Science.gov (United States)

    Beno, M; Martin, J; Sager, P

    2011-01-01

    Vacuum assisted closure (VAC-therapy) is a well established method in nearly all surgical disciplines. The aim is to present the efficiency of vacuum assisted closure in the treatment of acute and chronic wounds in patients admitted in the department of vascular surgery. Within the year 2008 there were 59 patients (44 men, 15 women) treated with VAC therapy in our Department of Vascular surgery (Landshut, Germany). VAC was used 22x (37.28 %) in therapy of ulcus cruris (venous, arterial, mixed genesis), 15x (25.42%) in patients with diabetic foot syndrome, 12x (20.33%) in secondary healing wounds and infected wounds, 5x (8.47%) in wounds after several injuries and soft skin tissue infections and 5x (8.47%) in wound infections connected with vascular graft infections after vascular revascularization. VAC therapy seems to be very effective in the management of patients with venous ulcers, especially after a proper surgical treatment (100%), patients with soft skin tissue infections (100%) and secondary healing wounds (100%) especially in combination with MESH-Grafting. In patients with diabetic foot syndrome (80%) and peripheral arterial occlusive disease (72.7%), an evaluation of peripheral blood perfusion and revascularization prior to VAC therapy is often necessary. Although VAC was used 5x in the therapy of infected vascular grafts, successful preservation of infected graft material was observed in only one case (infection of PTFE femoro-popliteal bypass graft). Vacuum assisted closure in vascular surgery proved to be simple and efficient method in therapy of acute and chronic wounds. The efficiency of VAC systems in therapy of infected graft material after revascularization needs further studies (Tab. 3, Ref. 10).

  18. Nevada Test Site closure program

    International Nuclear Information System (INIS)

    Shenk, D.P.

    1994-08-01

    This report is a summary of the history, design and development, procurement, fabrication, installation and operation of the closures used as containment devices on underground nuclear tests at the Nevada Test Site. It also addresses the closure program mothball and start-up procedures. The Closure Program Document Index and equipment inventories, included as appendices, serve as location directories for future document reference and equipment use

  19. MNC Subsidiary Closure

    DEFF Research Database (Denmark)

    de Faria, Pedro; Sofka, Wolfgang; Torres Preto, Miguel

    2013-01-01

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...... country but is also distant and therefore difficult to absorb. We predict an inverse u-shaped relationship between the exposure to foreign knowledge and the salary in the new job. We empirically support our predictions for a sample of almost 140,000 affected employees in Portugal from 2002 to 2009....

  20. 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.

  1. The effect of surgical treatment for secundum atrial septal defect in patients more than 30 years old.

    Science.gov (United States)

    Erkut, Bilgehan; Becit, Necip; Unlu, Yahya; Ceviz, Munacettin; Kocogullari, Cevdet Ugur; Ates, Azman; Karapolat, Bekir Sami; Kaygin, Mehmet Ali; Kocak, Hikmet

    2007-01-01

    We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect. We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation. The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period. Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.

  2. The effects of local nitroglycerin on the surgical delay procedure in prefabricated flaps by vascular implant in rats.

    Science.gov (United States)

    Sá, Jairo Zacchê de; Aguiar, José Lamartine de Andrade; Cruz, Adriana Ferreira; Schuler, Alexandre Ricardo Pereira; Lima, José Ricardo Alves de; Marques, Olga Martins

    2012-12-01

    To evaluate the effect of local nitroglycerin on the viable area of a prefabricated flap for vascular implant in rats, and to investigate the surgical delay procedure. A femoral pedicle was implanted under the skin of the abdominal wall in forty Wistar rats. The animals were divided into four groups of ten: group 1 - without surgical delay procedure and local nitroglycerin; group 2 - with surgical delay procedure, but without local nitroglycerin; group 3 - without surgical delay procedure, but with local nitroglycerin; and group 4 - with simultaneous surgical delay procedure and local nitroglycerin. The percentages of the viable areas, in relation to the total flap, were calculated using AutoCAD R 14. The mean percentage value of the viable area was 8.9% in the group 1. 49.4% in the group 2; 8.4% in the group 3 and 1.1% in the group 4. There was significant difference between groups 1 and 2 (p=0.005), 1 and 4 (p=0.024), 2 and 3 (p=0.003), 2 and 4 (p=0.001). These results support the hypothesis that the closure of the arterial venous channels is responsible for the phenomenon of surgical delay procedure. Local nitroglycerin did not cause an increase in the prefabricated viable flap area by vascular implantation and decreased the viable flap area that underwent delay procedures.

  3. Chernobyl: closure by 2000

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

    Discussions on the future of the Chernobyl nuclear plant between the Ukrainian government, the Group of Seven Industrial nations (GT) and the European Union (EU) are summarized. At the G7 meeting, a timetable for the closure of the entire station by 2000 was presented by Ukrainian officials. The timetable depends on financial commitments from Western governments. Without these, the project would take 10 to 15 years. Following this meeting, which took place on 16-17th May 1995. EU finance ministers authorized release of a ECU 85 million loan. On 23 May, the European Parliament's Committee on Research, Technology and Energy held a public hearing on the Chernobyl station. The primary topic was a feasibility study on the clean-up of Chernobyl 4 and plans for the sarcophagus. Other matters discussed included the effect of the delays and indecision in settling the plants's future. Safety improvements being made to other RBMKs were not being carried out at Chernobyl because of the expected closure. The replacement of the power now supplied to the Ukraine by the Chernobyl reactors is also an issue. The solution favoured by the Ukraine is to being on-line three VVER-1000s that are currently close to completion. Western governments find this solution difficult to accept, however. (UK)

  4. Tight closure and vanishing theorems

    International Nuclear Information System (INIS)

    Smith, K.E.

    2001-01-01

    Tight closure has become a thriving branch of commutative algebra since it was first introduced by Mel Hochster and Craig Huneke in 1986. Over the past few years, it has become increasingly clear that tight closure has deep connections with complex algebraic geometry as well, especially with those areas of algebraic geometry where vanishing theorems play a starring role. The purpose of these lectures is to introduce tight closure and to explain some of these connections with algebraic geometry. Tight closure is basically a technique for harnessing the power of the Frobenius map. The use of the Frobenius map to prove theorems about complex algebraic varieties is a familiar technique in algebraic geometry, so it should perhaps come as no surprise that tight closure is applicable to algebraic geometry. On the other hand, it seems that so far we are only seeing the tip of a large and very beautiful iceberg in terms of tight closure's interpretation and applications to algebraic geometry. Interestingly, although tight closure is a 'characteristic p' tool, many of the problems where tight closure has proved useful have also yielded to analytic (L2) techniques. Despite some striking parallels, there had been no specific result directly linking tight closure and L∼ techniques. Recently, however, the equivalence of an ideal central to the theory of tight closure was shown to be equivalent to a certain 'multiplier ideal' first defined using L2 methods. Presumably, deeper connections will continue to emerge. There are two main types of problems for which tight closure has been helpful: in identifying nice structure and in establishing uniform behavior. The original algebraic applications of tight closure include, for example, a quick proof of the Hochster-Roberts theorem on the Cohen-Macaulayness of rings of invariants, and also a refined version of the Brianqon-Skoda theorem on the uniform behaviour of integral closures of powers of ideals. More recent, geometric

  5. Comparison between primary closure with karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection

    International Nuclear Information System (INIS)

    Nafees, A.U.A.; Ahmed, M.

    2013-01-01

    Objective: The purpose of this study is to compare between primary closure with Karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection. Study Design: Randomized Clinical Trials (RCT). Place and Duration of Study: This study was carried out at Department of Surgery, CMH, Kharian over a period of 2 years from Sept 2010 to Oct 2012. Patients and Methods: Sixty patients were selected out of which 30 patients underwent open excision and secondary healing and 30 patients underwent Karydakis procedure. Post operatively these patients were observed for wound infection on date of discharge and weeks 1, 2 and 3. Results of both groups were compared for wound infection by applying chi-square test. Results: There was no statistically significant difference in the frequency of infection between the two groups when calculated during the complete course of study. Conclusion: Primary closure with Karydakis's technique and open procedure are satisfactory surgical procedures for pilonidal sinus disease in terms of post-operative wound infection. (author)

  6. Surgical smoke.

    Science.gov (United States)

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

  7. Early surgical treatment of retinal hemangioblastomas.

    Science.gov (United States)

    van Overdam, Koen A; Missotten, Tom; Kilic, Emine; Spielberg, Leigh H

    2017-02-01

    To evaluate the clinical course after early surgical treatment with excision of retinal hemangioblastomas (RHs) before development of major complications. Interventional case series of four eyes (four patients) with a peripheral RH that had not yet been treated by laser or cryotherapy prior to surgery. All eyes underwent 23-gauge vitrectomy with lesion excision. One patient underwent ligation of the feeder vessel prior to lesion excision. Best-corrected visual acuity and clinical course were assessed during a follow-up period of at least 4 years. Four patients (mean age 27.3 years; range 19-32) were included, of whom two had von Hippel-Lindau syndrome. Visual acuity improved in three patients (mean 4.8 lines; range 3-10) and remained stable at 0.0 logMAR in one patient. There were no intraoperative complications. Postoperative complications included transient mild vitreous haemorrhage (n = 2), and local epiretinal membrane formation at the excision location (n = 1). At 4 years postoperatively, there were no long-term complications. There was one case of a new lesion, which was effectively treated with laser. Vitrectomy with RH excision seems to be an effective approach for larger RHs and could be considered an early treatment option in selected cases. Postoperative complications were limited in scope of this case series. Important points to consider during vitrectomy are effective closure of feeder and draining vessels as well as complete removal of posterior hyaloid and epiretinal membranes in order to avoid postoperative vitreous haemorrhage and proliferative vitreoretinopathy. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  8. [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.

  9. 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.

  10. The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery.

    Science.gov (United States)

    Inaba, Kenji; Okoye, Obi; Aksoy, Hande; Skiada, Dimitra; Ault, Glenn; Sener, Stephen; Lam, Lydia; Benjamin, Elizabeth; Demetriades, Demetrios

    2016-10-01

    To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery. Emergency surgery patients are at high risk for retained foreign bodies. All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed. In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8. Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.

  11. Tubular closure mechanism

    International Nuclear Information System (INIS)

    Kalen, D.D.; Mitchem, J.W.

    1981-01-01

    An apparatus is provided for closing the bore of a tube and releasably securing articles within the tube under longitudinal load. A latching member has a cylindrical section and several circumferentially-spaced elongated latches hanging down from one end of the cylinder. An elongated actuator has integral cam and spline and is partly located within the latch with the cam radially contacting the latches and the spline projecting into the circumferential spaces between the latches. The actuator is axially movable between a position in which the latches are locked to the tube walls and a position in which the latches are secured from contact with the tube walls. Means are provided for axially moving the actuator such that the cam positions the latches; and means are also provided for engaging the articles within the tube. The closure is particularly applicable to tubular irradiation surveillance specimen assembly holders used in reactors

  12. Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia.

    Science.gov (United States)

    Fenster, Brett E; Nguyen, Bryant H; Buckner, J Kern; Freeman, Andrew M; Carroll, John D

    2013-10-15

    The aim of this study was to evaluate the ability of percutaneous patent foramen ovale (PFO) closure to improve systemic hypoxemia. Although PFO-mediated right-to-left shunt (RTLS) is associated with hypoxemia, the ability of percutaneous closure to ameliorate hypoxemia is unknown. Between 2004 and 2009, 97 patients who underwent PFO closure for systemic hypoxemia and dyspnea that was disproportionate to underlying lung disease were included for evaluation. All patients exhibited PFO-mediated RTLS as determined by agitated saline echocardiography. Procedural success was defined as implantation of a device without major complications and mild or no residual shunt at 6 months. Clinical success was defined as a composite of an improvement in New York Heart Association (NYHA) functional class, reduction of dyspnea symptoms, or decreased oxygen requirement. Procedural success was achieved in 96 of 97 (99%), and clinical success was achieved in 68 of 97 (70%). The presence of any moderate or severe interatrial shunt by agitated saline study (odds ratio [OR] = 4.7; p gender (OR = 0.30; p <0.017) decreased the likelihood of success. In conclusion, based on the largest single-center experience of patients referred for PFO closure for systemic hypoxemia, PFO closure was a mechanically effective procedure with an associated improvement in echocardiographic evidence of RTLS, NYHA functional class, and oxygen requirement. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Automated analysis of angle closure from anterior chamber angle images.

    Science.gov (United States)

    Baskaran, Mani; Cheng, Jun; Perera, Shamira A; Tun, Tin A; Liu, Jiang; Aung, Tin

    2014-10-21

    To evaluate a novel software capable of automatically grading angle closure on EyeCam angle images in comparison with manual grading of images, with gonioscopy as the reference standard. In this hospital-based, prospective study, subjects underwent gonioscopy by a single observer, and EyeCam imaging by a different operator. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. An eye was classified as having angle closure if there were two or more quadrants of closure. Automated grading of the angle images was performed using customized software. Agreement between the methods was ascertained by κ statistic and comparison of area under receiver operating characteristic curves (AUC). One hundred forty subjects (140 eyes) were included, most of whom were Chinese (102/140, 72.9%) and women (72/140, 51.5%). Angle closure was detected in 61 eyes (43.6%) with gonioscopy in comparison with 59 eyes (42.1%, P = 0.73) using manual grading, and 67 eyes (47.9%, P = 0.24) with automated grading of EyeCam images. The agreement for angle closure diagnosis between gonioscopy and both manual (κ = 0.88; 95% confidence interval [CI), 0.81-0.96) and automated grading of EyeCam images was good (κ = 0.74; 95% CI, 0.63-0.85). The AUC for detecting eyes with gonioscopic angle closure was comparable for manual and automated grading (AUC 0.974 vs. 0.954, P = 0.31) of EyeCam images. Customized software for automated grading of EyeCam angle images was found to have good agreement with gonioscopy. Human observation of the EyeCam images may still be needed to avoid gross misclassification, especially in eyes with extensive angle closure. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  14. Association of iris crypts with acute primary angle closure.

    Science.gov (United States)

    Koh, Victor; Chua, Jacqueline; Shi, Yuan; Thakku, Sri Gowtham; Lee, Ryan; Nongpiur, Monisha E; Baskaran, Mani; Kumar, Rajesh S; Perera, Shamira; Aung, Tin; Cheng, Ching-Yu

    2017-10-01

    To determine the relationship between iris surface features and acute primary angle closure (APAC) in eyes with angle closure. Case-control study involving Asian patients diagnosed with previous APAC, primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG) at an eye centre in Singapore between August 2012 and January 2015. Participants underwent ophthalmic examination and digital slit-lamp iris photography. Iris surface features were graded based on crypts, furrows and colour. Fellow eyes of APAC were compared with PACS and PAC/PACG eyes with regard to their iris surface features. Occurrence of APAC. A total of 309 patients (71 APAC, 139 PACS, 47 PAC and 52 PACG) were included (mean age: 67.7±7.2 years and 36.6% male). Compared with PACS, higher crypt grade was significantly associated with lower odds of APAC (OR=0.58 for one grade higher in crypt grade; p=0.027, adjusted for age, gender, ethnicity and pupil diameter). The results remained similar when compared with PAC/PACG group (OR=0.58 for one grade higher in crypt grade; p=0.043). We did not observe any significant associations between iris furrows or colour with presence of APAC. Our study comprising Asian eyes with angle closure suggests that the presence of a higher crypt grading may be protective for APAC. As such, assessing iris surface architecture for crypts could be a new measure for risk stratification of developing APAC in eyes with angle closure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Airport Movement Area Closure Planner, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — This SBIR research develops an automation tool improving temporary and permanent runway closure management. The Movement Area Closure Planner (MACP) provides airport...

  16. Transcatheter closure of atrial septal defect in a patient with Noonan syndrome after corrective surgery

    Directory of Open Access Journals (Sweden)

    Mangovski Ljupčo

    2015-01-01

    Full Text Available Introduction. Transcatheter atrial septal defect (ASD closure is considered to be a gold standard for patients with the suitable anatomy as compared to cardiac surgery. Reocurrence of ASD after surgical closure is a very rare late complication which can be successfully managed with transcatheter procedure. Case report. We reported a female patient with Noonan syndrome who presented with hemodinamically significant ASD 37 years after the corrective cardiac surgery. Due to numerous comorbidities which included severe kyphoscoliosis, pectus excavatum and multiple surgeries we decided to perform transcatheter closure of ASD. The procedure itself was very challenging due to the patient’s short stature and heart’s orientation in the chest, but was performed successfully. The subsequent follow-up was uneventful and the patient reported improvement in the symptoms. Conclusion. Transcatheter closure of ASD in a patient with Noonan syndrome with the history of surgically corrected ASD can be performed successfully, despite challenging chest anatomy.

  17. Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder

    OpenAIRE

    Xi, Er-Ping; Zhu, Jian; Zhu, Shui-Bo; Yin, Gui-Lin; Liu, Yong; Dong, Yong-Qiang; Zhang, Yu; Xia, Feng

    2012-01-01

    OBJECTIVE: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired,...

  18. Minimal debridement or simple wound closure as the only surgical treatment in war victims with low-velocity penetrating head injuries. Indications and management protocol based upon more than 8 years follow-up of 99 cases from Iran-Iraq conflict.

    Science.gov (United States)

    Amirjamshidi, Abbass; Abbassioun, Kazem; Rahmat, Hamid

    2003-08-01

    During military conflicts, surviving victims traditionally underwent large enough craniectomy or craniotomy to achieve extensive debridement of the in-driven bone, shell fragments, and debris. Meanwhile, the completely as well as the partially devitalized adjacent brain tissue would also be debrided. This might have led to additional neurologic deficit or lesser degree of recovery of functions. We studied the efficacy and safety of much more limited or even absence of surgical intervention in a selected group of wartime head-wounded patients. Among 1,150 war victims with penetrating head wounds referred to two major centers affiliated with Tehran University of Medical Sciences during the 8-year period spanning the Iran-Iraq conflict, there were 191 head-wounded patients who underwent either no surgical intervention or a very limited debridement. We have attempted to follow up as closely as possible for more than 8 years. Ninety-nine of them fulfilled the criteria to be included in this series. Close follow-up for development of cerebral infections, functional recovery, or development of new neurologic deficits and epilepsy were performed. At least 3 contrast-enhanced CT scans were taken for each patient. All patients were victims of the battle-field areas with low- to moderate-velocity missile or shell fragment injury. The Glasgow Coma Scale (GCS) scores of the patients were between 8-14 when visited by the first attending neurosurgery staff. The factors considered to be effective in the outcome analysis were the entry point, the number of the in-driven bone fragments, the retained shell fragments, the brain compartments affected, and the paranasal sinus or skull base involvement with or without cerebrospinal fluid (CSF) fistula. There were 13 unilobar, 44 bilobar, 4 trilobar, 38 transventricular, and 3 skull base lesions. The number of retained metal fragments varied between 1 to 6. The number of retained bone fragments varied between 1 to 5 in 73 victims and more

  19. Seven-year follow-up of percutaneous closure of patent foramen ovale.

    Science.gov (United States)

    Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Johansson, Magnus Carl; Furenäs, Eva; Eriksson, Peter; Dellborg, Mikael

    2013-12-01

    Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3 years (5 to 12.4 years). Mean age at PFO closure was 49 years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term.

  20. When the Battle is Lost and Won: Delayed Chest Closure After Bilateral Lung Transplantation.

    Science.gov (United States)

    Soresi, Simona; Sabashnikov, Anton; Weymann, Alexander; Zeriouh, Mohamed; Simon, André R; Popov, Aron-Frederik

    2015-10-12

    In this article we summarize benefits of delayed chest closure strategy in lung transplantation, addressing indications, different surgical techniques, and additional perioperative treatment. Delayed chest closure seems to be a valuable and safe strategy in managing patients with various conditions after lung transplantation, such as instable hemodynamics, need for high respiratory pressures, coagulopathy, and size mismatch. Therefore, this approach should be considered in lung transplant centers to give patients time to recover before the chest is closed.

  1. Obesity: An Independent Risk Factor for Insufficient Hemostasis Using the AngioSeal Vascular Closure Device After Antegrade Puncture

    Energy Technology Data Exchange (ETDEWEB)

    Minko, Peter, E-mail: peterminko@yahoo.com; Katoh, Marcus [University Hospital Saarland, Department of Diagnostic and Interventional Radiology (Germany); Graeber, Stefan [University Hospital Saarland, Institute of Medical Biometry, Epidemiology and Medical Informatics (Germany); Buecker, Arno [University Hospital Saarland, Department of Diagnostic and Interventional Radiology (Germany)

    2012-08-15

    Purpose: This study was designed to investigate the efficacy of the AngioSeal vascular closure device after antegrade puncture of the femoral artery. Methods: In a prospective study, 120 consecutive patients underwent lower limb vascular intervention by an antegrade access to the common femoral artery (CFA). After intervention, a 6F (n = 88) or an 8F (n = 32) AngioSeal vascular closure device was used to achieve hemostasis. The technical success or the cause of failure was documented. In addition, the coagulation status (platelets, INR, prothrombin time, atrial thromboplastin time (PTT)), hypertonus, locoregional habitus of the groin, body mass index (BMI), presence of calcifications, and history of previous surgical interventions of the CFA were evaluated. Results: Hemostasis was achieved in 97 patients (81%). In 12 patients (10%), persistent bleeding of the puncture site required manual compression. In another nine patients (8%) a kink of the sheath obviated the passage of the collagen plug toward the vessel, and in two patients the anchor dislodged out of the vessel, requiring manual compression. There were no significant differences between the groups of successful and unsuccessful sealing regarding the mean platelets (241 vs. 254 * 10{sup 9}/l; P = 0.86), INR (1.06 vs. 1.02; P = 0.52), prothrombin time (90% vs. 90%; P = 0.86), and PTT (30 vs. 31 s; P = 0.82). However, unsuccessful sealing was more likely in obese patients with an increased BMI (26.6 vs. 28.8 kg/m{sup 2}; P = 0.04). Conclusions: Obesity seems to be an independent risk factor for insufficient sealing using the AngioSeal vascular closure device after antegrade puncture of the CFA. In 8% of our patients, hemostasis could not be achieved due to kink of the flexible sheath.

  2. Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series.

    Science.gov (United States)

    Knackstedt, R W; Dixon, J A; O'Neill, P J; Herrera, F A

    2015-01-01

    Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may be apparent.

  3. Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

    Directory of Open Access Journals (Sweden)

    R. W. Knackstedt

    2015-01-01

    Full Text Available Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may

  4. Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique.

    Science.gov (United States)

    Shafi, Nabil A; Singh, Gagan D; Smith, Thomas W; Rogers, Jason H

    2018-05-01

    To describe a novel balloon sizing technique used during adult transcatheter patent ductus arteriosus (PDA) closure. In addition, to determine the clinical and procedural outcomes in six patients who underwent PDA balloon sizing with subsequent deployment of a PDA occluder device. Transcatheter PDA closure in adults has excellent safety and procedural outcomes. However, PDA sizing in adults can be challenging due to variable defect size, high flow state, or anatomical complexity. We describe a series of six cases where the balloon- pull through technique was successfully performed for PDA sizing prior to transcatheter closure. Consecutive adult patients undergoing adult PDA closure at our institution were studied retrospectively. A partially inflated sizing balloon was pulled through the defect from the aorta into the pulmonary artery and the balloon waist diameter was measured. Procedural success and clinical outcomes were obtained. Six adult patients underwent successful balloon pull-through technique for PDA sizing during transcatheter PDA closure, since conventional angiography often gave suboptimal opacification of the defect. All PDAs were treated with closure devices based on balloon PDA sizing with complete closure and no complications. In three patients that underwent preprocedure computed tomography, the balloon size matched the CT derived measurements. The balloon pull-through technique for PDA sizing is a safe and accurate sizing modality in adults undergoing transcatheter PDA closure. © 2017 Wiley Periodicals, Inc.

  5. Delayed primary closure of bladder exstrophy: immediate postoperative management leading to successful outcomes.

    Science.gov (United States)

    Baradaran, Nima; Stec, Andrew A; Schaeffer, Anthony J; Gearhart, John P; Mathews, Ranjiv I

    2012-02-01

    To present the critical features of our postoperative plan for children undergoing delayed primary bladder closure because appropriate postoperative management is crucial to successful exstrophy repair. Using an institutionally approved database, patients with bladder exstrophy whose primary bladder closure was performed at least 1 month after birth were identified. All aspects of the postoperative management were reviewed. A total of 20 patients (18 boys) were identified: 19 with classic bladder extrosphy and 1 with an exstrophy variant. The patients underwent closure at a mean age of 9.9 months. All patients underwent pelvic osteotomy and immobilization for an average of 34.8 days. Analgesia was administered by way of a tunneled epidural catheter in 90% of patients for an average of 18.8 days, and 12 patients (60%) required adjunct intravenous analgesia. Bilateral ureteral catheters and suprapubic tubes were used in all patients. Total parenteral nutrition was administered to 10 (83%) of 12 patients who underwent closure after 2000. All patients received preoperative antibiotics and 2 weeks of postoperative intravenous antibiotics that was followed by oral prophylaxis. The mean hospital stay was 6.3 weeks. With an average follow-up of 7.4 years, delayed closure was 100% successful. Successful delayed primary closure of bladder exstrophy requires a multidisciplinary approach. The keys to success include osteotomy, pelvic immobilization, analgesia, nutritional support, maximal bladder drainage, and infection prophylaxis. Copyright © 2012. Published by Elsevier Inc.

  6. Accelerating cleanup. Paths to closure Hanford Site

    International Nuclear Information System (INIS)

    Edwards, C.

    1998-01-01

    This document was previously referred to as the Draft 2006 Plan. As part of the DOE's national strategy, the Richland Operations Office's Paths to Closure summarizes an integrated path forward for environmental cleanup at the Hanford Site. The Hanford Site underwent a concerted effort between 1994 and 1996 to accelerate the cleanup of the Site. These efforts are reflected in the current Site Baseline. This document describes the current Site Baseline and suggests strategies for further improvements in scope, schedule and cost. The Environmental Management program decided to change the name of the draft strategy and the document describing it in response to a series of stakeholder concerns, including the practicality of achieving widespread cleanup by 2006. Also, EM was concerned that calling the document a plan could be misconstrued to be a proposal by DOE or a decision-making document. The change in name, however, does not diminish the 2006 vision. To that end, Paths to Closure retains a focus on 2006, which serves as a point in time around which objectives and goals are established

  7. Changes in Serum Natriuretic Peptide Levels after Percutaneous Closure of Small to Moderate Ventricular Septal Defects

    Directory of Open Access Journals (Sweden)

    Yuksel Kaya

    2012-01-01

    Full Text Available Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3±14.3 who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3±78.6 versus 26.8±15.6, =0.013. Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

  8. Dysphagia among adult patients who underwent surgery for esophageal atresia at birth.

    Science.gov (United States)

    Huynh Trudeau, Valérie; Maynard, Stéphanie; Terzic, Tatjana; Soucy, Geneviève; Bouin, Mickeal

    2015-03-01

    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. To determine the motor and anatomical causes of dysphagia. A total of 41 adults, followed at the Esophageal Atresia Clinic at Hôpital Saint-Luc (Montreal, Quebec), were approached to particpate in the present prospective study. Evaluation was completed using upper endoscopy, manometry and barium swallow for the participants who consented. The medical charts of respondents were systematically reviewed from the neonatal period to 18 years of age to assess medical and surgical history. All 41 patients followed at the clinic consented and were included in the study. Dysphagia was present in 73% of patients. Esophagogastroduodenoscopy was performed in 32 patients: hiatal hernia was present in 62% (n=20); esophageal diverticulum in 13% (n=4); macroscopic Barrett esophagus in 31% (n=10); and esophagitis in 19% (n=6). Histological esophagitis was present in 20% and intestinal metaplasia in 10%. There were no cases of dysplagia or adenocarcinoma. Esophageal manometry was performed on 56% of the patients (n=23). Manometry revealed hypomotility in 100% of patients and included an insufficient number of peristaltic waves in 96%, nonpropagating peristalsis in 78% and low-wave amplitude in 95%. Complete aperistalsis was present in 78%. The lower esophageal sphincter was abnormal in 12 (52%) patients, with incomplete relaxation the most common anomaly. Of the 41 patients, 29 (71%) consented to a barium swallow, which was abnormal in 13 (45%). The anomalies found were short esophageal dilation in 28%, delay in esophageal emptying in 14%, diverticula in 14% and stenosis in 7

  9. Closure report for N Reactor

    International Nuclear Information System (INIS)

    1994-01-01

    This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule

  10. Closure report for N Reactor

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule.

  11. Acute limb ischemia caused by incorrect deployment of a clip-based arterial closure device

    Directory of Open Access Journals (Sweden)

    Łukasz Dzieciuchowicz

    2016-04-01

    Full Text Available Failure of a vascular closure device most commonly results in a hemorrhage or pseudoaneurysm formation. In this paper a rare case of severe acute limb ischemia following incorrect deployment of a clip-based closure device (Starclose SE, Abbott Vascular in a 31-year-old woman is presented. Symptoms of acute limb ischemia occurred at the start of the ambulation, 6 h after completion of the procedure. Because of the severity of ischemia the patient was treated surgically, and limb perfusion was successfully restored. An attempt of closure of an inadvertently punctured narrow superficial femoral artery was identified as the cause of this complication.

  12. Transcatheter closure of large patent ductus arteriosus using custom made devices.

    Science.gov (United States)

    Rohit, Manoj Kumar; Gupta, Ankur

    2017-05-01

    There has been a paradigm shift in the transcatheter closure of patent ductus arteriosus (PDA) over the last 45 years. With the availability of various coils, plugs and occluders, PDA of almost all shapes and sizes are amenable to transcatheter closure. However, very large PDA diagnosed late in life are being referred for surgical closure in the absence of availability of large size devices, especially in developing countries. In this case series, we have described four patients with large PDA, three of which were closed by transcatheter custom made PDA occluders. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  13. Interferometric Imaging Directly with Closure Phases and Closure Amplitudes

    Science.gov (United States)

    Chael, Andrew A.; Johnson, Michael D.; Bouman, Katherine L.; Blackburn, Lindy L.; Akiyama, Kazunori; Narayan, Ramesh

    2018-04-01

    Interferometric imaging now achieves angular resolutions as fine as ∼10 μas, probing scales that are inaccessible to single telescopes. Traditional synthesis imaging methods require calibrated visibilities; however, interferometric calibration is challenging, especially at high frequencies. Nevertheless, most studies present only a single image of their data after a process of “self-calibration,” an iterative procedure where the initial image and calibration assumptions can significantly influence the final image. We present a method for efficient interferometric imaging directly using only closure amplitudes and closure phases, which are immune to station-based calibration errors. Closure-only imaging provides results that are as noncommittal as possible and allows for reconstructing an image independently from separate amplitude and phase self-calibration. While closure-only imaging eliminates some image information (e.g., the total image flux density and the image centroid), this information can be recovered through a small number of additional constraints. We demonstrate that closure-only imaging can produce high-fidelity results, even for sparse arrays such as the Event Horizon Telescope, and that the resulting images are independent of the level of systematic amplitude error. We apply closure imaging to VLBA and ALMA data and show that it is capable of matching or exceeding the performance of traditional self-calibration and CLEAN for these data sets.

  14. Iatrogenic obstruction of the aorta – a sequence of delayed, fatal complications after ‘off-label’ interventional persistent ductus arteriosus closure

    Directory of Open Access Journals (Sweden)

    Ireneusz Haponiuk

    2016-02-01

    Full Text Available A 10-month-old girl was admitted to the Intensive Care Unit with the symptoms of critical cardiac decompensation. In the 3rd month of life, 3 kg bw, she underwent an interventional persistent ductus arteriosus (PDA closure in a high-reference pediatric cardiology center. Echocardiography performed on admission showed myocardial injury, with poor contractility, mild pulmonary hypertension and severe stenosis of the isthmus of aorta. The girl was urgently referred for surgical removal with the use of extracorporeal circulation (ECC and deep hypothermia circulatory arrest (DHCA technique. In the 4th postoperative day (POD, she developed cardiovascular decompensation and died in the 7th POD due to circulatory arrest in the mechanism of refractory ventricular fibrillation. In autopsy there were found microscopic signs of apoptosis in parenchymal organs below iatrogenic ‘coarctation’, typical for chronic ischemia. In the segments proximal to iatrogenic aortic stenosis there were evident vascular changes characteristic for chronic severe arterial hypertension.

  15. Borehole closure in salt

    International Nuclear Information System (INIS)

    Fuenkajorn, K.; Daemen, J.J.K.

    1988-12-01

    Constitutive law parameters are determined from salt behavior characterization experiments. The results are applied to predict creep (time-dependent) closure of boreholes in salt specimens subjected to various loading configurations. Rheological models (linear and nonlinear viscoelastic and viscoplastic models), empirical models, and physical theory models have been formulated from the results of uniaxial creep tests, strain and stress rate controlled uniaxial tests, constant strain rate triaxial tests, cyclic loading tests, and seismic velocity measurements. Analytical solutions for a thick-walled cylinder subjected to internal and external pressures and for a circular hole in an infinite plate subjected to a biaxial or uniaxial stressfield have been derived from each of the linear viscoelastic models and from one of the empirical laws. The experimental results indicate that the salt samples behave as an elastic-viscoplastic material. The elastic behavior tends to be linear and time-independent. The plastic deformation is time-dependent. The stress increment to strain rate increment ratio gradually decreases as the stress level increases. The transient potential creep law seems to give the simplest satisfactory governing equation describing the viscoplastic behavior of salt during the transient phase. 204 refs., 27 figs., 29 tabs

  16. Closure and Sealing Design Calculation

    International Nuclear Information System (INIS)

    T. Lahnalampi; J. Case

    2005-01-01

    The purpose of the ''Closure and Sealing Design Calculation'' is to illustrate closure and sealing methods for sealing shafts, ramps, and identify boreholes that require sealing in order to limit the potential of water infiltration. In addition, this calculation will provide a description of the magma that can reduce the consequences of an igneous event intersecting the repository. This calculation will also include a listing of the project requirements related to closure and sealing. The scope of this calculation is to: summarize applicable project requirements and codes relating to backfilling nonemplacement openings, removal of uncommitted materials from the subsurface, installation of drip shields, and erecting monuments; compile an inventory of boreholes that are found in the area of the subsurface repository; describe the magma bulkhead feature and location; and include figures for the proposed shaft and ramp seals. The objective of this calculation is to: categorize the boreholes for sealing by depth and proximity to the subsurface repository; develop drawing figures which show the location and geometry for the magma bulkhead; include the shaft seal figures and a proposed construction sequence; and include the ramp seal figure and a proposed construction sequence. The intent of this closure and sealing calculation is to support the License Application by providing a description of the closure and sealing methods for the Safety Analysis Report. The closure and sealing calculation will also provide input for Post Closure Activities by describing the location of the magma bulkhead. This calculation is limited to describing the final configuration of the sealing and backfill systems for the underground area. The methods and procedures used to place the backfill and remove uncommitted materials (such as concrete) from the repository and detailed design of the magma bulkhead will be the subject of separate analyses or calculations. Post-closure monitoring will not

  17. Closure Using a Surgical Closure Device of Inadvertent Subclavian Artery Punctures During Central Venous Catheter Placement

    International Nuclear Information System (INIS)

    Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James

    2001-01-01

    Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)

  18. Predictors of transient left ventricular dysfunction following transcatheter patent ductus arteriosus closure in pediatric age.

    Science.gov (United States)

    Agha, Hala Mounir; Hamza, Hala S; Kotby, Alyaa; Ganzoury, Mona E L; Soliman, Nanies

    2017-10-01

    To evaluate the left ventricular function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure, and to identify the predictors of myocardial dysfunction post-PDA closure if present. Transcatheter PDA closure; conventional, Doppler, and tissue Doppler imaging; and speckle tracking echocardiography. To determine the feasibility and reliability of tissue Doppler and myocardial deformation imaging for evaluating myocardial function in children undergoing transcatheter PDA closure. Forty-two children diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler, and tissue Doppler imaging, and speckle-derived strain rate echocardiography were performed at preclosure and at 48 hours, 1 month, and 6 months postclosure. Tissue Doppler velocities of the lateral and septal mitral valve annuli were obtained. Global and regional longitudinal peak systolic strain values were determined using two-dimensional speckle tracking echocardiography. The median age of the patients was 2 years and body weight was 15 kg, with the mean PDA diameter of 3.11 ± 0.99 mm. M-mode measurements (left ventricular end diastolic diameter, left atrium diameter to aortic annulus ratio, ejection fraction, and shortening fraction) reduced significantly early after PDA closure ( p  closure causes a significant decrease in left ventricular performance early after PDA closure, which recovers completely within 1 month. Preclosure global longitudinal strain can be a predictor of postclosure myocardial dysfunction.

  19. [Risk factors of rupture of internal carotid artery during surgical resection of carotid body tumor].

    Science.gov (United States)

    Li, Y H; Wang, J S; Yao, C; Chang, G Q; Yin, H H; Li, S Q; Lü, W M; Hu, Z J; Wang, S M

    2017-06-13

    Objective: To investigate risk factors of rupture of internal carotid artery resection during carotid body tumor resection and to summarize our treatment experience. Methods: During the period from 1991 to 2016, rupture of internal carotid artery occurred in 27 patients (28 tumors) during surgical resection of carotid body tumor in the First Affiliated Hospital of Sun Yat-sen University. Their clinical and follow-up data were retrospectively collected and analyzed. For all patients underwent surgical resection during this period, Logistic regression analysis was used to investigate the risk factors of intraoperative rupture of internal carotid artery. Results: Of these 28 tumors, there were 15 (53.6%) tumors with diameter≥5 cm and 20 (71.4%) Shamblin Ⅲ tumors. Intraoperatively, shunt was applied for 8 (28.6%) cases. Thirteen (46.4%) patients underwent ligation of external carotid artery, while 2 (7.1%) patients accepted resection of cranial nerves. Direct closure/patchplasty, autologous vessels or graft reconstruction was used in 16, 10 and 2 cases, respectively. Postoperatively, stroke occurred in 4(14.3%) cases and cranial nerve deficit in 15 (53.6%) cases. During a median length of 36 (14-125) months, cranial nerve deficit persisted in 5 cases. Follow-up radiologic examination indicated 3 (10.7%) cases of targeted vessel occlusion. However, no new-onset stroke was identified. Among all patients underwent surgical resection of carotid body tumor, female ( OR =3.650, P =0.012), age≤25 years old ( OR =3.710, P =0.013) and Shamblin Ⅲ tumor ( OR =4.631, P =0.008) increase the risks of intraoperative carotid artery rupture. Conclusions: Shamblin Ⅲ tumor is the predictor of rupture of internal carotid artery. Intraoperative, properly increased blood pressure, intraoperative heparinization and use of shunt for those cases without well-compensated cranial collateral arteries are likely to decreasing the incidence of stroke.

  20. Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Sena Esteves, Sara; Cardoso, Carla; Silva, Ana; Abrunhosa, José; Almeida E Sousa, Cecília

    Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxiswith the modified Young's procedure. We describe the treatment of 4 patients with severe blood-transfusion-dependent epistaxis who underwent a modified Young's procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. Young's technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  1. Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

    Directory of Open Access Journals (Sweden)

    Tabasi Z.

    2010-01-01

    Full Text Available AbstractBackground and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.Conclusion: The Findings showed that non-closure of peritoneal layers as a shorter and simpler procedure has no influence on increasing post cesarean morbidity. Therefore, due to maternal health promotion and early neonatal breastfeeding, non closure of peritoneal

  2. Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

    Directory of Open Access Journals (Sweden)

    Z Tabasi

    2012-05-01

    Full Text Available

    Background and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.

    Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.

    Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.

    Conclusion: The
  3. Surgical orthodontics.

    Science.gov (United States)

    Strohl, Alexis M; Vitkus, Lauren

    2017-08-01

    The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

  4. Bladder exstrophy: An overview of the surgical management

    Directory of Open Access Journals (Sweden)

    Veereshwar Bhatnagar

    2011-01-01

    Full Text Available Background: The surgical management of urinary bladder exstrophy is challenging. This paper describes the personal experience in a tertiary care hospital over a period exceeding a quarter of a century. Methods: During the period 1984-2010, 248 patients of the epispadias-exstrophy complex have been treated. The cases of classical bladder exstrophy (n = 210 form the basis of this paper. The stages/procedures used in the surgical reconstruction of bladder exstrophy included bladder closure with anterior abdominal wall reconstruction, bladder neck repair, ureteric reimplantation, epispadias repair and augmentation colocystoplasty in various combinations. Some of these patients had their initial operations done prior to 1984 or in other hospitals. Evaluation methods included, amongst others, clinical evaluation and urodynamic assessment. Eight patients opted out of treatment; 15 patients underwent permanent urinary diversion by either ureterosigmoidostomy or colon conduit. The remaining 187 patients were treated with bladder reconstruction, and of these, 132 patients have had at least one attempt at bladder neck reconstruction with 56 of these patients having undergone an augmentation colocystoplasty. Results: A total of 105 patients had socially acceptable continence: 57 from the bladder neck reconstruction group and 48 from the bladder augmentation group. Further attempts at continence surgery have been offered to the inadequately continent patients. Conclusions: Surgical management of bladder exstrophy demands patience and perseverance. It is possible to provide all patients with socially acceptable continence with bladder neck division and catheterizable continent stoma as the last resort. Urodynamic assessment has emerged as an essential tool in the follow-up evaluation of these patients. Anticholinergic medication with imipramine or oxybutinin is a useful adjunct in the overall management.

  5. Estimating anesthesia and surgical procedure times from medicare anesthesia claims.

    Science.gov (United States)

    Silber, Jeffrey H; Rosenbaum, Paul R; Zhang, Xuemei; Even-Shoshan, Orit

    2007-02-01

    Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. In this article, the authors describe how well the anesthesia claim from Medicare can estimate chart times. The authors abstracted information on time of induction and entrance to the recovery room ("anesthesia chart time") from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania. The authors then merged the associated bills from claims data supplied from Medicare (Part B data) that included a variable denoting the time in minutes for the anesthesia service. The authors also investigated the time from incision to closure ("surgical chart time") on a subset of 1,888 patients. Anesthesia claim time from Medicare was highly predictive of anesthesia chart time (Kendall's rank correlation tau = 0.85, P < 0.0001, median absolute error = 5.1 min) but somewhat less predictive of surgical chart time (Kendall's tau = 0.73, P < 0.0001, median absolute error = 13.8 min). When predicting chart time from Medicare bills, variables reflecting procedure type, comorbidities, and hospital type did not significantly improve the prediction, suggesting that errors in predicting the chart time from the anesthesia bill time are not related to these factors; however, the individual hospital did have some influence on these estimates. Anesthesia chart time can be well estimated using Medicare claims, thereby facilitating studies with vastly larger sample sizes and much lower costs of data collection.

  6. Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition

    OpenAIRE

    Adriana Santos, Carla; Fonseca, Jorge; Brito, José; Fernandes, Tânia; Gonçalves, Luísa; Sousa Guerreiro, António

    2014-01-01

    Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedur...

  7. 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

  8. Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics.

    Science.gov (United States)

    Szatmári, Viktor

    2017-08-01

    Intra- and post-procedural prophylactic antibiotics are routinely administered by veterinary cardiologists to dogs that undergo trans-catheter embolization of a patent ductus arteriosus for prevention of implant-related infective endocarditis. The hypothesis of our study was that primary antibiotic prophylaxis is not necessary to prevent bacterial endocarditis. In this retrospective case series 54 client-owned dogs that underwent trans-catheter occlusion of a patent ductus arteriosus in a single tertiary veterinary referral center between 2004 and 2016 were evaluated. Follow-up information was gained by telephone interviews with the owners or the referring veterinarians, or from the digital archives of the authors' clinic. Inclusion criteria were that at least one metal implant (a coil or an Amplatz duct occluder) had to be delivered in the ductal ampulla, no local or systemic antibiotics were given on the day of the intervention or the week thereafter, at least 3 months of postoperative follow-up information was available, and the author was performing the procedure either as the primary or as the supervising cardiology specialist. None of the 54 dogs developed infective endocarditis in the postoperative 3 months. A study describing a similar population reports 2 of the included 47 dogs having developed infective endocarditis in the postoperative period despite the administration of intra- and post-procedural prophylactic antibiotics. We conclude that intra- and post-procedural antibiotic prophylaxis is not justified in dogs that undergo trans-catheter closure of a patent ductus arteriosus. Proper surgical technique and the use of new sterile catheters and implants are sufficient to prevent infective endocarditis in these dogs. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Alireza Ahmadi

    2014-01-01

    Full Text Available BACKGROUND: Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA. Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. METHODS: In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. RESULTS: There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090. The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001. This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031. PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$ or with Nit-Occlud coils (PFM (912.73 ± 565.94 US$, P < 0.001 was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650 had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths

  10. VAC therapy to promote wound healing after surgical revascularisation for critical lower limb ischaemia.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Pipitò, Narayana; Spinelli, Francesco; Grande, Raffaele; Butrico, Lucia; de Franciscis, Stefano; Serra, Raffaele

    2016-06-01

    Vacuum-assisted closure (VAC) therapy is a new emerging non-invasive system in wound care, which speeds up wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates, and facilitating the removal of bacteria from the wound. The application of sub-atmospheric pressure on the lesions seems to alter the cytoskeleton of the cells on the wound bed, triggering a cascade of intracellular signals that increase the rate of cell division and subsequent formation of granulation tissue. The aim of this study is to analyse the results of VAC therapy used as an adjuvant therapy for the treatment of foot wounds in patients affected by critical limb ischaemia (CLI) (Rutherford 6 class) after distal surgical revascularisation, to promote and accelerate the healing of ulcers. Twenty-nine patients (20 males, 9 females; mean age 68·4) affected by CLI of Rutherford 6 class, after surgical revascularisation of the lower limb, underwent VAC therapy in order to speed up wound healing. Complete wound healing was achieved in 19 patients (65·51%), in an average period of 45·4 ± 25·6 days. VAC therapy is a valid aid, after surgical revascularisation, to achieve rapid healing of foot lesions in patients with CLI. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  11. Contemporary Approach to the Diagnosis and Management of Primary Angle-Closure Disease.

    Science.gov (United States)

    Razeghinejad, M Reza; Myers, Jonathan S

    2018-05-16

    Primary angle closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that in many patients the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management. Copyright © 2018. Published by Elsevier Inc.

  12. Fuel channel closure and adapter

    International Nuclear Information System (INIS)

    Cashen, W.S.

    1985-01-01

    This invention provides a mechanical closure/actuating ram combination particularly suited for use in sealing the ends of the pressure tubes when a CANDU-type reactor is refueled. It provides a cluster that may be inserted into a fuel channel end fitting to provide at least partial closing off of a pressure tube while permitting the disengagement of the fueling machine and its withdrawal from the closure for other purposes. The invention also provides a ram/closure combination wherein the application of loading force to a deformable sealing disk is regulated by a massive load bar component forming part of the fueling machine and being therefore accessible for maintenance or replacement

  13. Comparison of conventional gauze therapy with vacuum assisted closure wound therapy in acute traumatic wounds

    International Nuclear Information System (INIS)

    Naqvi, S.H.; Jalil, M.; Butt, Q.; Malik, Z.U

    2013-01-01

    Objective: To compare the Vacuum Assisted Closure (Vac) wound therapy with Conventional Gauze Therapy (CGT) in management of acute traumatic wounds on the basis of time taken to achieve a vital red wound ready for definitive surgical closure. Study Design: Randomized control trial. Place and Duration of Study: Department of Surgery Combined Military Hospital Rawalpindi from Mar 2009 to Sep 2009. Patients and Methods: This study included 82 patients of acute traumatic wounds. Patients were randomly allotted to group A, in which wound was treated with new method of vacuum assisted closure (VAC) wound therapy and to group B, in which wound was managed by conventional gauze therapy (CGT). Outcomes were measured by the presence of vital red wound ready to be closed by surgical intervention. Patients with concomitant systemic pathology were not included in study. Results: Comparison between the two groups revealed mean time for wound healing 13 days in group A and 16.9 days in group B with significant difference (p value =0.029). Conclusion: Vacuum assisted closure wound therapy is an effective method in reducing time of wound healing for definitive surgical closure. (author)

  14. Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS.

    Science.gov (United States)

    Morville, Patrice; Akhavi, Ahmad

    2017-10-01

    The advent of Amplatzer Duct Occluder II additional Size (ADOIIAS) provided the potential to close hemodynamic significant patent ductus arteriosus (HSPDA) and to analyze the feasibility, safety and efficacy of the device. Treatment of a patent ductus arteriosus (PDA) in very premature neonates is still a dilemma for the neonatalogist who has to consider its significance and has to choose among different treatment options. Because surgical ligation and medical therapy both have their drawbacks, interventional catheterization might provide an alternative means of closing HSPDA. Between September 2013 and June 2015, 32 premature infants with complications related to HSPDA defined by ultrasound (US) underwent transcatheter closure. The procedure was performed in the catheterization laboratory by venous cannulation without angiography. The position of the occluder was directed by X-ray and US. In particular we looked at procedural details, device size selection, complications, and short and mid-term outcomes. Thirty two premature infants, all of whom had clinical complications related to HSPDA, born at gestational ages ranging between 23.6 and 36 weeks (mean ± standard deviation 28 ± 3 weeks) underwent attempted transcatheter PDA closure using the ADOIIAS. Their mean age and weight at the time of procedure was 25 days (range 8-70 days) and 1373 g (range 680-2480 g), respectively. Ten infants weighed ≤1,000g. All ducts were tubular. The mean PDA and device waist diameters were 3.2 ± 0.6mm (range 2.2-4) and 4.4 ± 0.6 mm, respectively, and the mean PDA and device lengths 5.2 ± 2.0 mm (range 2-10) and 3.4 ± 1.3 mm. Median fluoroscopy and procedural times were 11 min (range 3-24) and 28 min (range 10-90), respectively. Complete closure was achieved in all but one patient. There was no device migration. A left pulmonary artery (LPA) obstruction developed in one patient. Five infants died. Four deaths were related to complications of

  15. Intraoperative three-dimensional transesophageal echocardiography for assessing the defect geometries of mitral prosthetic paravalvular leak during transcatheter closure.

    Science.gov (United States)

    Wei, Jeng; Yin, Wei-Hsian; Lee, Yung-Tsai; Hsiung, Ming C; Tsai, Shen-Kou; Chuang, Yi Cheng; Ou, Ching-Huei; Chou, Yi-Pen

    2015-03-01

    Paravalvular leaks (PVLs) are a common complication of prosthetic valve replacement. Use of the transcatheter intervention technique is a suitable alternative in high-risk patients who may not tolerate repeat surgery. Common reasons for failure of this demanding intervention include poor imaging quality and unsuitable anatomy. The purpose of this study was to assess the usefulness and the incremental value of real-time three-dimensional (RT 3D) transesophageal echocardiography (TEE) over two-dimensional (2D) TEE findings in the evaluation of the geometry and track of mitral PVLs during transcatheter closure. Five patients with six mitral PVLs at high risk for repeat surgery underwent transcatheter leak closure. Intraoperative RT 3DTEE was used to assess the location, shape, number, and size of the defects. Transapical approaches were used in all cases with fluoroscopic and RT 3D TEE guidance of the wire and catheter, device positioning, and assessment of residual leak after the procedure. In all of the cases, defects with irregular crescent shapes and distorted tracks were clearly delineated by RT 3D TEE. This was compared to those results obtained through 2D TEE, which was unable to characterize the defects. Three cases showed small leaks, which were completely occluded with a patent ductus arteriosus (PDA) device in two cases, and a muscular ventricular septal defect (mVSD) occluder combined with coil devices in one case. One case involved a large leak and early device embolization of the muscular VSD occluder, which was removed surgically, and demonstrated a crescent-shaped defect. One patient had two releaks 2 months subsequent to the procedure due to two new extended leaks at the tails of the crescent-shaped defect. RT 3D TEE can clearly delineate the geometries of defects in their entirety, including shape, size, and location of the defect and track canal. It would also appear that RT 3D TEE is superior to 2D TEE in the process of guiding the wire through the

  16. 40 CFR 265.280 - Closure and post-closure.

    Science.gov (United States)

    2010-07-01

    ... contaminants caused by wind erosion; and (4) Compliance with § 265.276 concerning the growth of food-chain... and post-closure care objectives of paragraph (a) of this section: (1) Type and amount of hazardous..., including amount, frequency, and pH of precipitation; (5) Geological and soil profiles and surface and...

  17. Transcatheter closure of patent ductus arteriosus using the angled duct occluder

    Energy Technology Data Exchange (ETDEWEB)

    Yongwen, Qin; Xianxian, Zhao; Hong, Wu; Xing, Zheng; Jijun, Ding; Jianqiang, Hu [Second Military Medical Univ., Shanghai (China). Changhai Hospital, Dept. of Cardiology

    2004-04-01

    Objective: To assess the immediate efficacy of transcatheter closure of patent ductus arteriosus(PDA) using the angled duct occluder (ADO). Methods: 9 patients (1 male, 8 female) underwent transcatheter closure of PDA using the ADO. The mean PDA diameter at its narrowest segment was (5.8 {+-} 1.9) mm, ranging 3 to 10 mm. A 6 - 9F long sheath was used for the delivery of ADO. Results: The devices were deployed successfully in all patients. Angiographies showed no shunt across the device 15 min after the implantation of ADO. Within 1 week, echocardiography revealed complete closure in all patients. There were no complications. Conclusions: The transcatheter closure of PDA using ADO is an effective and safe procedure. The device matches with the shape of aortic cavity much more precisely than Amplatzer duct occluder. (authors)

  18. Transcatheter closure of patent ductus arteriosus using the angled duct occluder

    International Nuclear Information System (INIS)

    Qin Yongwen; Zhao Xianxian; Wu Hong; Zheng Xing; Ding Jijun; Hu Jianqiang

    2004-01-01

    Objective: To assess the immediate efficacy of transcatheter closure of patent ductus arteriosus(PDA) using the angled duct occluder (ADO). Methods: 9 patients (1 male, 8 female) underwent transcatheter closure of PDA using the ADO. The mean PDA diameter at its narrowest segment was (5.8 ± 1.9) mm, ranging 3 to 10 mm. A 6 - 9F long sheath was used for the delivery of ADO. Results: The devices were deployed successfully in all patients. Angiographies showed no shunt across the device 15 min after the implantation of ADO. Within 1 week, echocardiography revealed complete closure in all patients. There were no complications. Conclusions: The transcatheter closure of PDA using ADO is an effective and safe procedure. The device matches with the shape of aortic cavity much more precisely than Amplatzer duct occluder. (authors)

  19. The Effect on Somatic Growth of Surgical and Catheter Treatment of Secundum Atrial Septal Defects.

    Science.gov (United States)

    Chlebowski, Meghan M; Dai, Hongying; Kaine, Stephen F

    2017-10-01

    Historical studies suggest an association between atrial septal defect (ASD) and impaired growth with inconsistent improvement following closure. Limited data exist regarding the impact on growth in the era of transcatheter therapy. To evaluate the effect of closure on growth, we conducted a retrospective review of patients undergoing surgical or transcatheter closure during two time periods. Four hundred patients with isolated secundum ASD were divided into three cohorts: early surgical, contemporary surgical, and transcatheter. Data collected included demographics; height, weight, and body mass index (BMI) percentiles; catheterization hemodynamics; and co-morbidities. For all cohorts, there was no significant change in height or weight percentiles during two years after ASD closure. Age at repair was later for contemporary surgical and transcatheter cohorts (p indication for early ASD repair. However, early repair may be indicated in children with existing significant growth failure.

  20. First clinical experience with Celt ACD(®) : a femoral arterial puncture closure device.

    LENUS (Irish Health Repository)

    Jan, Aftab

    2013-08-01

    This prospective nonrandomized study compared the safety and efficacy of a novel arterial closure device (ACD) in common femoral artery procedures to that of the FDA submitted historical manual pressure control group, who underwent either a diagnostic angiogram (DA) or a percutaneous coronary intervention (PCI) procedure.

  1. Comparative Study Between Coaptive Film Versus Suture For Wound Closure After Long Bone Fracture Fixation

    Directory of Open Access Journals (Sweden)

    IM Anuar Ramdhan

    2013-03-01

    Full Text Available INTRODUCTION: Coaptive film (i.e., Steri-StripsTM is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. METHODS: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film. RESULTS: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. CONCLUSION: Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.

  2. The clinical effects of closure of the hernia gap after laparoscopic ventral hernia repair:

    DEFF Research Database (Denmark)

    Christoffersen, Mette W; Westen, Mikkel; Assadzadeh, Sami

    2014-01-01

    randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary...... outcomes are patient-rated cosmesis and hernia-specific quality of life. METHODS: A randomised, controlled, double-blinded study is planned. Based on power calculation, we will include 40 patients in each arm. Patients undergoing elective laparoscopic umbilical, epigastric or umbilical trocar-site hernia...... repair at Hvidovre Hospital and Herlev Hospital, Denmark, are invited to participate. CONCLUSION: The gap closure technique may induce more post-operative pain than the non-closure repair, but it may also be superior with regard to other important surgical outcomes. No studies have previously...

  3. Double-lock technique: a simple method to secure abdominal wall closure

    International Nuclear Information System (INIS)

    Jategaonkar, P.A.; Yadav, S.P.

    2013-01-01

    Secure closure of a laparotomy incision remains an important aspect of any abdominal operation with the aim to avoid the postoperative morbidity and hasten the patient's recovery. Depending on the operator's preference and experience, it may be done by the continuous or the interrupted methods either using a non-absorbable or delayed-absorbable suture. We describe a simple, secure and quick technique of abdominal wall closure which involves continuous suture inter-locked doubly after every third bite. This simple and easy to use mass closure technique can be easily mastered by any member of the surgical team and does not need any assistant. It amalgamates the advantages of both, the continuous and the interrupted methods of closures. To our knowledge, such a technique has not been reported in the literature. (author)

  4. Study of relationship between clinical factors and velopharyngeal closure in cleft palate patients

    Science.gov (United States)

    Chen, Qi; Zheng, Qian; Shi, Bing; Yin, Heng; Meng, Tian; Zheng, Guang-ning

    2011-01-01

    BACKGROUND: This study was carried out to analyze the relationship between clinical factors and velopharyngeal closure (VPC) in cleft palate patients. METHODS: Chi-square test was used to compare the postoperative velopharyngeal closure rate. Logistic regression model was used to analyze independent variables associated with velopharyngeal closure. RESULTS: Difference of postoperative VPC rate in different cleft types, operative ages and surgical techniques was significant (P=0.000). Results of logistic regression analysis suggested that when operative age was beyond deciduous dentition stage, or cleft palate type was complete, or just had undergone a simple palatoplasty without levator veli palatini retropositioning, patients would suffer a higher velopharyngeal insufficiency rate after primary palatal repair. CONCLUSIONS: Cleft type, operative age and surgical technique were the contributing factors influencing VPC rate after primary palatal repair of cleft palate patients. PMID:22279464

  5. 50 CFR 648.161 - Closures.

    Science.gov (United States)

    2010-10-01

    ... Bluefish Fishery § 648.161 Closures. (a) EEZ closure. NMFS shall close the EEZ to fishing for bluefish by... dealer permit holders that no commercial quota is available for landing bluefish in that state. ...

  6. Moment Closure for the Stochastic Logistic Model

    National Research Council Canada - National Science Library

    Singh, Abhyudai; Hespanha, Joao P

    2006-01-01

    ..., which we refer to as the moment closure function. In this paper, a systematic procedure for constructing moment closure functions of arbitrary order is presented for the stochastic logistic model...

  7. Anomalous muscle bundle in the right atrium; Implication to trans atrial device closure

    Directory of Open Access Journals (Sweden)

    Saji Philip

    2017-09-01

    Full Text Available Intracavitary muscle bands or aberrant bands have been well described in all four chambers of the heart but rarely seen thick muscular band crossing right atrium. We report a case of devisable secundum atrial septal defect with an intra-atrial anomalous muscular band, crossing right atrial wall to the rim of the secundum atrial septal defect warranting surgical closure.

  8. The relation between viscero-abdominal disproportion and type of omphalocele closure

    NARCIS (Netherlands)

    Peters, N.C.; Hooft, M.E.; Ursem, N.T.; Eggink, A.J.; Wijnen, R.M.H.; Tibboel, D.; Bonsel, G.J.; Cohen-Overbeek, T.E.

    2014-01-01

    OBJECTIVE: To investigate the relation between prenatal ultrasound measurements of viscero-abdominal disproportion and the expected type of postnatal surgical closure of an omphalocele. STUDY DESIGN: Retrospectively, 24 fetuses diagnosed with an isolated omphalocele in the 2nd trimester of pregnancy

  9. Factors affecting timing of closure and non-reversal of temporary ileostomies

    NARCIS (Netherlands)

    Sier, M. F.; van Gelder, L.; Ubbink, D. T.; Bemelman, W. A.; Oostenbroek, R. J.

    2015-01-01

    Although stoma closure is considered a simple surgical intervention, the interval between construction and reversal is often prolonged, and some ileostomies may never be reversed. We evaluated possible predictors for non-reversal and prolonged interval between construction and reversal. In a cohort

  10. Speech characteristics after palatal closure in subjects with isolated clefts: an exploration in Uganda

    NARCIS (Netherlands)

    Anke Luyten

    2014-01-01

    Cleft lip and/or palate (CL/P) is a congenital craniofacial defect that arises on average in 1.7 per 1000 live births. This anomaly causes atypical facial appearance, hearing problems, malocclusions and speech disorders. Outcomes in terms of speech are influenced by timing of surgical cleft closure.

  11. CIRSE Vascular Closure Device Registry

    International Nuclear Information System (INIS)

    Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2011-01-01

    Purpose: Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods: The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results: Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion: The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.

  12. 304 Concretion facility closure plan

    International Nuclear Information System (INIS)

    1990-04-01

    The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium Zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets in the 304 Concretion Facility, located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Concretion Facility (304 Facility). Clean closure of the 304 Facility is the proposed method for closure of the facility. Justification for this proposal is presented. 15 refs., 22 figs., 4 tabs

  13. Telephone switchboard closure | 19 December

    CERN Multimedia

    2014-01-01

    Exceptionally, the telephone switchboard will close at 4 p.m. on Friday, 19 December, instead of the usual time of 6 p.m., to allow time for closing all systems properly before the annual closure. Therefore, switchboard operator assistance to transfer calls from/to external lines will stop. All other phone services will run as usual.

  14. CIRSE Vascular Closure Device Registry

    Science.gov (United States)

    Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2010-01-01

    Purpose Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters. PMID:20981425

  15. Surgical competence.

    Science.gov (United States)

    Patil, Nivritti G; Cheng, Stephen W K; Wong, John

    2003-08-01

    Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

  16. Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy.

    Science.gov (United States)

    Kaafarani, Haytham M A; Kaufman, Derrick; Reda, Domenic; Itani, Kamal M F

    2010-10-01

    Surgical site infection (SSI) after ventral incisional hernia repair (VIH) can result in serious consequences. We sought to identify patient, procedure, and/or hernia characteristics that are associated with SSI in VIH. Between 2004 and 2006, patients were randomized in four Veteran Affairs (VA) hospitals to undergo laparoscopic or open VIH. Patients who developed SSI within eight weeks postoperatively were compared to those who did not. A bivariate analysis for each factor and a multiple logistic regression analysis were performed to determine factors associated with SSI. The variables studied included patient characteristics and co-morbidities (e.g., age, gender, race, ethnicity, body mass index, ASA classification, diabetes, steroid use), hernia characteristics (e.g., size, duration, number of previous incisions), procedure characteristics (e.g., open versus laparoscopic, blood loss, use of postoperative drains, operating room temperature) and surgeons' experience (resident training level, number of open VIH previously performed by the attending surgeon). Antibiotic prophylaxis, anticoagulation protocols, preparation of the skin, draping of the wound, body temperature control, and closure of the surgical site were all standardized and monitored throughout the study period. Out of 145 patients who underwent VIH, 21 developed a SSI (14.5%). Patients who underwent open VIH had significantly more SSIs than those who underwent laparoscopic VIH (22.1% versus 3.4%; P = 0.002). Among patients who underwent open VIH, those who developed SSI had a recorded intraoperative blood loss greater than 25 mL (68.4% versus 40.3%; P = 0.030), were more likely to have a drain placed (79.0% versus 49.3%; P = 0.021) and were more likey to be operated on by surgeons with less than 75 open VIH case experience (52.6% versus 28.4%; P = 0.048). Patient and hernia characteristics were similar between the two groups. In a multiple logistic regression analysis, the open surgical technique was

  17. Fechamento de canal arterial por minitoracotomia: técnica e resultados Patent ductus arteriosus (PDA closure with minithoracotomy: technique and results

    Directory of Open Access Journals (Sweden)

    Pedro R. SALERNO

    2000-09-01

    Full Text Available CASUÍSTICA E MÉTODOS: No período de novembro de 1996 a dezembro de 1997, 15 crianças portadoras de canal arterial (CA, sendo 12 do sexo feminino, com idade média de 2,7 anos, peso médio de 13,9 kg foram submetidas a fechamento do CA por minitoracotomia. O ecodopplercardiograma confirmou o diagnóstico em todos o casos e mostrou o diâmetro do CA entre 2 mm e 10 mm, com média de 4,06 mm. A indicação cirúrgica foi eletiva em todos os casos. A operação consistiu de minitoracotomia esquerda no 4º espaço intercostal de 2,5 cm a 3,0 cm, seguida de dissecção do CA e clipagem do mesmo com 2 clips metálicos. Não foi utilizada drenagem pleural em nenhum dos casos. RESULTADOS: Todos os pacientes receberam alta em média no 4º dia de pós-operatório, sem nenhum escape pelo CA ao ecodopplercardiograma. CONCLUSÃO: O fechamento de CA por minitoracotomia é uma alternativa de tratamento que reduz o período de internação, bom efeito cosmético e baixo índice de complicações.OBJECTIVE:The purpose of this study was to describe a new technique for closure of patent ductus arteriosus (PDA by minithoracotomy (2.5 a 3.0 cm and clipping the PDA with titanium clips. MATERIAL AND METHODS: From November 1996 to December 1997, 15 children with PDA underwent surgical closure. The mean age at the time of operation was 2.7 years, mean weight was 13.9 kg. The procedure was through a left minithoracotomy at the 4º intercostal space. The ductus was identified, dissected and isolated. Interruption of ductal flow was performed by direct clipping with two clips. The chest was closed without a chest drain. Unless the patient was ventilator dependent before the closure, the child usually was extubated in the operating room. RESULTS: Color doppler echocardiography demonstrated total occlusion of the ductus in all patients. All 15 patients were discharged from the hospital on the 4º postoperative day (mean. CONCLUSION: We conclude that surgical closure of

  18. 75 FR 29322 - Base Closure and Realignment

    Science.gov (United States)

    2010-05-25

    ... DEPARTMENT OF DEFENSE Office of the Secretary Base Closure and Realignment AGENCY: Office of...)(ii) of the Defense Base Closure and Realignment Act of 1990. It provides a partial list of military installations closing or realigning pursuant to the 2005 Base Closure and Realignment (BRAC) Report. It also...

  19. Surgical management of hyperthyroidism.

    Science.gov (United States)

    Quérat, C; Germain, N; Dumollard, J-M; Estour, B; Peoc'h, M; Prades, J-M

    2015-04-01

    Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05). Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications

  20. Non-vascular surgical mediastinum

    International Nuclear Information System (INIS)

    Schiavon, S.; Trenaghi, P.; Nardini, S.; Pagan, V.

    1989-01-01

    A review was made of the chest X-ray features of 120 patients who underwent surgical treatment for mediastinal non-vascular pathologies over the past 12 years in the Mestre Hospital. A method of analysis is proposed which takes into account not only the differences between the immediate post-operative period and the follow-up, but also the anatomotopographic partition and the surgical practice. Normal and pathological patterns for both of the above periods are described. The ''dimness'' of the arial tracheogram is emphasized as a usefull and early sign of mediastinal recurrence

  1. Surgical management of perforated peptic ulcer disease.

    Science.gov (United States)

    Sweeney, K J; Faolain, M O; Gannon, D; Gorey, T F; Kerin, M J

    2006-01-01

    Surgery for perforated peptic ulcer disease is one of the most common emergency procedures carried out in the western world. The role of postoperative empiric Helicobacter Pylori eradication therapy is controversial. The clinical, operative and postoperative surveillance details of 84 consecutive patients who underwent surgery for perforated peptic ulcer were reviewed. All patients underwent omentopexy +/- simple closure followed by proton pump therapy. Patients were followed-up for an average of 44 +/- 19 months. Females were older than male patients (59 +/- 20 vs. 46 + 17 years; pperforated peptic ulcer is associated with a significant perioperative mortality rate. Elderly female patients are particularly at risk.

  2. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indicatio...

  3. Surgical Instrument

    NARCIS (Netherlands)

    Dankelman, J.; Horeman, T.

    2009-01-01

    The present invention relates to a surgical instrument for minimall-invasive surgery, comprising a handle, a shaft and an actuating part, characterised by a gastight cover surrounding the shaft, wherein the cover is provided with a coupler that has a feed- through opening with a loskable seal,

  4. Advantages of CO2 laser use in surgical management of otosclerosis

    Directory of Open Access Journals (Sweden)

    Matković Svjetlana

    2003-01-01

    Full Text Available Background. Otosclerosis is a progressive osteo-destructive disorder of the bony labyrinth in which the fixation of the stapes causes the hearing loss. The aim of this study was the postoperative determination of parameters of the effect of surgical intervention on hearing and the incidence of complications and, on the basis of the differences in the examined parameters of the study, the estimation of the eficacy of the two mentioned surgical thechniques in the treatment of otosclerosis. Methods. In our research 40 patients with conductive hearing loss caused by otosclerosis underwent surgery with CO2 laser. Functional results were compared postoperatively with the results of 40 patients operated by the classical technique without the use of CO2 laser. The research was accomplished as a prospective comparative study. Results. The air-bone interval (gap as the difference between the rim of air and bone conductivity for separate frequencies did not significantly differ between the control and the experimental group. Both methods were effective in closing the air-bone gap with the rates of closure to within 10 dB in 82.6% and 75.3% for the laser and drill, respectively. The incidence of tinnitus was significantly lower in patients who underwent surgery with CO2 laser. The frequency of intraoperative and postoperative complications was significantly lower in the laser group. Differences were statistically significant for all parameters (p<0.05. Conclusion. On the basis of the degree of postoperative hearing improvement, tinnitus and the incidence of complications it can be concluded that the use of CO2 laser during inverse stapedoplasty represents an effective and safe method, justifying the promotion of its use in the surgical management of otosclerosis.

  5. Wound infection following stoma takedown: primary skin closure versus subcuticular purse-string suture.

    Science.gov (United States)

    Marquez, Thao T; Christoforidis, Dimitrios; Abraham, Anasooya; Madoff, Robert D; Rothenberger, David A

    2010-12-01

    Stoma closure has been associated with a high rate of surgical site infection (SSI) and the ideal stoma-site skin closure technique is still debated. The aim of this study was to compare the rate of SSI following primary skin closure (PC) versus a skin-approximating, subcuticular purse-string closure (APS). All consecutive patients undergoing stoma closure between 2002 and 2007 by two surgeons at a single tertiary-care institution were retrospectively assessed. Patients who had a new stoma created at the same site or those without wound closure were excluded. The end point was SSI, determined according to current CDC guidelines, at the stoma closure site and/or the midline laparotomy incision. There were 61 patients in the PC group (surgeon A: 58 of 61) and 17 in the APS group (surgeon B: 16 of 17). The two groups were similar in baseline and intraoperative characteristics, except that patients in the PC group were more often diagnosed with benign disease (p = 0.0156) and more often had a stapled anastomosis (p = 0.002). The overall SSI rate was 14 of 78 (18%). All SSIs occurred in the PC group (14 of 61 vs. 0 of 17, p = 0.03). Our study suggests that a skin-approximating closure with a subcuticular purse-string of the stoma site leads to less SSI than a primary closure. Randomized studies are needed to confirm our findings and assess additional end points such as healing time, cost, and patient satisfaction.

  6. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure.

    Science.gov (United States)

    Ates, Ufuk; Ergun, Ergun; Gollu, Gulnur; Sozduyar, Sumeyye; Kologlu, Meltem; Cakmak, Murat; Dindar, Huseyin; Yagmurlu, Aydin

    2018-03-01

    Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12-20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days. Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group. Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Transthoracic device closure of ventricular septal defects without cardiopulmonary bypass: experience in infants weighting less than 8 kg.

    Science.gov (United States)

    Xing, Quansheng; Wu, Qin; Pan, Silin; Ren, Yueyi; Wan, Hao

    2011-09-01

    Both surgical and percutaneous device closure of ventricular septal defect (VSD) have drawbacks and limitations in infants. We report our experiences and midterm results of transthoracic device closure of VSDs (TDCVs) without cardiopulmonary bypass (CPB) in infants. Between September 2007 and September 2009, 32 patients, with a mean age of 7.2 ± 4.7 months, body weight of 6.8 ± 2.8 kg, underwent this procedure. The procedure was performed in the operating room. A small subxiphoid incision was made. A purse-string suture was placed on the right ventricular free wall. The free wall was punctured using a trocar, then a guide wire was inserted and advanced to cross the VSD into the left ventricle under transesophageal echocardiographic guidance. A modified delivery sheath was then introduced over the guide wire. The device was delivered and deployed in position along the sheath to close the defect. A total of 30 cases (94%) were successfully closed, and the remaining two cases (6%) were converted to open heart repair. No patients received transfusion. There was no perioperative mortality, or any major complication. The mean size of the devices was 7.6 ± 3.4mm. The total operative time was less than 60 min, and the mean time for device implantation was 18.3 ± 9.4 min. All patients were extubated within 2h, and were discharged within 5 days after operation. The follow-up period ranged from 6 to 31 months (18.3 ± 9.6 months). There was no late major complication detected. Minimally invasive TDCV without CPB is a safe and effective alternative to the conventional operation in low-body-weight infants. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  8. Prevalence of patent foramen ovale and usefulness of percutaneous closure device in carcinoid heart disease.

    Science.gov (United States)

    Mansencal, Nicolas; Mitry, Emmanuel; Pillière, Rémy; Lepère, Céline; Gérardin, Benoît; Petit, Jérôme; Gandjbakhch, Iradj; Rougier, Philippe; Dubourg, Olivier

    2008-04-01

    The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. All patients underwent conventional and contrast echocardiography. Patients with clinical signs of dyspnea (New York Heart Association class > or =III), cyanosis, carcinoid heart disease (CHD), and severe PFO were referred for the percutaneous closure of PFO. The prevalence of PFO was 41% in patients with CS and 22% in the control group (p = 0.03) and was significantly higher in patients with CHD (59%, p = 0.009). Four patients (14% of those with CHD) were referred for the percutaneous closure of PFO, and 3 patients ultimately underwent PFO closure (using Amplatzer septal occluders). At 6-month follow-up, New York Heart Association class was improved in all patients, as well as arterial blood gas results (p = 0.04) and 6-minute walking distance (p = 0.03), but all patients presented residual right-to-left shunts. In conclusion, this prospective study demonstrates that in patients with CHD, the prevalence of PFO is high and that percutaneous closure of PFO is feasible, with a reduction in symptoms but with residual shunting.

  9. Revisiting the Landau fluid closure.

    Science.gov (United States)

    Hunana, P.; Zank, G. P.; Webb, G. M.; Adhikari, L.

    2017-12-01

    Advanced fluid models that are much closer to the full kinetic description than the usual magnetohydrodynamic description are a very useful tool for studying astrophysical plasmas and for interpreting solar wind observational data. The development of advanced fluid models that contain certain kinetic effects is complicated and has attracted much attention over the past years. Here we focus on fluid models that incorporate the simplest possible forms of Landau damping, derived from linear kinetic theory expanded about a leading-order (gyrotropic) bi-Maxwellian distribution function f_0, under the approximation that the perturbed distribution function f_1 is gyrotropic as well. Specifically, we focus on various Pade approximants to the usual plasma response function (and to the plasma dispersion function) and examine possibilities that lead to a closure of the linear kinetic hierarchy of fluid moments. We present re-examination of the simplest Landau fluid closures.

  10. Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus.

    Science.gov (United States)

    Ahmadi, Alireza; Sabri, Mohammadreza; Bigdelian, Hamid; Dehghan, Bahar; Gharipour, Mojgan

    2014-01-01

    Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including

  11. Analysis of the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair.

    Science.gov (United States)

    Chen, Qi; Li, Yang; Shi, Bing; Yin, Heng; Zheng, Guang-Ning; Zheng, Qian

    2013-12-01

    The objective of this study was to analyze the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair. Ninety-five nonsyndromic patients with cleft palate were enrolled. Two surgical techniques were applied in the patients: simple palatoplasty and combined palatoplasty with pharyngoplasty. All patients were assessed 6 months after the operation. The postoperative velopharyngeal closure (VPC) rate was compared by χ(2) test and the correlative factors were analyzed with logistic regression model. The postoperative VPC rate of young patients was higher than that of old patients, the group with incomplete cleft palate was higher than the group with complete cleft palate, and combined palatoplasty with pharyngoplasty was higher than simple palatoplasty. Operative age, cleft type, and surgical technique were the contributing factors for postoperative VPC rate. Operative age, cleft type, and surgical technique were significant factors influencing postoperative VPC rate of patients with cleft palate. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Limited resection for duodenal gastrointestinal stromal tumors: Surgical management and clinical outcome

    Science.gov (United States)

    Hoeppner, Jens; Kulemann, Birte; Marjanovic, Goran; Bronsert, Peter; Hopt, Ulrich Theodor

    2013-01-01

    AIM: To analyze our experience in patients with duodenal gastrointestinal stromal tumors (GIST) and review the appropriate surgical approach. METHODS: We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and 2011. Patient files, operative reports, radiological charts and pathology were analyzed. For surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection (LR). For extended resection pancreatoduodenectomy was performed. Age, gender, clinical symptoms of the tumor, anatomical localization, tumor size, mitotic count, type of resection resectional status, neoadjuvant therapy, adjuvant therapy, risk classification and follow-up details were investigated in this retrospective study. RESULTS: Nine patients (5 males/4 females) with a median age of 58 years were surgically treated. The median follow-up period was 45 mo (range 6-111 mo). The initial symptom in 6 of 9 patients was gastrointestinal bleeding (67%). Tumors were found in all four parts of the duodenum, but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients (33%). Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before resection. In one patient, the GIST resection was done by pancreatoduodenectomy. The 8 LRs included a segmental resection of pars 4 of the duodenum, 5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y duodeno-jejunostomy. One of these LRs was done minimally invasive; seven were done in open fashion. The median diameter of the tumors was 54 mm (14-110 mm). Using the Fletcher classification scheme, 3/9 (33%) tumors had high risk, 1/9 (11%) had intermediate risk, 4/9 (44%) had low risk, and 1/9 (11%) had very low risk for aggressive behaviour. Seven resections showed microscopically negative transsection margins (R0), two

  13. Early closure of postinfarction ventricular septal defects.

    Science.gov (United States)

    Martinelli, Luigi; Dottori, Vincenzo; Caputo, Enrico; Graffigna, Angelo; Pederzolli, Carlo

    2003-05-01

    According to the guidelines of the American College of Cardiology/American Heart Association early closure of postinfarction septal defects is now a class I indication although it still carries a relevant morbidity and mortality. The operative risk is related both to the critical hemodynamic conditions of the patient and to the technical difficulties posed by the friable tissue of the infarcted area. The most recent techniques involving the use of pericardial patches reinforced by acrylic glue have significantly reduced the hospital mortality. The aim of this study was to discuss the reliability of an aggressive, tissue-sparing surgical approach to this complication. We present a consecutive series of 12 patients operated upon between January 1998 and October 2001 within 12 hours of the onset of clinical evidence of postinfarction septal rupture. Repair was achieved with minimal septal debridement and the use of a large pericardial patch reinforced by a biological glue. Three cases of dehiscence required early reoperation with no hospital mortality. This procedure is technically feasible and allows early aggressive treatment of postinfarction septal rupture with satisfactory results.

  14. Observations on early and delayed colostomy closure.

    Science.gov (United States)

    Tade, A O; Salami, B A; Ayoade, B A

    2011-06-01

    Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

  15. 304 Concretion Facility Closure Plan

    International Nuclear Information System (INIS)

    1991-10-01

    The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with Zircaloy-2 and copper silicon allo , uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets (7.5-gal containers) in the 304 Concretion Facility (304 Facility), located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA) and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040 (Ecology 1991). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Facility. The strategy for closure of the 304 Facility is presented in Section 6.0

  16. Repository Closure and Sealing Approach

    International Nuclear Information System (INIS)

    A.T. Watkins

    2000-01-01

    The scope of this analysis will be to develop the conceptual design of the closure seals and their locations in the Subsurface Facilities. The design will be based on the recently established program requirements for transitioning to the Site Recommendation (SR) design as outlined by ''Approach to Implementing the Site Recommendation Baseline'' (Stroupe 2000) and the ''Monitored Geologic Repository Project Description Document'' (CRWMS M andO 1999b). The objective of this analysis will be to assist in providing a description for the Subsurface Facilities System Description Document, Section 2 and finally to document any conclusions reached in order to contribute and provide support to the SR. This analysis is at a conceptual level and is considered adequate to support the SR design. The final closure barriers and seals for the ventilation shafts, and the north and south ramps will require these openings to be permanently sealed to limit excessive air and water inflows and prevent human intrusion. The major tasks identified with closure in this analysis are: (1) Developing the overall subsurface seal layout and identifying design and operational interfaces for the Subsurface Facilities. (2) Summarizing the general site conditions and general rock characteristic with respect to seal location and describing the seal selected. (3) Identify seal construction materials, methodology of construction and strategic locations including design of the seal and plugs. (4) Discussing methods to prevent human intrusion

  17. Sternocleidomastoid flap augmentation of the pharyngeal closure after total laryngectomy.

    Science.gov (United States)

    Ibrahim, Sherif Gabr; Wahba, Basim Metwally; Elbatawi, Ahmed Mahmoud; Eltelety, Ahmad Mohamed

    2017-08-01

    The objective of the study was to evaluate the effect of sternocleidomastoid (SCM) flap augmentation of the pharyngeal closure after total laryngectomy on the incidence of pharyngocutaneous fistula (PCF). Thirty patients with T4a laryngeal carcinoma and none of them receiving primary radiotherapy previously were divided into two equal groups. Group A patients had SCM flap augmentation of the pharyngeal closure after total laryngectomy. Group B patients had the standard pharyngeal closure without augmentation. Both groups were followed up for 30 days postoperatively for the development of PCF. The use of the SCM added about extra 15 min to the surgical procedure in all patients (p laryngectomy. Three patients in each group developed PCF either early (10 days or less postoperatively) or late (more than 10 days but less than 30 days postoperatively). There was no statistically significant difference in the length of hospital stay between the two groups. The use of SCM flap did not reduce the incidence of PCF after total laryngectomy.

  18. Prognostic significance of pleural lavage cytology after thoracotomy and before closure of the chest in lung cancer.

    Science.gov (United States)

    Taniguchi, Yuji; Nakamura, Hiroshige; Miwa, Ken; Adachi, Yoshin; Fujioka, Shinji; Haruki, Tomohiro; Horie, Yasushi

    2009-07-01

    Some reports have described pleural lavage cytology (PLC) to be a prognostic factor for non-small cell lung cancer (NSCLC) patients. However, there have only been a few reports describing the findings both immediately after thoracotomy (PLC after thoracotomy) and before the closure of the chest (PLC before closure). From April 2002 to April 2008, both PLC after thoracotomy and PLC before closure were performed in 296 consecutive patients who underwent resections for NSCLC. PLC after thoracotomy was positive in 14 patients. The survival rate in the PLC after thoracotomy positive cases was significantly poorer than in PLC after thoracotomy negative cases (P=0.047). In contrast, there were 26 PLC before closure positive cases. The survival rate in the PLC before closure positive cases was significantly poorer than in the PLC before closure negative cases (PPLC after thoracotomy is not an independent prognostic factor in our study. However, PLC before closure was an independent prognostic factor based on multivariate analyses. We conclude that PLC before closure was found to be a better prognostic factor than PLC after thoracotomy for NSCLC patients.

  19. Surgical approach to pineal tumours.

    Science.gov (United States)

    Pluchino, F; Broggi, G; Fornari, M; Franzini, A; Solero, C L; Allegranza, A

    1989-01-01

    During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.

  20. Adequacy of velopharyngeal closure and speech competency following prosthetic management of soft palate resection

    International Nuclear Information System (INIS)

    ElDakkak, M

    1999-01-01

    Ten patients who had undergone soft palate resection for the removal of palatal tumors were studied. In each patient, the surgical defect involved the posterior margin of the soft palate and lead to velopharyngeal insufficiency. None of the patients suffered any speech, hearing or nasal problems before surgery. For each patient, a speech aid obturator was constructed and was used at least one month before the evaluation. Prosthetic management of each subject was evaluated as reflected in adequacy of velopharyngeal closure and speech competency. Various aspects of speech including intelligibility, articulation, nasality, hoarseness and overall speech were correlated with the adequacy of velopharyngeal closure. (author)

  1. Intraoperative closure of infant multiple muscular ventricular septal defects with Amplatzer occluder

    International Nuclear Information System (INIS)

    Liu Jinfen; Gao Wei; Zhu Zhongqun; Chen Huiwen; Zhang Yuqi

    2005-01-01

    Objective: To report the preliminary experience of intraoperative hybrid therapy for closure of multiple muscular ventricular septal defects (VSD) in a small infant. Methods: After median sternotomy, a AGA Amplatzer occluder was introduced through right ventricular surface to close 2 muscular ventricular septal defects under transesophageal echocardiographic guidance. Results: The infant survived after the treatment without residual shunting, and rehabilitated rapidly. Conclusions: Intraoperative hybrid therapy with combined surgical technique and interventional procedure for closure of multiple muscular VSD in small infant is a safe and effective method. (authors)

  2. Fontan fenestration closure and event-free survival.

    Science.gov (United States)

    Imielski, Bartlomiej R; Woods, Ronald K; Mussatto, Kathleen A; Cao, Yumei; Simpson, Pippa M; Tweddell, James S

    2013-01-01

    The purpose of the present study was to evaluate the association of open and closed Fontan fenestration status with event-free survival. All patients who underwent a fenestrated Fontan procedure at our institution from January 1994 through June 2007 were reviewed. Patient information was obtained from the medical records. The patients were assigned to 1 of 2 study groups, open or closed, according to their most recent fenestration status. Clinically relevant morbid events were tabulated, and Kaplan-Meier event analysis was used to create event-free probability curves with log-rank comparisons. A total of 161 patients were classified as open and 51 as closed. The median interval to an event was 1.1 years (interquartile range, 0.1-3.3 years) after the Fontan procedure. The median interval to closure was 1.2 years (interquartile range, 0.7-3.3 years). The median interval to an event was 1.5 years (interquartile range, 0.1-4.6 years) in the closed group and 1.1 years (interquartile range, 0.1-3.3 years) in the open group. Event-free probability analysis revealed no significant difference between the 2 groups (P = .15). The median follow-up arterial oxygen saturation was greater in the closed group (96.0%; interquartile range, 94.0%-97.0%) than in the open group (91.0%; interquartile range, 86.0%-95.0%; P < .0001). Fenestration closure was associated with greater arterial oxygen saturation but not greater event-free survival. The interval to an event was slightly less than the interval to fenestration closure, suggesting potential merit in the evaluation of earlier fenestration closure. Adoption of specific fenestration management guidelines might help improve the overall outcomes and enhance the quality of future studies. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  3. Early results of transcatheter closure of patent ductus arteriosus: retrospective study of 61 patients

    International Nuclear Information System (INIS)

    Beg, A.M.; Younas, M.; Chaudary, A.T.

    2013-01-01

    Patent ductus arteriosus (PDA) accounts for 6 - 11% of all congenital heart defects. Complications of PDA include congestive heart failure, repeated chest infections, pulmonary hypertension, and an increased risk of infective endocarditis. Transcatheter closure of PDA has largely replaced surgical ligation in different age groups. Currently, surgical intervention is restricted to premature babies or small infants with large symptomatic PDA, cases with unfavorable duct anatomy, and whenever the cost of the closure devices is unaffordable. PDA was the first example of congenital heart dis-ease to be treated by transcatheter closure, which becomes an established form of treatment for the majority of patients with PDA and as a safe alternative to surgery. The per-cutaneous technique was first described by Porstmanur et al., since then various devices such as Rashkind PDA umbrella, button device, PDA coils and most recently the Amplatzer duct occluder (ADO) have been introduced. The ADO device was designed to provide the most desirable characteristics for a percutaneous closure device that can be used in most if not all patients with PDA. These include user - friendly delivery system, high complete closure rate, small delivery system (allowing its use in small infants), trans-venous delivery route, ability to adapt to various PDA sizes and types, and the ability to retrieve or reposition the device prior to release from a secure delivery system. Common complications of trans-catheter closure of PDA include residual shunt, left pulmonary artery (LPA) obstruction, protrusion of the device into the aorta, and embolization of the device. Incidence of complications increases with certain types and large size ducts, and with the use of multiple coils for occlusion. There are only a few reports correlating out-come and complications with the learning curve and experience. In this study, we are reporting our initial experience with PDA closure using Amplatzer duct occluder (ADO

  4. Comparison of two spectral domain optical coherence tomography devices for angle-closure assessment.

    Science.gov (United States)

    Quek, Desmond T; Narayanaswamy, Arun K; Tun, Tin A; Htoon, Hla M; Baskaran, Mani; Perera, Shamira A; Aung, Tin

    2012-08-03

    To compare two spectral domain optical coherence tomography (SD-OCT) devices for the identification of angle structures and the presence of angle closure. This was a prospective comparative study. Consecutive patients underwent gonioscopy and anterior segment imaging using two SD-OCT devices (iVue and Cirrus). Images were evaluated for the ability to detect angle structures such as Schwalbe's line (SL), trabecular meshwork (TM), Schlemm's canal (SC), and scleral spur (SS), and the presence of angle closure. Angle closure was defined as iris contact with the angle wall anterior to the SS on SD-OCT, and nonvisibility of the posterior TM on gonioscopy. Angle closure in an eye was defined as ≥two quadrants of closed angles. AC1 statistic was used to assess the agreement between devices. Of the 69 subjects studied (46.4% male, 84.1% Chinese, mean age 64.0 ± 10.5 years), 40 subjects (40 eyes, 58.0%) had angle closure on gonioscopy. The most identifiable structure on Cirrus SD-OCT was the SS (82.2%) and SL on iVue SD-OCT (74.5%). Angle closure was indeterminable in 14.5% and 50.7% of Cirrus and iVue scans (P gonioscopy was only fair (AC1 = 0.35 and 0.50 for Cirrus and iVue, respectively). It was more difficult to determine angle closure status with iVue compared with Cirrus SD-OCT. There was fair agreement between both devices with gonioscopy for identifying angle closure.

  5. A COMPARATIVE STUDY OF SINGLE VERSUS DOUBLE LAYER CLOSURE ON LOWER SEGMENT CAESAREAN SCAR

    Directory of Open Access Journals (Sweden)

    Kirtirekha Mohapatra

    2016-10-01

    Full Text Available BACKGROUND There are few issues in modern obstetrics that have been as controversial as management of a woman with a prior caesarean delivery. Hence, it is required to have evidence based correct practice of this surgical procedure. Healing of the uterine incision and the strength of the scar should be the most important consideration. The aim of the study is to compare the effect of technique of uterine closure (Single Layer vs. Double Layer on subsequent pregnancies and to find out, which technique has a better maternal and neonatal outcome by strengthening the scar. MATERIALS AND METHODS 500 cases of previous caesarean section pregnancies were taken, 250 from single layer closure group and 250 from double layer closure group. The mode of delivery during present pregnancy was noted. Integrity of scar, thickness of scar, presence of adhesion were documented. The neonates were observed. Results were compared so as to draw an inference about the better method. RESULTS Mean age between the two groups were similar. Majority did not have history of premature rupture of membrane during previous pregnancy. Postoperative complications were more when double layer closure of uterine scar was done in index surgery. Interpregnancy gap of <3 years was more commonly present in double layer closure group (52.8% in double layer versus 34.8% in single layer. Single layer had more scar tenderness (21.2%, thinned out scars (34.6%, incomplete ruptures (7.1% and complete ruptures (2.8% than double layer closure group. Neonatal outcomes were not statistically different in both the groups. CONCLUSION Double layer uterine closure seems to have better impact on scar integrity as compared to single layer uterine closure.

  6. Storage shaft definitive closure plug and method

    International Nuclear Information System (INIS)

    Dardaine, M.

    1992-01-01

    A definitive closure plug system for radioactive waste storage at any deepness, is presented. The inherent weight of the closure materials is used to set in the plug: these materials display an inclined sliding surface in such a way that when the closure material rests on a stable surface of the shaft storage materials, the relative sliding of the different materials tends to spread them towards the shaft internal wall so as to completely occlude the shaft

  7. 100-D Ponds closure plan. Revision 1

    International Nuclear Information System (INIS)

    Petersen, S.W.

    1997-09-01

    The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit is clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure

  8. Closure Welding of Plutonium Bearing Storage Containers

    International Nuclear Information System (INIS)

    Cannell, G.R.

    2002-01-01

    A key element in the Department of Energy (DOE) strategy for the stabilization, packaging and storage of plutonium-bearing materials involves closure welding of DOE-STD-3013 Outer Containers (3013 container). The 3013 container provides the primary barrier and pressure boundary preventing release of plutonium-bearing materials to the environment. The final closure (closure weld) of the 3013 container must be leaktight, structurally sound and meet DOE STD 3013 specified criteria. This paper focuses on the development, qualification and demonstration of the welding process for the closure welding of Hanford PFP 3013 outer containers

  9. Prosthetic reconstruction with an obturator using swing-lock attachment for a patient underwent maxillectomy: A clinical report

    Science.gov (United States)

    2016-01-01

    Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth. PMID:27826392

  10. Septal Leaflet versus Chordal Detachment in Closure of Hard-To-Expose Ventricular Septal Defects.

    Science.gov (United States)

    Pourmoghadam, Kamal K; Boron, Agnieszka; Ruzmetov, Mark; Narasimhulu, Sukumar Suguna; Kube, Alicia; O'Brien, Michael C; DeCampli, William M

    2018-04-04

    Different techniques have been used for exposure of ventricular septal defect (VSD) margins when there is crowding of the VSD anatomy by tricuspid valve (TV) subvalvar apparatus. The aim of this study was to compare surgical outcomes, for the two techniques of TV leaflet detachment and the rarely described TV chordal detachment for hard-to-expose VSDs. Patients undergoing transatrial VSD repair were identified from our institutional database. Follow-up echocardiography and patient data were obtained from medical records. Between 1/2005-8/2016, 130 isolated conoventricular VSDs were repaired. Among these, 26patients had leaflet detachment, while 15 underwent chordal detachment, and 89 had regular VSD repair (reference group). There was no significant difference between the groups in age, weight, postoperative length-of-stay, genetic/syndromic abnormalities, time-to-extubation, and left and right ventricular systolic function. The cardiopulmonary bypass and cross-clamp time were significantly higher in leaflet detachment group, when compared with reference group (118+28vs102+32, p=0.02; and 73+20vs61+23, p=0.01, respectively). Echocardiographic follow-up were available for 87patients at a mean of 2.6years (1month-11years). Tricuspid regurgitation was rated as none or trivial in 66(76%), mild in 20(23%) and moderate in one reference group patient. There was no difference in presence of residual VSD, or degree of tricuspid regurgitation amongst the three groups. There was no reoperation for tricuspid regurgitation. Tricuspid valve leaflet and chordal detachment techniques provide equally viable and safe alternative to closure of hard-to-expose VSDs while maintaining appropriate TV function. Their use in our series did not lead to increased TV dysfunction at early-to-midterm echocardiographic assessment. Copyright © 2018. Published by Elsevier Inc.

  11. Self-Expandable Metal Stent for Closure of a Large Leak after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    G. Curcio

    2010-08-01

    Full Text Available In recent years, self-expandable metallic stents (SEMSs have emerged as a promising treatment alternative for the bridging and sealing of esophageal perforations and extensive anastomotic leaks after esophageal resection or total gastrectomy. A 56-year-old woman underwent a total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric signet ring cell carcinoma. Ten days later, esophagogastroduodenoscopy showed a 2 cm fistula in the distal end of the Roux limb of the anastomosis. This was confirmed by gastrografin esophagography. The patient was started on total parenteral nutrition. Having deemed clipping treatment for this fistula unfeasible, we decided to insert a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, N.C., USA. The stent was removed after ten days. Gastrografin esophagography showed no further contrast extravasation, and esophagogastroduodenoscopy showed closure of the fistula. No clinical complications were observed, and the patient was able to start normal per os nutrition. In conclusion, the treatment of symptomatic leaks in patients who have undergone esophagojejunostomy is challenging, and leakage from the jejunal stump can be a potentially serious complication. In the treatment of leakage after total gastrectomy, plastic stents (which are either too light or exercise too little radial force and totally covered metallic stents may not adhere sufficiently to the esophagojeujunal walls and, as a result, migrate beyond the anastomosis. The promising results of this report suggest that early stenting, using a partially silicone-coated SEMS, is a feasible alternative to surgical treatment in this category of patients.

  12. Epidural Hematoma and Abscess Related to Thoracic Epidural Analgesia: A Single-Center Study of 2,907 Patients Who Underwent Lung Surgery.

    Science.gov (United States)

    Kupersztych-Hagege, Elisa; Dubuisson, Etienne; Szekely, Barbara; Michel-Cherqui, Mireille; François Dreyfus, Jean; Fischler, Marc; Le Guen, Morgan

    2017-04-01

    To report the major complications (epidural hematoma and abscess) of postoperative thoracic epidural analgesia in patients who underwent lung surgery. Prospective, monocentric study. A university hospital. All lung surgical patients who received postoperative thoracic epidural analgesia between November 2007 and November 2015. Thoracic epidural analgesia for patients who underwent lung surgery. During the study period, data for 2,907 patients were recorded. The following 3 major complications were encountered: 1 case of epidural hematoma (0.34 case/1,000; 95% confidence interval 0.061-1.946), for which surgery was performed, and 2 cases of epidural abscesses (0.68 case/1,000; 95% confidence interval 0.189-2.505), which were treated medically. The risk range of serious complications was moderate; only the patient who experienced an epidural hematoma also experienced permanent sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Closure for spent-fuel transport and storage containers

    International Nuclear Information System (INIS)

    Ahner, S.; Knackstedt, H.G.; Srostlik, P.

    1980-01-01

    The container has a transport closure and a shielding closure. This shielding closure consists of two pieces (double closure system), which can be fartened to one another like a bayonet fixing. A central motion of rotation is enough to open the closure. It can be done remote-controlled as well as manually. (DG) [de

  14. Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life

    OpenAIRE

    Braulio, Renato; Gelape, Cláudio Léo; Araújo, Fátima Derlene da Rocha; Brandão, Kelly Nascimento; Abreu, Luciana Drummond Guimarães; Costa, Paulo Henrique Nogueira; Capanema, Flávio Diniz

    2013-01-01

    OBJECTIVE: To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates. METHODS: The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group NS) ...

  15. Closure of the Radial Forearm Free Flap Donor Site Using the Combined Local Triangular Full-Thickness Skin Graft.

    Science.gov (United States)

    Moreno-Sánchez, Manuel; González-García, Raúl; Ruiz-Laza, Luis; Manzano Solo de Zaldívar, Damián; Moreno-García, Carlos; Monje, Florencio

    2016-01-01

    Traditional donor-site closure has been associated with serious esthetic and functional morbidity. The purpose of this study was to assess morbidity in esthetics and function and measure the postoperative complications of the radial forearm free flap (RFFF) donor site after using combined local triangular full-thickness skin grafting. This prospective study of patients who underwent reconstruction of head and neck defects using an RFFF was conducted from July 2008 through December 2014. The donor site was repaired with a combined local triangular full-thickness skin graft. Quality of the scar, color match, tendon exposure, presence of necrosis, dehiscence of the suture, and presence of dysesthesia were recorded and analyzed using SPSS 21.0 software. One hundred consecutive patients (71 male and 29 female) underwent RFFF harvesting. RFFF donor-site defects ranged from 15 to 70 cm2; partial skin graft loss occurred in 7% of patients. Five patients (5%) had small dehiscences of the forearm skin graft, and 2 cases (2%) presented tendon exposure. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Esthetic results were considered excellent in 87%, good in 11%, and suboptimal in 2% of the cases. The combined local triangular full-thickness skin graft is a reliable method for closing RFFF donor-site defects because it obviates a second surgical site, it provides excellent color match and pliability, and it can be used for covering large defects of the donor site. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model.

    Science.gov (United States)

    Demir, Berat; Sarı, Murat; Binnetoglu, Adem; Yumusakhuylu, Ali Cemal; Filinte, Deniz; Tekin, İshak Özel; Bağlam, Tekin; Batman, Abdullah Çağlar

    2018-04-01

    The present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model. Thirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted. Pharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%). Fibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting or correction of valvular heart disease.

    Science.gov (United States)

    Shvartz, Vladimir A; Kiselev, Anton R; Karavaev, Anatoly S; Vulf, Kristina A; Borovkova, Ekaterina I; Prokhorov, Mikhail D; Petrosyan, Andrey D; Bockeria, Olga L

    2018-01-01

    Introduction: Our aim was to perform a comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or surgical correction of valvular heart disease (SCVHD ). Methods: The synchronous 15 minutes records of heart rate variability (HRV) and finger's photoplethysmographic waveform variability (PPGV) were performed in 42 cardiac surgery patients (12 women) aged 61.8 ± 8.6 years (mean ± standard deviation), who underwent CABG, and 36 patients (16 women) aged 54.2 ± 14.9 years, who underwent SCVHD , before surgery and in 5-7 days after surgery. Conventional time and frequency domain measures of HRV and index S of synchronization between the slow oscillations in PPGV and HRV were analyzed. We also calculated personal dynamics of these indices after surgery. Results: We found no differences ( Р > 0.05) in all studied autonomic indices (preoperative and post-surgery) between studied patients' groups, except for the preoperative heart rate, which was higher in patients who underwent SCVHD ( P = 0.013). We have shown a pronounced preoperative and post-surgery variability (magnitude of inter-quartile ranges) of all autonomic indices in studied patients. In the cluster analysis based on cardiovascular autonomic indices (preoperative and post-surgery), we divided all patients into two clusters (38 and 40 subjects) which did not differ in all clinical characteristics (except for the preoperative hematocrit, P = 0.038), index S, and all post-surgery HRV indices. First cluster (38 patients) had higher preoperative values of the HR, TP, HF, and HF%, and lower preoperative values of the LF% and LF/HF. Conclusion: The variability of cardiovascular autonomic indices in on-pump cardiac surgery patients (two characteristic clusters were identified based on preoperative indices) was not associated with their clinical characteristics and features of surgical procedure (including cardioplegia).

  18. Transitional nuclei near shell closures

    Energy Technology Data Exchange (ETDEWEB)

    Mukherjee, G. [Variable Energy Cyclotron Centre, 1/AF Bidhan Nagar, Kolkata 700064 (India); Pai, H. [Variable Energy Cyclotron Centre, 1/AF Bidhan Nagar, Kolkata 700064, India and Present Address: Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstrasse 9, 64289 Darmstadt (Germany)

    2014-08-14

    High spin states in Bismuth and Thallium nuclei near the Z = 82 shell closure and Cesium nuclei near the N = 82 shell closure in A = 190 and A = 130 regions, respectively, have been experimentally investigated using heavy-ion fusion evaporation reaction and by detecting the gamma rays using the Indian National Gamma Array (INGA). Interesting shape properties in these transitional nuclei have been observed. The results were compared with the neighboring nuclei in these two regions. The total Routhian surface (TRS) calculations have been performed for a better understanding of the observed properties. In mass region A = 190, a change in shape from spherical to deformed has been observd around neutron number N = 112 for the Bi (Z = 83) isotopes with proton number above the magic gap Z = 82, whereas, the shape of Tl (Z = 81) isotopes with proton number below the magic gap Z = 82 remains stable as a function of neutron number. An important transition from aplanar to planar configuration of angular momentum vectors leading to the occurance of nuclar chirality and magnetic rotation, respectively, has been proposed for the unique parity πh{sub 11/2}⊗νh{sub 11/2} configuration in Cs isotopes in the mass region A ∼ 130 around neutron number N = 79. These results are in commensurate with the TRS calculations.

  19. Criticality assessment of LLRWDF closure

    International Nuclear Information System (INIS)

    Sarrack, A.G.; Weber, J.H.; Woody, N.D.

    1992-01-01

    During the operation of the Low Level Radioactive Waste Disposal Facility (LLRWDF), large amounts (greater than 100 kg) of enriched uranium (EU) were buried. This EU came primarily from the closing and decontamination of the Naval Fuels Facility in the time period from 1987--1989. Waste Management Operations (WMO) procedures were used to keep the EU boxes separated to prevent possible criticality during normal operation. Closure of the LLRWDF is currently being planned, and waste stabilization by Dynamic Compaction (DC) is proposed. Dynamic compaction will crush the containers in the LLRWDF and result in changes in their geometry. Research of the LLRWDF operations and record keeping practices have shown that the EU contents of trenches are known, but details of the arrangement of the contents cannot be proven. Reviews of the trench contents, combined with analysis of potential critical configurations, revealed that some portions of the LLRWDF can be expected to be free of criticality concerns while other sections have credible probabilities for the assembly of a critical mass, even in the uncompacted configuration. This will have an impact on the closure options and which trenches can be compacted

  20. Mini-open vacuum-assisted closure therapy with instillation for debilitated and septic patients with pleural empyema.

    Science.gov (United States)

    Sziklavari, Zsolt; Ried, Michael; Neu, Reiner; Schemm, Rudolf; Grosser, Christian; Szöke, Tamas; Hofmann, Hans-Stefan

    2015-08-01

    This prospective study is an evaluation of the mini-open vacuum-assisted closure with instillation (Mini-VAC-Instill) therapy for the treatment of complicated pleural empyema. We investigated septic patients in poor general physical condition (Karnofsky index ≤50%) with multimorbidity and/or immunosuppression who were treated by minimally invasive intrathoracic VAC-Instill therapy without the insertion of an open-window thoracostomy (OWT) between December 2012 and November 2014. All patients underwent mini-thoracotomy with position of a tissue retractor, surgical debridement and local decortication. Surgery was followed by intrathoracic vacuum therapy including periodic instillation using antiseptics. The VAC dressings were changed under general anaesthesia and the chest wall was closed during the same hospital stay. All patients received systemic antibiotic therapy. Fifteen patients (13 males, median age: 71 years) underwent intrathoracic Mini-VAC-Instill dressings for the management of pleural empyema without bronchopleural fistula. The median length of vacuum therapy was 9 days (5-25 days) and the median number of VAC changes per patient was 1 (1-5). In-hospital mortality was 6.7% (n = 1) and was not related to Mini-VAC-Instill therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in 85.7% of surviving patients (12 of 14). After the follow-up at an average of 13.2 months (range, 3-25 months), we observed recurrence once, 21 days after discharge. Two patients died in the late postoperative period (Day 43 and Day 100 after discharge) of fulminant urosepsis and carcinoma-related multiorgan failure, respectively. Analysis of the follow-up interviews in the outpatient clinic showed a good quality of life and a subjectively good long-term aesthetic result. Mini-VAC-Instill therapy is an upgrade of Mini-VAC, which guarantees the advantage of an open treatment, including flushing but without OWT. This

  1. 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.

  2. 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.

  3. Clinical investigation on angle-closure glaucoma patients with cataract treated by phacoemulsification combined with trabeculectomy

    Directory of Open Access Journals (Sweden)

    Yu-Sheng Wang

    2013-11-01

    Full Text Available AIM: To investigate the effectiveness of phacoemulsification with intraocular lens(IOLimplantation combined with trabeculectomy in patients with cataract and angle-closure glaucoma.METHODS: In 36 cases(46 eyesof angle-closure glaucoma with cataract, phacoemulsification with foldable IOL implantation combined with trabeculectomy was performed. Data of pre- and post-operation, including visual acuity, intraocular pressure, filtering bleb, anterior chamber depth, chamber angle, and funds were all recorded and analyzed in detail.RESULTS: During the follow-up of 3 months to 2 years,visual acuity of 43 eyes(93.5%got improved, and intraocular pressure in 44 eyes(95.7%were controlled in normal range(CONCLUSION: Phacoemulsification with IOL implantation combined with trabeculectomy is an effective and safe surgical technique for patients with angle-closure glaucoma and cataract, with satisfied control of intraocular pressure, deepening of anterior chamber, opening of anterior chamber angle, and improving visual function.

  4. Printing tattoo effect after use of Dermabond®Prineo® Skin closure system

    Directory of Open Access Journals (Sweden)

    Shabeer Ahmad Wani

    2017-03-01

    Full Text Available Abdominoplasty is a very common procedure in the plastic surgery practice and may lead to a variety of unfavorable results including incision site complications. The surgical adhesives system, which entered into daily practice to replace the need for subcuticular closure for skin, saves time and may have better wound appearance. Dermabond® Prineo® Skin Closure System (Ethicon Inc., Somerville, NJ, USA has two major components: 2–Octyl cyanoacrylate glue and a flexible, self-adhesive polyester mesh. It can be used with or without sutures, and has the added benefit of waterproofing, and microbial resistance. It also saves time. This case describes a male patient who experienced a “printing tattoo” effect following an elective procedure of abdominoplasty and the results after this closure system was used.

  5. Incidence of Bradycardia and Outcomes of Patients Who Underwent Orbital Atherectomy Without a Temporary Pacemaker.

    Science.gov (United States)

    Lee, Michael S; Nguyen, Heajung; Shlofmitz, Richard

    2017-02-01

    We analyzed the incidence of bradycardia and the safety of patients with severely calcified coronary lesions who underwent orbital atherectomy without the insertion of a temporary pacemaker. The presence of severely calcified coronary lesions can increase the complexity of percutaneous coronary intervention due to the difficulty in advancing and optimally expanding the stent. High-pressure inflations to predilate calcified lesions may cause angiographic complications like perforation and dissection. Suboptimal stent expansion is associated with stent thrombosis and restenosis. Orbital atherectomy safely and effectively modifies calcified plaque to facilitate optimal stent expansion. The incidence of bradycardia in orbital atherectomy is unknown. Fifty consecutive patients underwent orbital atherectomy from February 2014 to September 2016 at our institution, none of whom underwent insertion of a temporary pacemaker. The final analysis included 47 patients in this retrospective study as 3 patients were excluded because of permanent pacemaker implantation. The primary endpoint was significant bradycardia, defined as bradycardia requiring emergent pacemaker placement or a heart rate pacemaker appears to be safe.

  6. Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

    Science.gov (United States)

    Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

    2017-01-01

    The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  7. 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%.

  8. [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.

  9. Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

    International Nuclear Information System (INIS)

    Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

    1989-01-01

    The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

  10. Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial)

    DEFF Research Database (Denmark)

    Park, J; Danielsen, A K; Angenete, E

    2018-01-01

    BACKGROUND: A temporary ileostomy may reduce symptoms from anastomotic leakage after rectal cancer resection. Earlier results of the EASY trial showed that early closure of the temporary ileostomy was associated with significantly fewer postoperative complications. The aim of the present study...... was to compare health-related quality of life (HRQOL) following early versus late closure of a temporary ileostomy. METHODS: Early closure of a temporary ileostomy (at 8-13 days) was compared with late closure (at more than 12 weeks) in a multicentre RCT (EASY) that included patients who underwent rectal...... after resection using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29 and Short Form 36 (SF-36®). RESULTS: There were 112 patients available for analysis. Response rates of the questionnaires were 82-95 per cent, except for EORTC QLQ-C30 at 12...

  11. The effect of fasting on surgical performance

    DEFF Research Database (Denmark)

    Schefte, David Fenger; Rosenstock, Steffen Jais

    2016-01-01

    BACKGROUND: It is unknown whether fasting has any impact on surgical performance. This simulator-based study investigates whether fasting affects surgical performance. METHODS: Twelve healthy medical students [seven women, mean age 26.5 years (range 23-34)] with no prior experience with surgical...... simulators underwent a short course introduction to the LapSim(®) simulator. After having reached a predefined level, the participants performed five simulated salpingectomies on the LapSim(®) simulator 5-30 days after the initial introduction. The procedures took place at 9 a.m. and 2 p.m. after fasting...... in the longitudinal axis with the left hand. CONCLUSION: The simulator-based study suggests that 17 h of fasting does not deteriorate surgical performance. Further studies on the effect of fasting on surgical performance are needed....

  12. Comparison of axial lengths in occludable angle and angle-closure glaucoma-The Bhaktapur Glaucoma Study

    NARCIS (Netherlands)

    Thapa, S.S.; Paudyal, I.; Khanal, S.; Paudel, N.; van Rens, G.H.M.B.

    2011-01-01

    Purpose. To compare the anterior chamber depth (ACD) and axial length of eyes in a population-based sample among normal, occludable angle, and primary angle-closure glaucoma (PACG) groups. Methods. Totally, 3979 subjects from a population-based glaucoma prevalence study underwent complete ocular

  13. Hospital closure: Phoenix, Hydra or Titanic?

    Science.gov (United States)

    Dunne, T; Davis, S

    1996-01-01

    Very little has been published about the effects of hospital closure in terms of the service, financial or management issues of the process. Attempts through a case-study format to redress the balance and as such represents the reflections of practitioners who have recently undergone the experience of hospital closure and the often neglected issues arising both during and after the process.

  14. Key financial ratios can foretell hospital closures.

    Science.gov (United States)

    Lynn, M L; Wertheim, P

    1993-11-01

    An analysis of various financial ratios sampled from open and closed hospitals shows that certain leverage, liquidity, capital efficiency, and resource availability ratios can predict hospital closure up to two years in advance of the closure with an accuracy of nearly 75 percent.

  15. 40 CFR 264.178 - Closure.

    Science.gov (United States)

    2010-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Use and Management of Containers § 264.178 Closure. At closure, all hazardous waste and hazardous waste residues must be removed...

  16. Hanford Patrol Academy Demolition Sites Closure Plan

    International Nuclear Information System (INIS)

    1992-11-01

    From 1975 to 1991 the Hanford Patrol Academy Demolition Sites (HPADS) were used for demolition events. These demolition events were a form of thermal treatment for spent or abandoned chemical waste. Because the HPADS will no longer be used for this thermal activity, the sites will be closed. Closure will be conducted pursuant to the requirements of the Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and 40 CFR 270.1. Closure also will satisfy closure requirements of WAC 173-303-680 and for the thermal treatment closure requirements of 40 CFR 265.381. This closure plan presents a description of the HPADS, the history of the waste treated, and the approach that will be followed to close the HPADS. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. Only dangerous constituents derived from HPADS operations will be addressed in this closure plan in accordance with WAC 173-303-610(2)(b)(i). The HPADS are actually two distinct soil closure areas within the Hanford Patrol Academy training area

  17. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    International Nuclear Information System (INIS)

    Chan, Gabriel; Quek, Lawrence Hwee Han; Tan, Glenn Leong Wei; Pua, Uei

    2016-01-01

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  18. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Gabriel, E-mail: dr.changabriel@gmail.com; Quek, Lawrence Hwee Han, E-mail: lawrence-quek@ttsh.com.sg [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Tan, Glenn Leong Wei, E-mail: glenn-tan@ttsh.com.sg [Tan Tock Seng Hospital, Department of General Surgery (Singapore); Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2016-07-15

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  19. Some Recent Developments in Turbulence Closure Modeling

    Science.gov (United States)

    Durbin, Paul A.

    2018-01-01

    Turbulence closure models are central to a good deal of applied computational fluid dynamical analysis. Closure modeling endures as a productive area of research. This review covers recent developments in elliptic relaxation and elliptic blending models, unified rotation and curvature corrections, transition prediction, hybrid simulation, and data-driven methods. The focus is on closure models in which transport equations are solved for scalar variables, such as the turbulent kinetic energy, a timescale, or a measure of anisotropy. Algebraic constitutive representations are reviewed for their role in relating scalar closures to the Reynolds stress tensor. Seamless and nonzonal methods, which invoke a single closure model, are reviewed, especially detached eddy simulation (DES) and adaptive DES. Other topics surveyed include data-driven modeling and intermittency and laminar fluctuation models for transition prediction. The review concludes with an outlook.

  20. Resection and Primary Closure of Edematous Glossoepiglottic Mucosa in a Dog Causing Laryngeal Obstruction.

    Science.gov (United States)

    Schabbing, Kevin J; Seaman, Jeffrey A

    An approximately 22 mo old male neutered English bulldog was evaluated for acute onset of dyspnea with suspected brachycephalic obstructive airway syndrome (BOAS). Laryngoscopic exam revealed diffuse, severe edema and static displacement of redundant glossoepiglottic (GE) mucosa causing complete obstruction of the larynx and epiglottic entrapment. Static displacement of the GE mucosa was observed and determined to be the overriding component of dyspnea in this patient with BOAS. Resection and primary closure with two separate, simple continuous sutures of the GE mucosa were performed. Resection and primary closure of the GE mucosa resolved the acute onset of dyspnea in this patient. Surgical correction of the stenotic nares, elongated soft palate, and everted laryngeal saccules were performed under the same anesthetic procedure. Static displacement of the GE mucosa may occur in patients with BOAS. Surgical resection and closure of the GE mucosa resolved this patient's dyspnea and is recommended in airway obstruction. It remains to be determined if primary closure and subsequent tensioning or scar tissue of the GE mucosa results in further complications related to restricted epiglottic movement.

  1. Successful Retrieval of an Embolized Vascular Closure Device (Angio-Seal{sup ®}) After Peripheral Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Jud, Philipp, E-mail: philipp.jud@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Portugaller, Rupert; Bohlsen, Dennis [Medical University of Graz, Division of Vascular and Interventional Radiology, Department of Radiology (Austria); Gary, Thomas; Brodmann, Marianne [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Hackl, Gerald [Medical University of Graz, Division of Intensive Care, Department of Internal Medicine (Austria); Hafner, Franz [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

    2017-06-15

    A 55-year-old male with peripheral arterial disease underwent angioplasty of the right lower limb arteries via antegrade femoral access. Angio-Seal{sup ®} closure device was used to treat the puncture site, whereby the intravascular sealing anchor accidentally embolized into the malleolar region of the right posterior tibial artery. Successful retrieval of the anchor was accomplished by a SpiderFX embolic protection device. This technique may be a useful approach to retrieve embolized foreign bodies via endovascular access.

  2. Pit closures - effects and alternatives

    Energy Technology Data Exchange (ETDEWEB)

    Stott, A G

    1987-02-01

    During the last decade, British Coal has closed around 100 mines. This article illustrates the effect of pit closures on the colliery's workforce, and the local community and its economy. Working conditions at Newmarket Colliery and the Selby coalfield are compared within the context of British Coal's national transfer market. British Coal's transfer benefits include resettlement payments and mortgage subsidies. The job creation venture of British Coal Enterprise Ltd. has helped to create over 3700 new jobs in 264 projects, involving a total investment of 38 M pounds sterling. The article also discusses deputies' qualifications and prospects for recently qualified management staff, and gives a comparison of losses suffered by the different mining unions.

  3. Closure for milliliter scale bioreactor

    Science.gov (United States)

    Klein, David L.; Laidlaw, Robert D.; Andronaco, Gregory; Boyer, Stephen G.

    2010-12-14

    A closure for a microreactor includes a cap that is configured to be inserted into a well of the microreactor. The cap, or at least a portion of the cap, is compliant so as to form a seal with the well when the cap is inserted. The cap includes an aperture that provides an airway between the inside of the well to the external environment when the cap is inserted into the well. A porous plug is inserted in the aperture, e.g., either directly or in tube that extends through the aperture. The porous plug permits gas within the well to pass through the aperture while preventing liquids from passing through to reduce evaporation and preventing microbes from passing through to provide a sterile environment. A one-way valve may also be used to help control the environment in the well.

  4. Closure of Microcosm for refurbishment

    CERN Multimedia

    2014-01-01

    Since 1994, the Microcosm exhibition has given the opportunity to visitors of all ages and backgrounds to have a first glimpse into the secrets of physics.   To ensure that Microcosm can continue fulfilling its educational aims at the same level of quality for many years to come, it is closing for renovation work on 8 December 2014 and is expected to reopen during Summer 2015. During the closure, the “Fun with Physics” workshop will not take place, but the Universe of Particles exhibition in the Globe and the Passport to the Big Bang circuit will remain accessible to the public, free of charge and with no need to book in advance.  Guided tours of CERN are also available (advance booking required via this page).

  5. Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hsieh, Y.-C.; Yap, Y.-S.; Hung, C.-H.; Chen, C.-H.; Lu, S.-N.; Wang, J.-H.

    2013-01-01

    Aim: To evaluate the incidence and associated factors of postoperative intense pain and haemodynamic changes during radiofrequency ablation of hepatocellular carcinoma. Materials and methods: A total of 123 consecutive hepatocellular carcinoma patients who underwent radiofrequency ablation were prospectively recruited. Patient factors, tumour characteristics, procedural factors, intraoperative haemodynamic changes, complications, postoperative events, laboratory values before and after ablation, and postoperative pain were evaluated. Postoperative pain was scored using a visual analogue scale after the procedure. Results: The mean age of the patients was 65.6 ± 9.6 years. In multiple logistic regression analysis, patients who underwent general anaesthesia [odds ratio (95% CI): 2.68 (1.23–5.81); p = 0.013] and had more postoperative nausea and vomiting episodes [3.10 (1.11–8.63); p = 0.036] were associated with intense pain. These findings remain robust after propensity score matching. For mean difference values between before and after RFA, higher in change in aspartate transaminase (p = 0.026), alanine transaminase (p = 0.016) and white blood cell count (p = 0.015), and lower in change in haemoglobin (p = 0.009) were also correlated with intense pain. There was no significant difference in haemodynamic changes between the general anaesthesia and local anaesthesia group during ablation. Conclusion: General anaesthesia, postoperative nausea and vomiting, and laboratory factors were associated with postoperative intense pain in patients who underwent radiofrequency ablation. Counselling and modification of analgesics should be considered in patients with related factors for intense pain

  6. Safety and Tolerability of Transitioning from Cangrelor to Ticagrelor in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Badreldin, Hisham A; Carter, Danielle; Cook, Bryan M; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

    2017-08-01

    The 3 phase 3 CHAMPION (Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials collectively demonstrated the safety of transitioning from cangrelor, a potent, parenteral rapidly-acting P2Y 12 inhibitor, to clopidogrel in patients who underwent percutaneous coronary intervention (PCI). However, variation in timing of therapy, site-specific binding, and drug half-lives may theoretically complicate switching to other oral P2Y 12 inhibitors. Since regulatory approval, limited data are available regarding the "real-world" safety and tolerability of transitioning to these more potent oral P2Y 12 antagonists. From November 2015 to January 2017, we evaluated the clinical profiles and efficacy and safety outcomes in cangrelor-treated patients who underwent PCI transitioned to clopidogrel (n = 42) or ticagrelor (n = 82) at a large, tertiary care center. Most patients receiving cangrelor underwent PCI with a drug-eluting stent for acute coronary syndrome via a radial approach in the background of unfractionated heparin. Stent thrombosis within 48 hours was rare and occurred in 1 patient treated with ticagrelor. Global Use of Strategies to Open Occluded Coronary Arteries-defined bleeding occurred in 20% of patients switched to ticagrelor and 29% of patients switched to clopidogrel, but none were severe or life-threatening. In conclusion, rates of stent thrombosis and severe/life-threatening bleeding were low and comparable with those identified in the CHAMPION program, despite use of more potent oral P2Y 12 inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. [Periprocedural and late complications after percutaneous closure of patent foramen ovale: a single centre experience].

    Science.gov (United States)

    Węglarz, Przemysław; Konarska Kuszewska, Ewa; Spisak Borowska, Katarzyna; Machowski, Jerzy; Drzewiecka-Gerber, Agnieszka; Kuszewski, Piotr; Jackson, Christopher L; Opala, Grzegorz; Trusz Gluza, Maria

    2012-01-01

    Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure. To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event. 149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months. Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs. Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.

  8. Does velopharyngeal closure pattern affect the success of pharyngeal flap pharyngoplasty?

    Science.gov (United States)

    Armour, Alexis; Fischbach, Simone; Klaiman, Paula; Fisher, David M

    2005-01-01

    Historically at The Hospital for Sick Children in Toronto, pharyngeal flap pharyngoplasty has been the treatment of choice for treatment of velopharyngeal insufficiency, regardless of velopharyngeal closure pattern. The authors hypothesize that pharyngeal flap pharyngoplasty is more effective in treating velopharyngeal insufficiency in patients with circular or sagittal velopharyngeal closure and less effective in treating the coronal closure pattern. Ninety-three patients who underwent superiorly based pharyngeal flap surgery for velopharyngeal insufficiency were evaluated in a retrospective chart review. Closure pattern was determined preoperatively by nasopharyngoscopy or multiview videofluoroscopy. Nasalance was assessed preoperatively and at 6 weeks and 1 year postoperatively. Nasalance during nonnasal speech was decreased on average, for all closure patterns, postoperatively. However, a significantly higher percentage of patients were corrected to normal nasalance scores in thenoncoronal group than in the coronal group (57 percent versus 35 percent, respectively) at 1 year postoperatively (p approach to the management of velopharyngeal insufficiency and are more inclined to treat coronal pattern velopharyngeal insufficiency with sphincter pharyngoplasty.

  9. Comparison of EyeCam and anterior segment optical coherence tomography in detecting angle closure.

    Science.gov (United States)

    Baskaran, Mani; Aung, Tin; Friedman, David S; Tun, Tin A; Perera, Shamira A

    2012-12-01

    To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard. Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated. The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT. The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

  10. Closure of tubular patent ductus arteriosus with the Amplatzer Vascular Plug IV: feasibility and safety.

    Science.gov (United States)

    Baruteau, Alban-Elouen; Lambert, Virginie; Riou, Jean-Yves; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme

    2015-01-01

    Closure of tubular patent ductus arteriosus remains a challenging procedure. Anecdotal use of Amplatzer Vascular Plug IV for tubular ductus closure has been reported but feasibility and safety in a consecutive patients' series remain unknown. We performed a monocenter prospective study at the Marie Lannelongue Hospital in Paris, France. From 2009 to 2014, a total of 47 patients (39 infants, 3 children, and 5 adults) underwent ductus closure with the Plug IV. Ductus morphology was a type E in 34 (72.3%) patients and a type C in 13 (27.7%) patients. Ductus closure occurred in 39 (83.0%) infants at a median age of seven months (range: 3-23 months) and a median weight of 6.9 kg (range: 4.1-17.0 kg). A past history of prematurity and very low birth weight was found in 33 (70.2%) of them. Twelve (25.5%) patients had pulmonary hypertension. Mean Plug IV diameter was 1.9 ± 0.1 mm larger than the mean maximal ductus diameter. Early complete closure of the ductus was obtained in all patients. Early migration of an undersized Plug IV occurred in one (2.1%) patient and was suitable for percutaneous device retrieval. After a mean follow-up of 3.4 ± 1.4 years, all patients are alive and asymptomatic, no late complication occurred. Transcatheter closure of tubular ductus with the Amplatzer Vascular Plug IV can be safe and effective, with a 100% early occlusion rate. This device, suitable for a 4F sheath, is a new alternative for tubular ductus closure in low-body-weight infants. © The Author(s) 2014.

  11. Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries.

    Science.gov (United States)

    Azem, Foad; Yovel, Israel; Wagman, Israel; Kapostiansky, Rita; Lessing, Joseph B; Amit, Ami

    2003-05-01

    To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. Case report. A maternity hospital in Tel Aviv that is a major tertiary care and referral center. A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. Outcome of IVF cycle. A twin pregnancy in the first cycle. This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.

  12. [A Case of Ascending Colon Cancer with Lynch Syndrome Who Underwent XELOX Adjuvant Chemotherapy].

    Science.gov (United States)

    Takase, Koki; Murata, Kohei; Kagawa, Yoshinori; Nose, Yohei; Kawai, Kenji; Sakamoto, Takuya; Naito, Atsushi; Murakami, Kohei; Katsura, Yoshiteru; Omura, Yoshiaki; Takeno, Atsushi; Nakatsuka, Shinichi; Takeda, Yutaka; Kato, Takeshi; Tamura, Shigeyuki

    2018-01-01

    Lynch syndrome is an inherited syndrome with the development of the colorectal and various other cancers. Lynch syndrome is caused by mutations in the mismatch repair genes. A 33 year-old male underwent XELOX adjuvant chemotherapy for ascending colon cancer with Lynch syndrome. Although efficacy of 5-FU is not demonstrated in Lynch syndrome, MOSAIC trial had suggested a benefit from FOLFOX compared with 5-FU in patients who have colorectal cancer with Lynch syndrome. Oxaliplatin-based adjuvant chemotherapy can be a therapeutic option for colorectal cancer in lynch syndrome patients.

  13. Patent Ductus Arteriosus closure in preterms less than 2kg: Surgery versus transcatheter.

    Science.gov (United States)

    Pamukcu, Ozge; Tuncay, Aydin; Narin, Nazmi; Baykan, Ali; Korkmaz, Levent; Argun, Mustafa; Ozyurt, Abdullah; Sunkak, Suleyman; Uzum, Kazim

    2018-01-01

    As new devices come into the market, percutaneous techniques improve and interventionalists become more experienced; percutaneous closure gets more common in preterms. In this study we aimed to compare efficacy and safety of Patent Ductus Arteriosus closure surgically versus transcatheter method in preterms Patent Ductus Arteriosus closure in preterms. Between the dates July 1997 to October 2014 in our center Patent Ductus Arteriosus of 26 patients Patent Ductus Arteriosus closure group was significantly more than the surgery group. Mean gestational age of the patients in Group A was 30±1.8weeks, in group B was 28.6±3.5weeks. In group A; all cases were closed successfully except 4 cases: device embolization in 2, cardiac tamponade and iatrogenic aortic coarctation were seen. Pneumomediastinum and chylothorax were the major complications of the surgery group. There was no statistically significance between complication and success rates between two groups. Percutaneous Patent Ductus Arteriosus closure is the candidate for taking the place of surgery in preterms. However, it is not applied routinely; can only be done in fully equipped large centers by experienced interventionalists. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Profile of angle closure in a tertiary care center in north India

    Directory of Open Access Journals (Sweden)

    Ichhpujani Parul

    2010-01-01

    Full Text Available Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA, intraocular pressure (IOP, gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434 were diagnosed to have various subtypes of angle closure. Mean (±SD age at presentation was significantly higher for males (57.57 ± 11.62 years as compared to females (53.64 ± 10.67 years ( P < 0001. Primary angle closure glaucoma (PACG was most frequently diagnosed subtype (49.38% followed by Primary angle closure (PAC (39.68% and Primary angle closure suspect (PACS (10.93% respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction. Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical

  15. Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

    Science.gov (United States)

    Doll, Dietrich; Matevossian, Edouard; Luedi, Markus M; Schneider, Ralf; van Zypen, Dominic; Novotny, Alexander

    2015-01-01

    The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrence-free survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow-up of up to 20 years after primary PSD surgery. Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20-year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures. © 2015 S. Karger AG, Basel.

  16. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

    Science.gov (United States)

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-07-01

    Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

  17. USE OF VACUUM-ASSISTED CLOSURE (VAC) IN COMPLICATED PERINEAL WOUNDS: ANALYSIS OF CASES

    OpenAIRE

    Blaž Trotovšek; Danijela Semenič

    2015-01-01

    Treatment of perineal wounds has been one of the challenges of surgery since its inception. Vacuum-assisted closure provides a new option that can be used in concert with a wide variety of standard existing surgical techniques. It was originally developed for treatment of chronic wounds in patients with diabetes. It has rapidly evolved into a widely accepted treatment also for acute, contaminated and complicated wounds from failed operations. User-friendliness of the technique and a high rate...

  18. Multidisciplinary Assessment in Optimising Results of Percutaneous Patent Foramen Ovale Closure.

    Science.gov (United States)

    Davies, Allan; Ekmejian, Avedis; Collins, Nicholas; Bhagwandeen, Rohan

    2017-03-01

    Percutaneous patent foramen ovale (PFO) closure is a therapeutic option to prevent recurrent cerebral ischaemia in patients with cryptogenic stroke and transient cerebral ischaemia (TIA). The apparent lack of benefit seen in previous randomised trials has, in part, reflected inclusion of patients with alternate mechanisms of stroke. The role of formal neurology involvement in accurately delineating the likely aetiology of stroke or TIA is crucial in appropriate identification of patients for device closure. Furthermore, as the benefits of device closure may accrue over time, long-term follow-up is essential to define the role of device closure in management of presumed cryptogenic stroke. We retrospectively reviewed our experience with percutaneous PFO device closure since 2005. All subjects who underwent PFO closure at John Hunter and Lake Macquarie Private Hospitals were included in the study. All patients referred for device closure following cryptogenic stroke or TIA had first undergone formal neurology review with appropriate imaging and exclusion of paroxysmal atrial arrhythmia. Patients with a history of transient ischaemic attack (TIA) are frequently referred to a specialised clinic, aimed to identify patients with conditions not referable to cerebral ischaemia, with investigations initiated by the specialist clinic to elucidate an underlying aetiology. Outcome data was derived from the Hunter New England Area Local Health District Cardiac and Stroke Outcomes Unit, in addition to review of the medical record. The Cardiac and Stroke Outcomes Unit prospectively identified all patients presenting with stroke, TIA and atrial fibrillation. One hundred and twelve consecutive patients undergoing percutaneous patent foramen ovale closure between 2005 and 2015 were identified. The average age was 42.7 years and 57 (50.9%) patients were male. Cryptogenic stroke (68.8%) and transient cerebral ischaemia (23.2%) were the most common indications for PFO closure, with the

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

    Science.gov (United States)

    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.

  20. 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.

  1. 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.

  2. Effectiveness of a new gelatin sealant system for dural closure.

    Science.gov (United States)

    Kawai, Hisashi; Nakagawa, Ichiro; Nishimura, Fumihiko; Motoyama, Yasushi; Park, Young-Su; Nakamura, Mitsutoshi; Nakase, Hiroyuki; Suzuki, Shuko; Ikada, Yoshito

    2014-10-01

    Watertight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. In this study, the authors test the use of a new gelatin glue as a dural sealant in in vitro and in vivo canine models of transdural CSF leakage. The in vitro model was sutured semicircles of canine dura mater and artificial dural substitute. The sutures were sealed with gelatin glue (n  =  20), fibrin glue (n  =  20), or a polyethylene glycol (PEG)-based hydrogel sealant (n  =  20). Each sample was set in a device to measure water pressure, and pressure was increased until leakage occurred. Bonding strength was subjectively evaluated. The in vivo model was dogs who underwent dural excision and received either no sealant (control group; n  =  5) or gelatin glue sealant (n  =  5) before dural closure. Twenty-eight days post-surgery, the maximum intracranial pressure was measured at the cisterna magna using Valsalva maneuver and tissue adhesion was evaluated. The water pressure at which leakage occurred in the in vitro model was higher with gelatin glue (76·5 ± 39·8 mmHg) than with fibrin glue (38·3 ± 27·4 mmHg, P control group (13·8 ± 4·0 mmHg, P control group (P  =  0·005). The new gelatin glue provides an effective watertight closure when used as an adjunct to sutured dural repair.

  3. Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

    Directory of Open Access Journals (Sweden)

    Eunhyun Cho

    2013-09-01

    Full Text Available Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA by using an Amplatzer vascular plug (AVP.&lt;br&gt; Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared.&lt;br&gt;Results: The mean age of the patients was 54.9±45.7 months old. The PDAs were of type C (n=5, type D (n=12 and type E (n=3. The mean pulmonary end diameter of the PDA was 1.7±0.6 mm, and the aortic end diameter was 3.6±1.4 mm. The mean length was 7.3±1.8 mm. We used 3 types of AVP devices: AVP I (n=5, AVP II (n=7, and AVP IV (n=8. The ratio of AVP size to the pulmonary end diameter was 3.37±1.64, and AVP size/aortic end ratio was 1.72±0.97. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P =0.002. The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter (1.10±0.31, P =0.032. &lt;br&gt;Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

  4. Percutaneous closure of a large patent ductus arteriosus in a preterm newborn weighing 1400 g without using arterial sheath: an innovative technique.

    Science.gov (United States)

    Garg, Gaurav; Garg, Vishal; Prakash, Amit

    2018-03-01

    Percutaneous closure of patent ductus arteriosus is well established in infants weighing >5 kg, but data regarding outcome of preterm especially very low birth weight infants is minimal. Although surgical ligation of patent ductus arteriosus is the preferred and well-accepted modality of treatment after failure of drug therapy in preterm infants, it has also got its own demerits in such a small and fragile subset. Device closure in infants weighing closure of large patent ductus arteriosus. Percutaneous closure of patent ductus arteriosus was done successfully and the infant was discharged on room air with a weight of 1.8 kg. We present here an innovative technique in which successful patent ductus arteriosus device closure was done in a 1.4-kg infant without using arterial sheath.

  5. Comparative study between fasciocutaneous and myocutaneous flaps in the surgical treatment of pressure ulcers of the sacral region

    Directory of Open Access Journals (Sweden)

    D. Oksman

    2018-06-01

    Full Text Available Introduction: Decubitus ulcers of the sacral region are common conditions in bedridden patients. Deep lesions (Stages III and IV often require surgical treatment for closure. Flaps of the region are the first choice for treatment. We present our experience in the treatment of these lesions and compare two different approaches: local fasciocutaneous flap and gluteus maximus myocutaneous flap with V-Y advancement. Method: From March 2009 to May 2014, 32 patients underwent closure of sacral pressure ulcers by flaps, 17 of them with rotational local fasciocutaneous flaps and 15 with myocutaneous flaps of the gluteus maximus muscle with V-Y advancement. Evolution regarding complications and rate of success after two months was compared between the groups. Results: Out of the 32 operated patients we obtained resolution of lesions after two months in 23 (71.8%, 10 patients in the fasciocutaneous flap group (58.8% and 13 cases in the myocutaneous flap group (86.6%. The most common complication was partial dehiscence of sutures in 12 patients (37.5%, 8 patients in the fasciocutaneous flap group (47% and 4 patients in the myocutaneous flap group (26.6%. The group of patients reconstructed with local fasciocutaneous flaps presented 3 cases with seroma, one with hematoma and 6 with partial cutaneous necrosis; these patients also required more drainage time. Conclusions: Both the local rotational fasciocutaneous flap and the myocutaneous flap of the gluteus maximus muscle in V-Y flap can be used in the surgical treatment of sacral ulcers. In our experience, a reduced success rate and more complications were found in the local fasciocutaneous reconstructive method. Keywords: Pressure ulcer, Fasciocutaneous flap, Myocutaneous flap, Gluteus maximus muscle

  6. Nickel elution properties of contemporary interatrial shunt closure devices.

    Science.gov (United States)

    Verma, Divya Ratan; Khan, Muhammad F; Tandar, Anwar; Rajasekaran, Namakkal S; Neuharth, Renée; Patel, Amit N; Muhlestein, Joseph B; Badger, Rodney S

    2015-02-01

    We sought to compare nickel elution properties of contemporary interatrial shunt closure devices in vitro. There are two United States Food and Drug Administration (FDA)-approved devices for percutaneous closure of secundum atrial septal defect: the Amplatzer septal occluder (ASO; St Jude Medical Corporation) and Gore Helex septal occluder (HSO; W.L. Gore & Associates). The new Gore septal occluder (GSO) device is in clinical trials. These are also used off-label for patent foramen ovale closure in highly selected patients. These devices have high nickel content. Nickel allergy is the most common reason for surgical device explantation. Nickel elution properties of contemporary devices remain unknown. We compared nickel elution properties of 4 devices - ASO, GSO, HSO, and sternal wire (SW) - while Dulbecco's phosphate-buffered saline (DPBS) served as control. Three samples of each device were submerged in DPBS. Nickel content was measured at 14 intervals over 90 days. Nickel elution at 24 hours, compared to control (0.005 ± 0.0 mg/L), was significantly higher for ASO (2.98 ± 1.65 mg/L; P=.04) and SW (0.03 ± 0.014 mg/L; P=.03). Nickel levels at 90 days, compared to control (0.005 ± 0.0 mg/L) and adjusting for multiple comparisons, were significantly higher for ASO (19.80 ± 2.30 mg/L; P=.01) and similar for HSO (P=.34), GSO (P=.34), and SW (P=.34). ASO had significantly higher nickel elution compared to HSO, GSO, and SW (P=.01). There is substantial variability in nickel elution; devices with less exposed nickel (HSO and GSO) have minimal elution. The safety of low nickel elution devices in patients with nickel allergy needs to be evaluated in prospective trials.

  7. Current management of surgical oncologic emergencies.

    Science.gov (United States)

    Bosscher, Marianne R F; van Leeuwen, Barbara L; Hoekstra, Harald J

    2015-01-01

    For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  8. Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

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    Shahram Paydar

    2014-08-01

    Full Text Available Introduction: Emergency department thoracotomy (EDT may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male. The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19% were alive to be transported to OR (defined as ED survived. The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived was 6.9% (4 cases. Only one case (1.7% survived to discharge from hospital (mortality rate=98.3%. There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04. The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04 and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02 were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome.

  9. Transcatheter Closure of Patent Ductus Arteriosus in Children with the Occlutech Duct Occluder.

    Science.gov (United States)

    Bilici, Meki; Demir, Fikri; Akın, Alper; Türe, Mehmet; Balık, Hasan; Kuyumcu, Mahir

    2017-12-01

    The aim of this study was to evaluate the feasibility, efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with the Occlutech duct occluder (ODO) in children. We reviewed the clinical records of 71 patients who underwent percutaneous closure of PDA with an ODO between September 2014 and August 2016. The Occlutech duct occluder was applied to 71 patients during the study period (September 2014-August 2016), and the results were analyzed in this study. Forty-two of the patients were female and 29 male. The median age was 20.5 months (range, 6-194 months) and median weight was 16 kg (range, 6-68 kg). The PDA was classified as type A in 54 patients (76.1%), type E in 14 (19.7%), type C in 2 (2.8%) and type B in 1 (1.4%) based on the Krichenko classification. A standard ODO device was used for the transcatheter closure procedure in 66 patients and the long-shank ODO device in 5. In the echocardiographic measurement of PDA, the median smallest diameter was 2.7 mm (range, 1.5-7.0 mm), and in the angiographic measurement, the median smallest diameter was 2.5 mm (range, 1.5-6.5 mm). All 71 patients underwent successful PDA closure with the ODO. Angiography following the procedure showed complete closure in 47 patients (66.2%), mild residual shunt in 13 patients (18.3%) and a trivial shunt in 11 patients (15.5%). Color flow Doppler echocardiogpaphy at 24 h post-implantation showed that complete closure was achieved in 65 patients (91.5%), and 6 patients (8.5%) had mild residual shunt. All patients (100%) had complete closure at 30 days of follow-up. The results of this study showed that the Occlutech PDA occluder device is safe and effective in the closure of PDA. As the pulmonary artery side of the device is wider than the aortic side, protrusion toward the aortic side and embolization are prevented, but there is residual shunt in the early period, although this residual shunt disappeared after a few months.

  10. Social and macro economic impact of closure

    International Nuclear Information System (INIS)

    Medeliene, D.

    1999-01-01

    The social consequences of closure of Ignalina NPP will largely depend on the actions the Government takes. If it puts in place the conditions which enable the International Financial Institutions to assist Lithuania, both in providing loans and grants for decommissioning and (in the case of the EU) providing Structural Adjustment Funds for the regional economic development of the Visaginas area, then solutions to the problems of closure can be found. But if the Government delays putting into place the necessary conditions, then Lithuania will be left to solve the problems of - inter alia necessary - closure of Ignalina NPP on its own. (author)

  11. Left ventricular dysfunction after closure of large patent ductus arteriosus.

    Science.gov (United States)

    Galal, M Omar; Amin, Mohamed; Hussein, Arif; Kouatli, Amjad; Al-Ata, Jameel; Jamjoom, Ahmed

    2005-03-01

    Changes in left ventricular dimensions and performance were studied in 43 patients after transcatheter occlusion or surgical ligation of patent ductus arteriosus. The patients were assigned to 2 groups based on their ductal diameter: >/= 3.1 mm to group A (n = 27) and ventricular end-diastolic diameter than group B, while all patients had normal shortening fraction and ejection fraction. Within 1 month after intervention, left ventricular end-diastolic diameter showed a trend towards regression while shortening fraction and ejection fraction decreased significantly in group A. There were no significant changes in these parameters in group B. Between 1 and 6 months after intervention, left ventricular performance improved in most of the group A patients who were followed up. We conclude that closure of large ductus arteriosus in children leads to significant immediate deterioration of left ventricular performance, which appears to recover within a few months. Echocardiographic study before hospital discharge is recommended in these patients. Serious deterioration of ventricular performance after closure may warrant the use of angiotensin converting enzyme inhibitors.

  12. Tremendous bleeding complication after vacuum-assisted sternal closure

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    Isgro Frank

    2011-02-01

    Full Text Available Abstract Vacuum-assisted closure (VAC of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved. No contraindications for the use in deep sternal wounds in cardiac surgery are described. In our case report we illustrate a scenario were a patient developed severe bleeding from the ascending aorta by penetration of wire fragments in the vessel. We conclude that all free particles in the sternum have to be removed completely before negative pressure is used.

  13. Correlation between location of transposed ovary and function in cervical cancer patients who underwent radical hysterectomy.

    Science.gov (United States)

    Yoon, Aera; Lee, Yoo-Young; Park, Won; Huh, Seung Jae; Choi, Chel Hun; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

    2015-05-01

    The study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies. Retrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function. Twenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24-39 years) and 21.3 kg/m² (range, 17.7-31.2 kg/m²), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4-143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, -2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = -8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = -59.93, P = 0.05; overweight: β = -40.62, P = 0.041). Location of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.

  14. Beneficial Effect of the Nutritional Support in Children Who Underwent Hematopoietic Stem Cell Transplant.

    Science.gov (United States)

    Koç, Nevra; Gündüz, Mehmet; Tavil, Betül; Azik, M Fatih; Coşkun, Zeynep; Yardımcı, Hülya; Uçkan, Duygu; Tunç, Bahattin

    2017-08-01

    The aim of this study was to evaluate nutritional status in children who underwent hematopoietic stem cell transplant compared with a healthy control group. A secondary aim was to utilize mid-upper arm circumference as a measure of nutritional status in these groups of children. Our study group included 40 children (18 girls, 22 boys) with mean age of 9.2 ± 4.6 years (range, 2-17 y) who underwent hematopoietic stem cell transplant. Our control group consisted of 20 healthy children (9 girls, 11 boys). The children were evaluated at admission to the hospital and followed regularly 3, 6, 9, and 12 months after discharge from the hospital. In the study group, 27 of 40 patients (67.5%) received nutritional support during hematopoietic stem cell transplant, with 15 patients (56%) receiving enteral nutrition, 6 (22%) receiving total parenteral nutrition, and 6 (22%) receiving enteral and total parenteral nutrition. Chronic malnutrition rate in the study group was 47.5% on admission to the hospital, with the control group having a rate of 20%. One year after transplant, the rate decreased to 20% in the study group and 5% in the control group. The mid-upper arm circumference was lower in children in the study group versus the control group at the beginning of the study (P groups at follow-up examinations (P > .05). During follow-up, all anthropometric measurements increased significantly in both groups. Monitoring nutritional status and initiating appropriate nutritional support improved the success of hematopoietic stem cell transplant and provided a more comfortable process during the transplant period. Furthermore, mid-upper arm circumference is a more sensitive, useful, and safer parameter that can be used to measure nutritional status of children who undergo hematopoietic stem cell transplant.

  15. Transcatheter Closure of Patent Ductus Arteriosus in Extremely Premature Newborns: Early Results and Midterm Follow-Up.

    Science.gov (United States)

    Zahn, Evan M; Peck, Daniel; Phillips, Alistair; Nevin, Phillip; Basaker, Kaylan; Simmons, Charles; McRae, Marion E; Early, Tracy; Garg, Ruchira

    2016-12-12

    The goal of this study was to describe early and midterm outcomes of extremely premature newborns (EPNs) who underwent transcatheter echocardiographically guided patent ductus arteriosus (PDA) closure. Surgical ligation of PDA in EPNs confers significant risk for procedural morbidity and adverse long-term outcomes. The Amplatzer Vascular Plug II was used in all cases. Post-ligation syndrome was defined using previously published parameters. Patients were followed at pre-specified intervals, and prospectively collected data were reviewed. Transcatheter closure was attempted in 24 EPNs (mean procedural age 30 days [range 5 to 80 days], mean procedural weight 1,249 g [range 755 to 2,380 g]) and was successful in 88%. The 3 procedural failures were related to the development of left pulmonary artery (LPA) stenosis caused by the device, and all devices were removed uneventfully. Complications included 2 instances of device malposition, resolved with device repositioning, and 1 instance of LPA stenosis, requiring an LPA stent. There were no procedural deaths, cases of post-ligation syndrome, residual PDA, or device embolization. Survival to discharge was 96% (23 of 24), with a single late death unrelated to the procedure. After a median follow-up period of 11.1 months, all patients were alive and well, with no residual PDA or evidence of LPA or aortic coarctation. This newly described technique can be performed safely with a high success rate and minimal procedural morbidity in EPNs. Early and midterm follow-up is encouraging. Future efforts should be directed toward developing specific devices for this unique application. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Agnieszka Prusinowska

    2016-07-01

    Full Text Available According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

  17. Left atrial appendage closure: a new technique for clinical practice.

    Science.gov (United States)

    John Camm, A; Colombo, Antonio; Corbucci, Giorgio; Padeletti, Luigi

    2014-03-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is associated with increased risk for stroke mainly due to cardiac embolism from the left atrial appendage (LAA). Occlusion of the LAA by means of a device represents a valid alternative to oral anticoagulation, mainly in patients who cannot tolerate this therapy because of a high bleeding risk. Recent data on the endocardial device WATCHMAN show encouraging results for this patient population in terms of stroke risk reduction compared to the expected rate as well as in terms of implant success. This article reviews all relevant publications related to the main surgical and transcatheter devices used for LAA closure (LAAC). PROTECT-AF, the first prospective randomized trial conducted on this technique, showed that LAA occlusion using the WATCHMAN was noninferior to warfarin for a combined end-point in patients with nonvalvular AF. There is a lack of large-scale randomized trials on long-term stroke risk in patients submitted to LAAC. Most studies are relatively small and focus on the comparison of different surgical techniques with regard to complete/incomplete closure success. More recently, PROTECT-AF long-term results (4-year follow-up) demonstrated that LAAC was statistically superior to warfarin in terms of efficacy. This review concludes that it is now appropriate to consider these techniques for patients with AF who are at high risk for stroke for whom effective conventional or novel anticoagulant therapy is not available or who present problems in managing drug treatment. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Surgical management of pilonidal sinus patients by primary and secondary repair methods: a comparative study

    Directory of Open Access Journals (Sweden)

    Haji Barati B

    2010-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Gross difference in return to work exists in pilonidal sinus patients operated by primary and secondary repair. This survey was to evaluate the results of surgical management of pilonidal sinus with primary or secondary closure."n"nMethods: In a randomized clinical trial, patients with pilonidal sinus referring to the surgical clinic of Shariati Hospital in Tehran, Iran between March 2007 and March 2009 were underwent either excision with midline closure (primary, n=40, or excision without closure (secondary, n=40. The recorded outcomes were hospital stay, healing time, time off work, postoperative pain, patient's satisfaction and the recurrence rate."n"nResults: Majority of the patients were male (87.50%. There was no significant difference in the hospital stay. Time off work (8.65±1.73 Vs. 11.53±2.33 days, p=0.001 and healing time (3.43±0.92 Vs. 5.3±0.79 days, p=0.001 were shorter in primary group; but, there were no significant differences in hospital stay and number of visits. Intensity of postoperative pain in the 1st (37.75±6.5 Vs. 43.63±5.06, p=0.001, 2nd (26.75±6.66 Vs. 34.63±5.48, p=0.001, 3rd (18.25±6.05 Vs. 27.88±6.88, p=0.001, and 7th (8.45±3.85 Vs. 17.88±6.19, p=0.001 days were

  19. Surgical Ligation of Patent Ductus Arteriosus in Very-low-birth-weight Premature Infants in the Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Yu-Chen Ko

    2009-01-01

    Full Text Available This study reported our experience of bedside patent ductus arteriosus (PDA ligation for prematurity in the neonatal intensive care unit (NICU. Between April 1992 and March 2006, 41 very-low-birth-weight premature infants underwent PDA ligation in the NICU. There were 18 male and 23 female infants. The mean gestational age and birth weight were 26.9 weeks and 900.9 g, respectively. Preoperatively, 25 infants were ventilator-dependent. After operation, there were five deaths caused by complications of prematurity. Surgical complications occurred in four and all recovered well after treatment. Twenty preoperatively intubated babies survived and were extubated at 21.6 ± 12.7 days postoperatively. In conclusion, bedside PDA ligation in the NICU is safe and effective. It can avoid transportation of critically ill, very small infants. We suggest surgical closure as the primary treatment in very-low-birth-weight infants who are ventilator-dependent to avoid the possible complications of indomethacin and prolonged intubation.

  20. Sustained long-term benefit of patent foramen ovale closure on migraine.

    Science.gov (United States)

    Trabattoni, Daniela; Fabbiocchi, Franco; Montorsi, Piero; Galli, Stefano; Teruzzi, Giovanni; Grancini, Luca; Gatto, Pamela; Bartorelli, Antonio L

    2011-03-01

    This single-center, observational, prospective study evaluated the impact of patent foramen ovale (PFO) closure on migraine attacks over time. PFO closure may reduce the frequency and severity of migraine headaches in patients with significant right-to-left shunts. Between May 2000 and September 2009, 305 consecutive patients (mean age, 43 ± 12 years; 54.5% women) with a prior embolic cerebrovascular event underwent PFO closure with the Amplatzer PFO occluder for recurrence prevention. All patients had right-to-left shunts; the shunts were associated with migraine symptoms in 77 (25%), either alone (n = 64, 83%) or with aura (n = 13, 17%). Septal aneurysm was present in 15 (19.5%) migraine patients, and 43 (56%) had a previous transient brain ischemic attack. All migraine patients had a computed tomography scan or magnetic resonance imaging, indicating a previous brain ischemic lesion. All 305 patients underwent transthoracic echocardiography with clinical follow-up at 24 hr, at 3, 6, and 12 months, and then yearly. An acute migraine attack occurred 24-48 hr after PFO closure in 28 (36.4%) of 77 patients. There was a significant reduction (>50%) in the number and intensity of attacks in 46 (60.5%) of 77 patients at the 3-month follow-up. At the 12-month follow-up, migraine had ceased in 23 (46%) patients, and 20 (40%) had a reduction in the migraine recurrence rate and disabling symptoms. These results were maintained at follow-up (mean, 28 ± 27 months). There was overall improvement in migraine in 89% of the treated patients. Percutaneous PFO closure in migraineurs may provide beneficial mid-term and long-term results, with significant reduction in the intensity and frequency of headache symptoms. Copyright © 2010 Wiley-Liss, Inc.

  1. Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices.

    Science.gov (United States)

    McKellar, Stephen H; Deo, Salil; Daly, Richard C; Durham, Lucian A; Joyce, Lyle D; Stulak, John M; Park, Soon J

    2014-01-01

    A competent aortic valve is essential to providing effective left ventricular assist device support. We have adopted a practice of central aortic valve closure by placing a simple coaptation stitch at left ventricular assist device implantation in patients with significant aortic insufficiency. We conducted a follow-up study to evaluate the efficacy and durability of this procedure. The study included patients who had undergone continuous flow left ventricular assist device implantation. The patients were divided into 2 groups, those who did not require any aortic procedure because the valve was competent and those who underwent central aortic valve closure for mild or greater aortic regurgitation. The clinical endpoints were mortality, progression or recurrence of aortic insufficiency, and reoperation for aortic valve pathologic features. Aortic insufficiency was measured qualitatively from mild to severe on a scale of 0 to 5. A total of 123 patients received continuous flow left ventricular assist devices from February 2007 to August 2011. Of those, 18 (15%) underwent central aortic valve closure at left ventricular assist device implantation because of significant aortic insufficiency (1.8 ± 1.4) and 105 who did not (competent aortic valve, 0.15 ± 0.43; P assist device-supported patients, with follow-up extending into 2 years. Although aortic insufficiency progressed over time in those with minimal native valve regurgitation initially, no such progression was noted in those with central aortic valve closure. Additional investigation is needed to evaluate whether prophylactic central aortic valve closure should be performed at left ventricular assist device implantation to avoid problematic aortic regurgitation developing over time, in particular in patients undergoing left ventricular assist device implantation for life-long (destination therapy) support. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights

  2. 2101-M pond closure plan

    International Nuclear Information System (INIS)

    1993-06-01

    This document describes activities for the closure of a surface impoundment (2101-M Pond) at the Hanford Site. The 2101-H Pond was initially constructed in 1953 to serve as a drainage collection area for the 2101-H Building. (Until the Basalt Waste Isolation Project (BWIP) Laboratory was constructed in the 2101-M Building in 1979--1981, the only source contributing discharge to the pond was condensate water from the 2101-H Building heating, ventilation, and air conditioning (HVAC) system. The drains for the BWIP Laboratory rooms were plumbed into a 4-in., cast-iron, low-pressure drain pipe that carries waste water from the HVAC system to the pond. During the active life of the BWIP Laboratory, solutions of dissolved barium in groundwater samples were discharged to the 2101-M Pond via the laboratory drains. As a result of the discharges, a Part A permit application was initially submitted to the Washington State Department of Ecology (Ecology) in August 1986 which designates the 2101-M Pond as a surface impoundment

  3. Efficacy of Paracetamol in Closure of Ductus Arteriosus in Infants under 32 Weeks of Gestation

    Directory of Open Access Journals (Sweden)

    Ines Tofe

    2018-02-01

    Full Text Available BackgroundStandard medical treatment for patent ductus arteriosus (PDA closure has been indomethacin/ibuprofen or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of this study was to present our experience with intravenous paracetamol for closing PDA in preterm neonates presenting contraindication to ibuprofen or ibuprofen had failed and no candidates for surgical ligation because of huge instability.Materials and methodsWe conducted a retrospective case series study in a neonatal intensive care unit from a tertiary hospital. 9 preterm infants ≤32 weeks of gestational age with hemodynamically significant PDA (hsPDA were enrolled. They received 15 mg/kg/6h intravenous paracetamol for ductal closure. Demographic data and transaminase levels before and after treatment were collected.Results30 preterm babies were diagnosed of hsPDA. 11/30 received ibuprofen with closure in 81.1%. 9 received intravenous paracetamol mainly due to bleeding disorders or thrombocytopenia. Successful closure on paracetamol was achieved in seven of nine babies (77.7%. There was a significant increase in transaminase levels in two patients. They required no treatment for normalization.ConclusionParacetamol is an effective option in closure PDA. It should be a first-line therapeutic option when there are contraindications for ibuprofen treatment. Transaminases must be checked during treatment.

  4. Reliability assessment of underground shaft closure

    International Nuclear Information System (INIS)

    Fossum, A.F.; Munson, D.E.

    1994-01-01

    The intent of the WIPP, being constructed in the bedded geologic salt deposits of Southeastern New Mexico, is to provide the technological basis for the safe disposal of radioactive Transuranic (TRU) wastes generated by the defense programs of the United States. In determining this technological basis, advanced reliability and structural analysis techniques are used to determine the probability of time-to-closure of a hypothetical underground shaft located in an argillaceous salt formation and filled with compacted crushed salt. Before being filled with crushed salt for sealing, the shaft provides access to an underground facility. Reliable closure of the shaft depends upon the sealing of the shaft through creep closure and recompaction of crushed backfill. Appropriate methods are demonstrated to calculate cumulative distribution functions of the closure based on laboratory determined random variable uncertainty in salt creep properties

  5. 32 CFR 989.25 - Base closure and realignment.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Base closure and realignment. 989.25 Section 989... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.25 Base closure and realignment. Base closure or realignment may entail special requirements for environmental analysis. The permanent base closure...

  6. Transcatheter closure of ventricular septal defect with Occlutech Duct Occluder.

    Science.gov (United States)

    Atik-Ugan, Sezen; Saltik, Irfan Levent

    2018-04-01

    Patent ductus arteriosus occluders are used for transcatheter closure of ventricular septal defects, as well as for closure of patent ductus arteriosus. The Occlutech Duct Occluder is a newly introduced device for transcatheter closure of patent ductus arteriosus. Here, we present a case in which the Occlutech Duct Occluder was successfully used on a patient for the closure of a perimembraneous ventricular septal defect.

  7. Occupancy estimation and the closure assumption

    Science.gov (United States)

    Rota, Christopher T.; Fletcher, Robert J.; Dorazio, Robert M.; Betts, Matthew G.

    2009-01-01

    1. Recent advances in occupancy estimation that adjust for imperfect detection have provided substantial improvements over traditional approaches and are receiving considerable use in applied ecology. To estimate and adjust for detectability, occupancy modelling requires multiple surveys at a site and requires the assumption of 'closure' between surveys, i.e. no changes in occupancy between surveys. Violations of this assumption could bias parameter estimates; however, little work has assessed model sensitivity to violations of this assumption or how commonly such violations occur in nature. 2. We apply a modelling procedure that can test for closure to two avian point-count data sets in Montana and New Hampshire, USA, that exemplify time-scales at which closure is often assumed. These data sets illustrate different sampling designs that allow testing for closure but are currently rarely employed in field investigations. Using a simulation study, we then evaluate the sensitivity of parameter estimates to changes in site occupancy and evaluate a power analysis developed for sampling designs that is aimed at limiting the likelihood of closure. 3. Application of our approach to point-count data indicates that habitats may frequently be open to changes in site occupancy at time-scales typical of many occupancy investigations, with 71% and 100% of species investigated in Montana and New Hampshire respectively, showing violation of closure across time periods of 3 weeks and 8 days respectively. 4. Simulations suggest that models assuming closure are sensitive to changes in occupancy. Power analyses further suggest that the modelling procedure we apply can effectively test for closure. 5. Synthesis and applications. Our demonstration that sites may be open to changes in site occupancy over time-scales typical of many occupancy investigations, combined with the sensitivity of models to violations of the closure assumption, highlights the importance of properly addressing

  8. Surgical treatment for ectopic atrial tachycardia.

    Science.gov (United States)

    Graffigna, A; Vigano, M; Pagani, F; Salerno, G

    1992-08-01

    Atrial tachycardia is an infrequent but potentially dangerous arrhythmia which often determines cardiac enlargement. Surgical ablation of the arrhythmia is effective and safe, provided a careful atrial mapping is performed and the surgical technique is tailored to the individual focus location. Eight patients underwent surgical ablation of ectopic atrial tachycardia between 1977 and 1990. Different techniques were adopted for each patient according to the anatomical location of the focus and possibly associated arrhythmias. Whenever possible, a closed heart procedure was chosen. In 1 patient a double focal origin was found and treated by separate procedures. In 1 patient with ostium secundum atrial septal defect and atrial flutter, surgical isolation of the right appendage and the ectopic focus was performed. In all patients ectopic atrial tachycardia was ablated with maintenance of the sinoatrial and atrioventricular nodal function as well as internodal conduction. In follow-up up to December 1991, no recurrency was recorded.

  9. Special closures for steel drum shipping containers

    International Nuclear Information System (INIS)

    Bonzon, L.L.; Otts, J.V.

    1976-01-01

    The objective of this program was to develop special lid closures for typical, steel drum, radioactive material shipping containers. Previous experience and testing had shown that the existing container was adequate to withstand the required environmental tests for certification, but that the lid and closure were just marginally effective. Specifically, the lid closure failed to consistently maintain a tight seal between the container and the lid after drop tests, thus causing the package contents to be vulnerable in the subsequent fire test. Recognizing the deficiency, the United States Energy Research and Development Administration requested the development of new closure(s) which would: (1) be as strong and resistant to a drop as the bottom of the container; (2) have minimal economic impact on the overall container cost; (3) maximize the use of existing container designs; (4) consider crush loads; and (5) result in less dependence on personnel and loading procedures. Several techniques were evaluated and found to be more effective than the standard closure mechanism. Of these, three new closure techniques were designed, fabricated, and proven to be structurally adequate to provide containment when a 454-kg drum was drop tested from 9.14-m onto an unyielding surface. The three designs were: (1) a 152-mm long lid extension or skirt welded to the standard drum lid, (2) a separate inner lid, with 152-mm long skirt and (3) C-clamps used at the container-lid interface. Based upon structural integrity, economic impact, and minimal design change, the lid extension is the recommended special closure

  10. Exceptional closure of UNIQA office at CERN

    CERN Multimedia

    HR Department

    2009-01-01

    The UNIQA office at CERN will be closed from Wednesday 18 February to Friday 20 February due to painting work. During this closure, the Headquarters of UNIQA in Geneva will remain at the disposal of the members. See details https://cern.ch/chis/UNIQA_Offices.asp The CERN office will re-open on Monday 23 February according to the normal schedule. We apologise for any inconvenience caused by this closure.

  11. Vacuum-assisted closure to aid wound healing in foot and ankle surgery.

    Science.gov (United States)

    Mendonca, Derick A; Cosker, Tom; Makwana, Nilesh K

    2005-09-01

    Although vacuum-assisted closure (VAC) is a well-established technique in other surgical specialties, its use has not been established in the foot and ankle. The aims of this study were to determine if vacuum-assisted closure therapy (VAC) helps assist closure in diabetic foot ulcers and wounds secondary to peripheral vascular disease, if it helps debride wounds, and if it prevents the need for further surgery. We retrospectively reviewed 15 patients (18 wounds or ulcers) with primary diagnoses of diabetes (10 patients), chronic osteomyelitis (two patients), peripheral vascular disease (two patients), and spina bifida (one patient). Eleven of the 15 patients had serious comorbidities, such as peripheral neuropathy, renal failure, and wound dehiscence. All wounds were surgically debrided before VAC therapy was applied according to the manufacturer's instructions. The main outcome measures were time to satisfactory wound closure, changes in the wound surface area, and the need for further surgery. Satisfactory healing was achieved in 13 of the 18 wounds or ulcers at an average of 2.5 months. VAC therapy failed in five patients (five class III ulcers), three of whom required below-knee amputations. Wound or ulcer size decreased from an average of 7.41 cm(2) before treatment to an average of 1.58 cm(2) after treatment. VAC therapy is a useful adjunct to the standard treatment of chronic wound or ulcers in patients with diabetes or peripheral vascular disease. Its use in foot and ankle surgery leads to a quicker wound closure and, in most patients, avoids the need for further surgery.

  12. A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.

    Science.gov (United States)

    Hattori, Yasunori; Doi, Kazuteru; Ikeda, Keisuke; Estrella, Emmanuel P

    2006-01-01

    To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. Therapeutic, Level III.

  13. 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.

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

    International Nuclear Information System (INIS)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee

    2016-01-01

    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

  15. ASD Closure in Structural Heart Disease.

    Science.gov (United States)

    Wiktor, Dominik M; Carroll, John D

    2018-04-17

    While the safety and efficacy of percutaneous ASD closure has been established, new data have recently emerged regarding the negative impact of residual iatrogenic ASD (iASD) following left heart structural interventions. Additionally, new devices with potential advantages have recently been studied. We will review here the potential indications for closure of iASD along with new generation closure devices and potential late complications requiring long-term follow-up. With the expansion of left-heart structural interventions and large-bore transseptal access, there has been growing experience gained with management of residual iASD. Some recently published reports have implicated residual iASD after these procedures as a potential source of diminished clinical outcomes and mortality. Additionally, recent trials investigating new generation closure devices as well as expanding knowledge regarding late complications of percutaneous ASD closure have been published. While percutaneous ASD closure is no longer a novel approach to managing septal defects, there are several contemporary issues related to residual iASD following large-bore transseptal access and new generation devices which serve as an impetus for this review. Ongoing attention to potential late complications and decreasing their incidence with ongoing study is clearly needed.

  16. Fenestrated Transcatheter ASD Closure in Adults with Diastolic Dysfunction and/or Pulmonary Hypertension: Case Series and Review of the Literature.

    Science.gov (United States)

    Abdelkarim, Ayman; Levi, Daniel S; Tran, Bao; Ghobrial, Joanna; Aboulhosn, Jamil

    2016-12-01

    This study aims to evaluate the safety and efficacy of transcatheter fenestrated ASD closure and to summarize the literature regarding the published techniques and outcomes of transcatheter partial ASD closure. Patients with left ventricular diastolic dysfunction (LVDD) or right ventricular (RV) dysfunction and/or pulmonary hypertension (PHT) may suffer untoward consequences of complete closure of an ostium secundum atrial septal defect (ASD). Therefore, for patients that fall under these categories we suggest partial occlusion of the defect, which may be better tolerated than complete defect closure. After obtaining IRB approval, a search for patients that have undergone percutaneous ASD closure was performed in the Ahmanson/UCLA Adult Congenital Heart Disease Center database to identify which patients received a fenestrated ASD closure device. Eight consecutive patients ranging between 22 and 83 years of age (mean 48 years) with PHT and/or LVDD or RV dysfunction who underwent fenestrated transcatheter ASD closure at UCLA were identified. None of the subjects experienced complications related to the procedure. Postprocedure clinical evaluation showed improvement in symptoms and exercise capacity. Available follow-up transthoracic echocardiography data (mean 4 months, range 0-20 months) demonstrated patent fenestrations in four of eight patients. None of the patients had thromboembolic or infectious complications and there were no device migrations, erosions or embolizations. Partial ASD occlusion in patients with diastolic dysfunction or RV dysfunction and/or PHT is safe and may be better tolerated than complete ASD closure in selected patients. © 2016 Wiley Periodicals, Inc.

  17. 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.

  18. Association of PTP1B with Outcomes of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy.

    Science.gov (United States)

    Rivera Franco, Monica M; Leon Rodriguez, Eucario; Martinez Benitez, Braulio; Villanueva Rodriguez, Luisa G; de la Luz Sevilla Gonzalez, Maria; Armengol Alonso, Alejandra

    2016-01-01

    PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR). Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5%) and overexpression (≥5%). Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR ( P = 0.2). However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens ( P = 0.02). Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B over-expression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  19. Association of PTP1B with Outcomes of Breast Cancer Patients who Underwent Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Monica M. Rivera Franco

    2016-01-01

    Full Text Available PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR. Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5% and overexpression (≥5%. Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR (P = 0.2. However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens (P = 0.02. Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B overexpression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

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

    Science.gov (United States)

    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.

  1. Determination of auto-antibodies to native and oxidized low-density lipoproteins (LDL) in serum of patients underwent coronariography in the Medical-Surgical Research Center (MSRC)

    International Nuclear Information System (INIS)

    Conde CerdeiraI, Hector; Soto Lopez, Yosdel; Aroche Aportela, Ronald

    2010-01-01

    Low-density lipoprotein (LDL) oxidation is an important event in atherosclerosis development. The relationship between oxidized LDL (oxLDL) autoantibodies and coronary artery disease (CAD) remains controversial. IgM and IgG autoantibodies to oxLDL were measured in twenty patients undergoing clinically indicated coronary angiography, and in ten young healthy volunteers from the Center of Molecular Immunology. The levels of IgM autoantibodies to oxLDL did not differ between no CAD patients and healthy subjects, but the levels of IgM autoantibodies to oxLDL of these two groups were higher compared with the one of CAD patient group. Our results, although preliminary, supports the hypothesis that this kind of Abs might be inversely associated with the presence of atherosclerosis

  2. Long-term progress of six cases of malignant peripheral nerve sheath tumors of the mediastinum that underwent surgical treatment: Case report series

    Directory of Open Access Journals (Sweden)

    Yuki Nakajima

    2016-01-01

    Discussion and conclusions: Nerve sheath tumors localized within the membrane offer good long-term prognosis even if malignant. Furthermore, long-term survival is possible even if the tumor has invaded neighboring organs, provided it can be completely excised. In cases where complete excision is difficult, a multidisciplinary approach including radiotherapy and anti-cancer drug treatment may contribute to improved prognosis but this is a subject that requires further study.

  3. Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults.

    Science.gov (United States)

    P, Sudhakar; Jose, John; George, Oommen K

    Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook's detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77mmHg to 33mmHg;P=0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients. Copyright © 2017. Published by Elsevier B.V.

  4. Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults

    Directory of Open Access Journals (Sweden)

    Sudhakar P

    2018-03-01

    Full Text Available Background: Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. Methods: This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Results: Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years. Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix, 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days. In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014. No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. Conclusions: In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients. Keywords: Patent ductus arteriosus, Amplatzer duct occluder, Lifetech duct occluder, Cera device, Residual shunt

  5. 16. Optimal guidance of percutaneous device closure of PDA by transthoracic echocardiography

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    M. Alobaidan

    2016-07-01

    Full Text Available Patent ductus arteriosus (PDA is common congenital cardiac lesion and the most accepted way of management is transcatheter occlusion by device which is usually done under fluoroscopy guidance. Transoesophageal echo cardiography and transaortic imaging were used in adult to guide the procedure which is with certain applications in pediatric age group transthoracic echocardiography (TTE in pediatric population provides excellent images for PDA and may replace the use of fluoroscopy to guide PDA closure at least in special situations. To highlight the feasibility of device closure under guidance of TTE to be applied in sick patients who are not suitable for transfer to cardiac catheter laboratory or those with contraindication to contrast and or radiation application. 18 patients from July 2013 to May 2015 underwent TTE guidance device closure of PDA, 1 patient was excluded after device embolization which necessitate retrieval under fluoroscopy (fluoro.. Conscious sedation was used in 17 patients except 1 who was sick and already ventilated in ICU, there were 11 female and 7 male, antegrade approach was used in 10 patients with partial fluoro and retrograde approach in 8 patients without fluoro. Median age is 7 months, median weight is 8 kg (3.2–11 kg, 2 patients with renal impairment, 2 with Leukemia, median procedure time is 35 min, median fluoro. is 2.2 min, PDA size were small in 13 patients and moderate in 5, immediate closure is achieved in all. The devices were ADOI, ADOS, ADOII, Occlutech, and AVP2. Device embolization in 1 with successful retrieval and second device was used with complete closure percutaneous PDA closure under TTE guidance is feasible, safe and recommended in selected patients with certain situation.

  6. Do submucous myoma characteristics affect fertility and menstrual outcomes in patients underwent hysteroscopic myomectomy?

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    Ahmed Namazov

    2015-06-01

    Full Text Available Background: Submucous myomas may be associated with menorrhagia, infertility and dysmenorrhea. Objective: The aim of this study was to determine the long term effects of submucousal myoma resection on menorrhagia and infertility; also to detect whether the type, size, and location of myoma affect the surgical success. Materials and Methods: .Totally 98 women referred to hysteroscopy for symptomatic submucousal fibroids (menorrhagia (n=51 and infertility (n=47 between 2005- 2010 were enrolled in this historical cohort study Pregnancy rates and menstrual improvement rates were compared according to myoma characteristics (size, type and location. Results: After a mean postoperative period of 23±10 months in 51 patients with excessive bleeding, 13 had recurrent menorrhagia (25%. In Other 38 patients excessive bleeding was improved (75%. The improvement rates by location and myoma type: lower segment 100%, fundus 92%, and corpus 63%; type 0 70%, type 1 78%, type 2 80%. The mean sizes of myoma in recurred and improved patients were 23.33 mm and 29.88 mm respectively. 28 of 47 infertile women spontaneously experienced thirty pregnancies (60%. Pregnancy rates according to myoma location and type: lower segment 50%, fundus 57%, and corpus 80%; type 0 75%, type 1 62%, type 2 50%. The mean myoma size in patients who became pregnant was 30.38 mm; in patients who did not conceive was 29.95 mm. Conclusion: The myoma characetesitics do not affect improvement rates after hysteroscopic myomectomy in patients with unexplained infertility or excessive uterine bleeding.

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

    Science.gov (United States)

    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

  8. 105-DR Large Sodium Fire Facility closure activities evaluation report

    International Nuclear Information System (INIS)

    Adler, J.G.

    1996-01-01

    This report evaluates the closure activities at the 105-DR Large Sodium Fire Facility. The closure activities discussed include: the closure activities for the structures, equipment, soil, and gravel scrubber; decontamination methods; materials made available for recycling or reuse; and waste management. The evaluation compares these activities to the regulatory requirements and closure plan requirements. The report concludes that the areas identified in the closure plan can be clean closed

  9. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  10. Accelerating cleanup: Paths to closure

    International Nuclear Information System (INIS)

    1998-06-01

    This report describes the status of Environmental Management's (EM's) cleanup program and a direction forward to complete achievement of the 2006 vision. Achieving the 2006 vision results in significant benefits related to accomplishing EM program objectives. As DOE sites accelerate cleanup activities, risks to public health, the environment, and worker safety and health are all reduced. Finding more efficient ways to conduct work can result in making compliance with applicable environmental requirements easier to achieve. Finally, as cleanup activities at sites are completed, the EM program can focus attention and resources on the small number of sites with more complex cleanup challenges. Chapter 1 describes the process by which this report has been developed and what it hopes to accomplish, its relationship to the EM decision-making process, and a general background of the EM mission and program. Chapter 2 describes how the site-by-site projections were constructed, and summarizes, for each of DOE's 11 Operations/Field Offices, the projected costs and schedules for completing the cleanup mission. Chapter 3 presents summaries of the detailed cleanup projections from three of the 11 Operations/Field Offices: Rocky Flats (Colorado), Richland (Washington), and Savannah River (South Carolina). The remaining eight Operations/Field Office summaries are in Appendix E. Chapter 4 reviews the cost drivers, budgetary constraints, and performance enhancements underlying the detailed analysis of the 353 projects that comprise EM's accelerated cleanup and closure effort. Chapter 5 describes a management system to support the EM program. Chapter 6 provides responses to the general comments received on the February draft of this document

  11. Percutaneous device closure of patent ductus arteriosus with pulmonary artery hypertension: long-term results.

    Science.gov (United States)

    Vijayalakshmi, Ishwarappa Balekundri; Setty, Natraj; Narasimhan, Chitra; Singla, Vivek; Manjunath, Cholenahalli Nanjappa

    2014-12-01

    Device closure of patent ductus arteriosus (PDA) is treatment of choice. But device closure in presence of pulmonary artery hypertension (PAH) remains a challenge. Data on patient selection, technical considerations, and complications are limited. To know the challenges and efficacy of device closure of PDA with PAH. Out of 1,325 cases of device closure of PDA, 246 (18.6%) with PAH formed the study material. To test the feasibility, chosen device is used to occlude PDA for ten minutes without oxygen inhalation. The device is released only if PAH reduced. PAH decreased in all except in 1 patient after closure with muscular ventricular septal occluder (MVSDO), pulmonary artery pressure (PAP) transiently increased (became supra-systemic), without significant reduction in aortic pressure. Device embolized in 8 patients (3.3%). Percutaneous retrieval was done in 4 (by snare in 2 and by fixing the cable to device in 2) and replaced with bigger devices. The surgical removal of the embolized MVSDO and ligation was done in 4 cases. All patients were on oral sildenafil and bosentan until PAP regressed to normal. Follow up was from 6 months to 9 years. No residual shunt in any patient on follow-up. The PAP regressed to normal in all except 5 cases (2.03%) of Down's syndrome with systemic PAP. Device closure of PDA with PAH is feasible, safe in all age groups. Temporary PDA occlusion with device is effective and time saving for evaluating pulmonary vascular reactivity. Device embolization in aorta is higher with severe PAH. Novel method of retrieval is effective. © 2014, Wiley Periodicals, Inc.

  12. Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

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    Psaila Josephine

    2009-10-01

    Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

  13. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

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    Crystal L. Ramanujam

    2016-06-01

    Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

  14. Association between ambient air pollution and pregnancy rate in women who underwent IVF.

    Science.gov (United States)

    Choe, S A; Jun, Y B; Lee, W S; Yoon, T K; Kim, S Y

    2018-04-05

    Are the concentrations of five criteria air pollutants associated with probabilities of biochemical pregnancy loss and intrauterine pregnancy in women? Increased concentrations of ambient particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) during controlled ovarian stimulation (COS) and after embryo transfer were associated with a decreased probability of intrauterine pregnancy. Exposure to high ambient air pollution was suggested to be associated with low fertility and high early pregnancy loss in women. Using a retrospective cohort study design, we analysed 6621 cycles of 4581 patients who underwent one or more fresh IVF cycles at a fertility centre from January 2006 to December 2014, and lived in Seoul at the time of IVF treatment. To estimate patients' individual exposure to air pollution, we computed averages of hourly concentrations of five air pollutants including PM10, NO2, CO, sulphur dioxide (SO2) and ozone (O3) measured at 40 regulatory monitoring sites in Seoul for each of the four exposure periods: period 1 (start of COS to oocyte retrieval), period 2 (oocyte retrieval to embryo transfer), period 3 (embryo transfer to hCG test), and period 4 (start of COS to hCG test). Hazard ratios (HRs) from the time-varying Cox-proportional hazards model were used to estimate probabilities of biochemical pregnancy loss and intrauterine pregnancy for an interquartile range (IQR) increase in each air pollutant concentration during each period, after adjusting for individual characteristics. We tested the robustness of the result using generalised linear mixed model, accounting for within-woman correlation. Mean age of the women was 35 years. Average BMI was 20.9 kg/m2 and the study population underwent 1.4 IVF cycles on average. Cumulative pregnancy rate in multiple IVF cycles was 51.3% per person. Survival analysis showed that air pollution during periods 1 and 3 was generally associated with IVF outcomes. Increased NO2 (adjusted HR = 0.93, 95% CI

  15. Use of Vacuum-assisted closure in management of open abdominal wound with multiple enterocutaneous fistulae during chemotherapy: A case report

    Science.gov (United States)

    Fujino, Shiki; Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Fukata, Tadafumi; Yagi, Toshiya; Fujiwara, Yoshiyuki; Yano, Masahiko

    2015-01-01

    Introduction Vacuum-assisted closure (VAC) is useful for treating complex wounds because it promotes granulation. In the present report, a successful case of VAC used for an open abdominal wound with enterocutaneous fistulae after multiple intestinal perforations during chemotherapy is described. Presentation of case A 73-year-old man was admitted to our hospital with severe abdominal pain. He underwent surgical resection for ascending colon cancer 4 years ago and was administered chemotherapy with bevacizumab for recurrence. Physical examination and computed tomography revealed perforation of the intestine, and an emergency operation was performed. Following this procedure, other intestinal perforations occurred, resulting in an open abdominal wound at postoperative day (POD) 10. To isolate enteric contents and promote granulation, VAC was applied to the abdominal wound with enterocutaneous fistulae. Oral intake started at POD 21 and the wound size became smaller. Further, an ostomy bag was directly attached to the most oral perforation site. The patient recovered from life-threatening events without severe infection and was transferred to another hospital close to his home at POD 180. Discussion Gastrointestinal perforation is known to be one of the fatal adverse events of bevacizumab. In this case four gastrointestinal perforations were observed. Isolation of enteric contents is important to heal the wound and VAC is an effective therapy for the management of open abdominal wounds even with enterocutaneous fistulae. Conclusion Innovative VAC use for the management of open abdominal wounds can improve the nutritional status and overall wound healing of the patient. PMID:26599504

  16. 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.

  17. The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

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    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.

  18. Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment

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    Hakim Slaoui

    2014-07-01

    Full Text Available Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes.

  19. Surgical repair of idiopathic scrotal elephantiasis.

    Science.gov (United States)

    Zacharakis, Evangelos; Dudderidge, Tim; Zacharakis, Emmanouil; Ioannidis, Evangelos

    2008-02-01

    Scrotal lymphedema (scrotal elephantiasis) is uncommon outside of filariasis endemic regions. We present a case of a 65-year-old with idiopathic lymphedema of the scrotum and functional impairment of the penis. The patient underwent surgical excision of the edematous subcutaneous tissues and plastic reconstruction of his penis and scrotum. Three years later, the patient showed no signs of local recurrence, had complete restoration of urinary and sexual function and was extremely satisfied with the result. Surgical management was an effective strategy in the management of scrotal lymphedema in this case.

  20. 40 CFR 264.228 - Closure and post-closure care.

    Science.gov (United States)

    2010-07-01

    ... remaining wastes to a bearing capacity sufficient to support final cover; and (iii) Cover the surface....112 must include both a plan for complying with paragraph (a)(1) of this section and a contingent plan... practicably removed at closure; and (ii) The owner or operator must prepare a contingent post-closure plan...

  1. Factors affecting successful closure of hemodynamically significant patent ductus arteriosus with indomethacin in extremely low birth weight infants.

    Science.gov (United States)

    Yang, Chuan-Zhong; Lee, Jiun

    2008-05-01

    The incidence of patent ductus arteriosus (PDA) is high in extremely low birth weight (ELBW) infants. Indomethacin has been widely used in the prophylaxis and treatment of hemodynamically significant PDA. This retrospective study was undertaken to identify factors such as birth weight, gestational age, gender, fetal growth retardation, ductal size, timing of the first dose of indomethacin and side effects of indomethacin, which may affect the successful closure of the PDA with indomethacin in ELBW infants. A cohort of 139 ELBW infants who had received indomethacin treatment for PDA during a consecutive period of more than three years (September 2000 to December 2003) was retrospectively analyzed. Administration of indomethacin was associated with closure of PDA in 108 (77.7%) of 139 ELBW infants, and only 19.4% of infants required surgical ligation of the ductus eventually. There was no significant relationship between closure of PDA with gestational age, gender, fetal growth retardation, and ductal size. A higher birth weight and early use of indomethacin after birth could significantly increase the closure rate of PDA (P<0.05). Side effects of indomethacin such as transient oliguria and hyponatremia during indomethacin therapy did not affect PDA closure. Indomethacin is effective for the treatment of PDA in ELBW infants. A higher rate of ductal closure is related to the increase of birth weight. PDA closure with indomethacin is age-related, and early administration of indomethacin could increase PDA closure and reduce the incidence of hyponatremia. There is no significant difference in major morbidities such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) after early treatment. Early screening for hemodynamically significant PDA in ELBW infants and early treatment with indomethacin are recommended.

  2. [Surgical tactics in duodenal trauma].

    Science.gov (United States)

    Ivanov, P A; Grishin, A V

    2004-01-01

    Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

  3. Delayed closure of the palatal defect using buccal inversion and palatal rotation flaps after maxillectomy.

    Science.gov (United States)

    Jung, Seunggon; Kook, Min-Suk; Park, Hong-Ju; Oh, Hee-Kyun

    2013-03-01

    Maxillectomy leaves oronasal and oroantral defects that result in functional impairment of mastication, deglutition, and speech. Many treatment options are suggested and tried including the palatal flap as local flap. Although palatal flaps have been used to repair various oral cavity defects, they have certain limitations due to the dimensions. The amount and location of the palatal tissues available are important for palatal repair. Secondary intentional healing after maxillectomy will allow the epithelialization of the defect margin adjacent to remained palate, and there will be more mucosa that is available for closure of the defect. We delayed the closure of the palatal defect, while the patient underwent prosthetic treatment for functional recovery in 5 maxillectomy patients. Delayed closure of palatal defect with local flap was done at 10.8 ± 7.9 months after the maxillectomy. While delayed closure in hemimaxillectomy patients left postoperative fistula, it provided separation of the oral cavity and nasal/sinus cavity and adequate surface for prosthesis in partial maxillectomy patients.

  4. Are patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia satisfied with nostril closure surgery?

    Science.gov (United States)

    Ichimura, Keiichi; Kikuchi, Hisashi; Imayoshi, Shoichiro; Yamauchi, Tomohiko; Ishikawa, Kotaro

    2012-02-01

    Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation. Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities. Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery. Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  5. Tissue reactions of abdominal integuments to surgical sutures in sonography

    Directory of Open Access Journals (Sweden)

    Andrzej Smereczyński

    2014-03-01

    Full Text Available Classical abdominal surgeries usually require long incisions of the abdominal integuments followed by tight closure with adequate suturing material. Nonabsorbable sutures may cause various reactions, including granuloma reactions, both sterile and inflammatory. The aim of the study was to analyze prospective ultrasound examinations of the abdominal integuments in order to detect tissue reactions to surgical sutures. Material and methods: For 10 years, ultrasound examinations of the abdominal integuments involved the assessment of surgical scars in all patients who underwent open or closed surgeries for various reasons (in total 2254 patients. Ultrasound examinations were performed only with the use of linear probes with the frequency ranging from 7 to 12 MHz. Each scar in the abdominal integuments was scanned in at least two planes. When a lesion was detected, the image was enlarged and the transducer was rotated by approximately 180° in order to capture the dimensions of the granuloma and the most characteristic image of the suture. Moreover, vascularization of the lesion was also assessed with the use of color Doppler mode set to detect the lowest flows. Results: All granulomas (19 lesions, two in one patient created hypoechoic oval or round nodules, were relatively well-circumscribed and their size ranged from 8 × 4 mm to 40 × 14 mm. In the center of the lesion, it was possible to notice a thread that was coiled to various degrees and presented itself as a double, curved hyperechoic line. In 9 out of 19 granulomas, slight peripheral vascularization was observed. The substantial majority of the lesions (n = 15 were in contact with the fascia. In seven patients, compression with the transducer induced known local pain (n = 4 or intensified pain that had already been present (n = 3; all of these granulomas infiltrated the fascia and showed slight peripheral vascularization. Cutaneous fistulae developed in two patients with purulent

  6. Scalp Wound Closure with K wires: An alternative easier method to scalp wound closure.

    Science.gov (United States)

    Ramesh, S; Ajik, S

    2012-12-01

    Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure.

  7. First Branchial Arch Fistula: A Rarity and a Surgical Challenge.

    Science.gov (United States)

    Rajkumar, J S; Ganesh, Deepa; Anirudh, J R; Akbar, S; Joshi, Niraj

    2016-06-01

    Although 2(nd) Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1(st) arch fistulae are much rarer (branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.

  8. Quality of life in locally advanced prostate cancer patients who underwent hormonal treatment combined with radiotherapy

    International Nuclear Information System (INIS)

    Koga, Hirofumi; Naito, Seiji; Fukui, Iwao; Tsukamoto, Taiji; Matsuoka, Naoki; Fujimoto, Hiroyuki

    2004-01-01

    The aim of this study is to estimate the feasibility of quality of life (QOL) research and to evaluate the QOL prospectively in locally advanced prostate cancer patients treated with hormonal treatment combined with radiotherapy. The treatment schedule was that patients with decreasing prostatic specific antigen (PSA) levels below 10 ng/ml after receiving 6 months of neoadjuvant hormonal treatment were randomly divided into two groups; one group was the continuous hormonal treatment group and the other was the intermittent hormonal treatment group. Both groups received a total dose of 72 Gy external beam radiotherapy with concomitant hormonal treatment followed by 6 months of adjuvant hormonal treatment following radiotherapy. At 14 months, patients either underwent continuous or intermittent hormonal treatment according to the random allocation. QOL was assessed at baseline, and at 6, 8, 14, and 20 months after treatment using functional assessment of cancer treatment-general (FACT-G), P with the other 3 items comprising bother of urination, bother of bowel movement, and bother of sexual activity. Between January 2000 and June 2003, a total of 188 patients were enrolled in this study. The rate of collection of baseline QOL sheets was 98.0%. The rate of answer to questions of QOL sheets was 99.0%. At baseline, the average score of FACT-G, P was 120.7 and the maximum score was more than twice the minimum score. Dysfunction of urination and bowel movement was correlated with the bother of urination and bowel movement, respectively. On the other hand, dysfunction of sexual activity was not correlated with the bother of sexual activity. In June 2003, all of the QOL sheets at baseline, and at 6, 8, and 14 months were completely collected from a total of 72 patients. Although QOL at 8 months was significantly affected compared with QOL at baseline and at 6 months, QOL at 14 months was significantly improved compared with that at 8 months and there was no significant

  9. Vacuum-assisted closure therapy in the management of lung abscess.

    Science.gov (United States)

    Sziklavari, Zsolt; Ried, Michael; Hofmann, Hans-Stefan

    2014-09-06

    Despite significant advances in the treatment of thoracic infections, complex lung abscess remains a problem in modern thoracic surgery. We describe the novel application of vacuum-assisted closure for the treatment of a lung abscess. The technical details and preliminary results are reported. After the initial failed conservative treatment of an abscess, minimally invasive surgical intervention was performed with vacuum-assisted closure. The vacuum sponges were inserted in the abscess cavity at the most proximal point to the pleural surface. The intercostal space of the chest wall above the entering place was secured by a soft tissue retractor. The level of suction was initially set to 100 mm Hg, with a maximum suction of 125 mm Hg. The sponge was changed once on the 3rd postoperative day. The abscess cavity was rapidly cleaned and decreased in size. The mini-thoracotomy could be closed on the 9th postoperative day. Closure of the cavity was simple, without any short- or long-term treatment failure. This technique reduced the trauma associated with the procedure. The patient was discharged on the 11th postoperative day. Vacuum-assisted closure systems should be considered for widespread use as an alternative option for the treatment of complicated pulmonary abscess in elderly, debilitated, immunocompromised patients after failed conservative treatment.

  10. TOPOGRAPHIC CHANGES OF THE MACULA AFTER CLOSURE OF IDIOPATHIC MACULAR HOLE.

    Science.gov (United States)

    Pak, Kang Yeun; Park, Keun Heung; Kim, Kyong Ho; Park, Sung Who; Byon, Ik Soo; Kim, Hyun Woong; Chung, In Young; Lee, Joo Eun; Lee, Sang Joon; Lee, Ji Eun

    2017-04-01

    To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2-4 mm and outer; 4-6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. The average displacement was 57.2 μm at an angle of -3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 μm) than in the outer ring (35.3 μm, P macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

  11. Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures.

    Science.gov (United States)

    Aguiar, Arthur Almeida; Lima, Luciana Cavalvanti; Araújo, Cláudia Corrêa de; Gallindo, Rodrigo Melo

    2017-12-29

    To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease. Copyright © 2017. Published by Elsevier Editora Ltda.

  12. Stomal Closure: Strategies to Prevent Incisional Hernia

    Science.gov (United States)

    Harries, Rhiannon L.; Torkington, Jared

    2018-01-01

    Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias. PMID:29670882

  13. Closure of shallow underground injection wells

    International Nuclear Information System (INIS)

    Veil, J.A.; Grunewald, B.

    1993-01-01

    Shallow injection wells have long been used for disposing liquid wastes. Some of these wells have received hazardous or radioactive wastes. According to US Environmental Protection Agency (EPA) regulations, Class IV wells are those injection wells through which hazardous or radioactive wastes are injected into or above an underground source of drinking water (USDW). These wells must be closed. Generally Class V wells are injection wells through which fluids that do not contain hazardous or radioactive wastes are injected into or above a USDW. Class V wells that are responsible for violations of drinking water regulations or that pose a threat to human health must also be closed. Although EPA regulations require closure of certain types of shallow injection wells, they do not provide specific details on the closure process. This paper describes the regulatory background, DOE requirements, and the steps in a shallow injection well closure process: Identification of wells needing closure; monitoring and disposal of accumulated substances; filling and sealing of wells; and remediation. In addition, the paper describes a major national EPA shallow injection well enforcement initiative, including closure plan guidance for wells used to dispose of wastes from service station operations

  14. Stomal Closure: Strategies to Prevent Incisional Hernia

    Directory of Open Access Journals (Sweden)

    Rhiannon L. Harries

    2018-04-01

    Full Text Available Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.

  15. Strategic Planning for Hot Cell Closure

    International Nuclear Information System (INIS)

    LANGSTAFF, D.C.

    2001-01-01

    The United States Department of Energy (DOE) and its contractor were remediating a large hot cell complex to mitigate the radiological hazard. A Resource Conservation and Recovery Act (RCRA) closure unit was determined to be located within the complex. The regulator established a challenge to develop an acceptable closure plan on a short schedule (four months). The scope of the plan was to remove all excess equipment and mixed waste from the closure unit, establish the requirements of the legally binding Closure Plan and develop an acceptable schedule. The complex has several highly radioactive tanks, tank vaults, piping, and large hot cells containing complex chemical processing equipment. Driven by a strong need to develop an effective strategy to meet cleanup commitments, three principles were followed to develop an acceptable plan: (1) Use a team approach, (2) Establish a buffer zone to support closure, and (3) Use good practice when planning the work sequence. The team was composed of DOE, contractor, and Washington State Department of Ecology (Regulator) staff. The team approach utilized member expertise and fostered member involvement and communication. The buffer zone established an area between the unregulated parts of the building and the areas that were allegedly not in compliance with environmental standards. Introduction of the buffer zone provided simplicity, clarity, and flexibility into the process. Using good practice means using the DOE Integrated Safety Management Core Functions for planning and implementing work safely. Paying adequate attention to detail when the situation required contributed to the process credibility and a successful plan

  16. Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures.

    Science.gov (United States)

    Cardenas-Camarena, Lazaro; Dorado, Carlos; Guerrero, Maria Teresa; Nava, Rosa

    2017-06-01

    Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients. From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications. Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications. All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: 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 .

  17. 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.

  18. Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis. Studies in patients with WPW syndrome who underwent surgery

    Energy Technology Data Exchange (ETDEWEB)

    Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

    1987-09-01

    Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.).

  19. Morbid Obesity with Achalasia: A Surgical Challenge

    OpenAIRE

    Hagen, Monika E.; Sedrak, Micheal; Wagner, Oliver J.; Jacobsen, Garth; Talamini, Mark; Horgan, Santiago

    2010-01-01

    Achalasia is a relatively rare medical condition that is classically not associated with obesity. The surgical treatment of a simultaneous occurrence of these two diseases requires careful consideration, and only a few reports can be found in the literature combining a Heller myotomy with gastric bypass, duodenal switch, or gastric banding. We report the case of a 69-year-old female patient with early achalasia and obesity who underwent simultaneous laparoscopic gastric sleeve resection and r...

  20. Biological constraints do not entail cognitive closure.

    Science.gov (United States)

    Vlerick, Michael

    2014-12-01

    From the premise that our biology imposes cognitive constraints on our epistemic activities, a series of prominent authors--most notably Fodor, Chomsky and McGinn--have argued that we are cognitively closed to certain aspects and properties of the world. Cognitive constraints, they argue, entail cognitive closure. I argue that this is not the case. More precisely, I detect two unwarranted conflations at the core of arguments deriving closure from constraints. The first is a conflation of what I will refer to as 'representation' and 'object of representation'. The second confuses the cognitive scope of the assisted mind for that of the unassisted mind. Cognitive closure, I conclude, cannot be established from pointing out the (uncontroversial) existence of cognitive constraints. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Hanford Patrol Academy demolition sites closure plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-30

    The Hanford Site is owned by the U.S. Government and operated by the U.S. Department of Energy, Richland Operations Office. Westinghouse Hanford Company is a major contractor to the U.S. Department of Energy, Richland Operations Office and serves as co-operator of the Hanford Patrol Academy Demolition Sites, the unit addressed in this paper. This document consists of a Hanford Facility Dangerous Waste Part A Permit Application, Form 3 (Revision 4), and a closure plan for the site. An explanation of the Part A Form 3 submitted with this closure plan is provided at the beginning of the Part A section. This Hanford Patrol Academy Demolition Sites Closure Plan submittal contains information current as of December 15, 1994.

  2. Development of an arid site closure plan

    International Nuclear Information System (INIS)

    Nyhan, J.W.; Barnes, F.J.

    1987-01-01

    This document describes the development of a prototype plan for the effective closure and stabilization of an arid low-level waste disposal site. This plan will provide demonstrated closure techniques for a trench in a disposal site at Los Alamos. The accuracy of modeling soil water storage by two hydrologic models, CREAMS and HELP, was tested by comparing simulation results with field measurements of soil moisture in eight experimental landfill cover systems having a range of well-defined soil profiles and vegetative covers. Regression analysis showed that CREAMS generally represented soil moisture more accurately than HELP simulations. Precautions for determining parameter values for model input and for interpreting simulation results are discussed. A specific example is presented showing how the field-validated hydrologic models can be used to develop a final prototype closure plan. 15 refs., 13 figs., 3 tabs

  3. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

    Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn

    2016-01-01

    incision between January 1995 and June 2012 were reviewed. Horses with a laryngotomy incision closed in three layers for primary healing were included. Descriptive data on healing characteristics and complications of laryngotomy wounds were collected from the medical records and via follow......The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....

  4. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  5. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  6. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...

  7. Hamiltonian closures in fluid models for plasmas

    Science.gov (United States)

    Tassi, Emanuele

    2017-11-01

    This article reviews recent activity on the Hamiltonian formulation of fluid models for plasmas in the non-dissipative limit, with emphasis on the relations between the fluid closures adopted for the different models and the Hamiltonian structures. The review focuses on results obtained during the last decade, but a few classical results are also described, in order to illustrate connections with the most recent developments. With the hope of making the review accessible not only to specialists in the field, an introduction to the mathematical tools applied in the Hamiltonian formalism for continuum models is provided. Subsequently, we review the Hamiltonian formulation of models based on the magnetohydrodynamics description, including those based on the adiabatic and double adiabatic closure. It is shown how Dirac's theory of constrained Hamiltonian systems can be applied to impose the incompressibility closure on a magnetohydrodynamic model and how an extended version of barotropic magnetohydrodynamics, accounting for two-fluid effects, is amenable to a Hamiltonian formulation. Hamiltonian reduced fluid models, valid in the presence of a strong magnetic field, are also reviewed. In particular, reduced magnetohydrodynamics and models assuming cold ions and different closures for the electron fluid are discussed. Hamiltonian models relaxing the cold-ion assumption are then introduced. These include models where finite Larmor radius effects are added by means of the gyromap technique, and gyrofluid models. Numerical simulations of Hamiltonian reduced fluid models investigating the phenomenon of magnetic reconnection are illustrated. The last part of the review concerns recent results based on the derivation of closures preserving a Hamiltonian structure, based on the Hamiltonian structure of parent kinetic models. Identification of such closures for fluid models derived from kinetic systems based on the Vlasov and drift-kinetic equations are presented, and

  8. A kinematic view of loop closure.

    Science.gov (United States)

    Coutsias, Evangelos A; Seok, Chaok; Jacobson, Matthew P; Dill, Ken A

    2004-03-01

    We consider the problem of loop closure, i.e., of finding the ensemble of possible backbone structures of a chain segment of a protein molecule that is geometrically consistent with preceding and following parts of the chain whose structures are given. We reduce this problem of determining the loop conformations of six torsions to finding the real roots of a 16th degree polynomial in one variable, based on the robotics literature on the kinematics of the equivalent rotator linkage in the most general case of oblique rotators. We provide a simple intuitive view and derivation of the polynomial for the case in which each of the three pair of torsional axes has a common point. Our method generalizes previous work on analytical loop closure in that the torsion angles need not be consecutive, and any rigid intervening segments are allowed between the free torsions. Our approach also allows for a small degree of flexibility in the bond angles and the peptide torsion angles; this substantially enlarges the space of solvable configurations as is demonstrated by an application of the method to the modeling of cyclic pentapeptides. We give further applications to two important problems. First, we show that this analytical loop closure algorithm can be efficiently combined with an existing loop-construction algorithm to sample loops longer than three residues. Second, we show that Monte Carlo minimization is made severalfold more efficient by employing the local moves generated by the loop closure algorithm, when applied to the global minimization of an eight-residue loop. Our loop closure algorithm is freely available at http://dillgroup. ucsf.edu/loop_closure/. Copyright 2004 Wiley Periodicals, Inc. J Comput Chem 25: 510-528, 2004

  9. Transcatheter closure of patent ductus arteriosus: 11 years of clinical experience in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

    Science.gov (United States)

    Djer, Mulyadi M; Saputro, Dimas Dwi; Putra, Sukman Tulus; Idris, Nikmah Salamia

    2015-06-01

    Transcatheter closure of patent ductus arteriosus (PDA) has been suggested to be the standard treatment of PDA. Although, in general, the procedure shows a high successful rate, outcomes may vary among pediatric cardiology centers. To evaluate the effectiveness of transcatheter closure of PDA in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, this was a retrospective study on patients who underwent transcatheter closure of PDA in Cipto Mangunkusumo Hospital during the period of 2002-2013. Hospital registry was reviewed and data about patients' characteristics, PDA severity, procedure, and outcomes were retrieved. There were 298 patients, of whom 90 were males, who underwent transcatheter closure of PDA during the study period. Median age was 3.4 years (1 months-18 years), and median body weight was 12 (3.6-59) kg. The diameter of PDA ranged from 1.1 to 15.4 mm with a median of 3.7 mm. Device could be deployed in all patients, in which most were the Amplatzer ductal occluder (69.8 %) and the remainders were coils. Median fluoroscopy time was 15.4 (1.5-87) min, and procedure time was 76 (30-200) min. Complete closure was achieved in most patients (97.3 %), whereas device migration occurred in a minority (0.3 %) of patients. No major complication occurred during or after the procedure. Transient anemia and bradycardia were found in 3.7 and 1.3 % patients, respectively. Most patients were discharged from the hospital at 1 day after the procedure. Transcatheter closure method is a safe and effective procedure to close PDA.

  10. Reactor vessel closure head replacements in 1997

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    The Framatome-Jeumont Industrie consortium have completed in 1997 28 reactor vessel (RV) closure head replacements, including five on 1300 MWe class PWR units. Framatome manages the operations and handles removal and reinstallation of equipment (not including the control rod drive mechanisms (CRDM)) and the requalification tests, while JI, which manufactures the CRDMs, is involved in the CRDM cutting, re-machining and welding operations, using tools of original design, in order to optimize the RV closure head operation in terms of costs, schedule and dosage

  11. Closure properties of Watson-Crick grammars

    Science.gov (United States)

    Zulkufli, Nurul Liyana binti Mohamad; Turaev, Sherzod; Tamrin, Mohd Izzuddin Mohd; Azeddine, Messikh

    2015-12-01

    In this paper, we define Watson-Crick context-free grammars, as an extension of Watson-Crick regular grammars and Watson-Crick linear grammars with context-free grammar rules. We show the relation of Watson-Crick (regular and linear) grammars to the sticker systems, and study some of the important closure properties of the Watson-Crick grammars. We establish that the Watson-Crick regular grammars are closed under almost all of the main closure operations, while the differences between other Watson-Crick grammars with their corresponding Chomsky grammars depend on the computational power of the Watson-Crick grammars which still need to be studied.

  12. Straight line closure of congenital macrostomia

    Directory of Open Access Journals (Sweden)

    Schwarz Richard

    2004-01-01

    Full Text Available The results of patients operated on by Nepal Cleft Lip and Palate Association (NECLAPA surgeons for congenital macrostomia were prospectively studied between January 2000 and December 2002. There were four males and three females with a median age of 10 years. Three had an associated branchial arch syndrome. In all patients an overlapping repair of orbicularis oris was done. Six patients had a straight line closure with excellent cosmetic results and one a Z-plasty with a more obvious scar. All had a normal appearing commissure. Overlapping orbicularis repair with straight line skin closure for this rare congenital anomaly is recommended.

  13. Environmental considerations in mine closure planning

    International Nuclear Information System (INIS)

    Ricks, G.

    1997-01-01

    Mine closure planning considers the best ways to plan and manage the environmental changes and socio-economic effects associated with the closing of mines. While the criteria for judging successful closures may vary, it is particularly important for physical, chemical and biological stability to be achieved and for final land use to be appropriate. Trust funds are increasingly favoured as a practical means of fulfilling the requirement for a financial surety and of ensuring that financial provision is available at the end of the mine's life. (author)

  14. Uncertainty Quantification of Multi-Phase Closures

    Energy Technology Data Exchange (ETDEWEB)

    Nadiga, Balasubramanya T. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Baglietto, Emilio [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States)

    2017-10-27

    In the ensemble-averaged dispersed phase formulation used for CFD of multiphase ows in nuclear reactor thermohydraulics, closures of interphase transfer of mass, momentum, and energy constitute, by far, the biggest source of error and uncertainty. Reliable estimators of this source of error and uncertainty are currently non-existent. Here, we report on how modern Validation and Uncertainty Quanti cation (VUQ) techniques can be leveraged to not only quantify such errors and uncertainties, but also to uncover (unintended) interactions between closures of di erent phenomena. As such this approach serves as a valuable aide in the research and development of multiphase closures. The joint modeling of lift, drag, wall lubrication, and turbulent dispersion|forces that lead to tranfer of momentum between the liquid and gas phases|is examined in the frame- work of validation of the adiabatic but turbulent experiments of Liu and Banko , 1993. An extensive calibration study is undertaken with a popular combination of closure relations and the popular k-ϵ turbulence model in a Bayesian framework. When a wide range of super cial liquid and gas velocities and void fractions is considered, it is found that this set of closures can be validated against the experimental data only by allowing large variations in the coe cients associated with the closures. We argue that such an extent of variation is a measure of uncertainty induced by the chosen set of closures. We also nd that while mean uid velocity and void fraction pro les are properly t, uctuating uid velocity may or may not be properly t. This aspect needs to be investigated further. The popular set of closures considered contains ad-hoc components and are undesirable from a predictive modeling point of view. Consequently, we next consider improvements that are being developed by the MIT group under CASL and which remove the ad-hoc elements. We use non-intrusive methodologies for sensitivity analysis and calibration (using

  15. Special closure for radioactive shipping container

    International Nuclear Information System (INIS)

    Otts, J.V.

    1976-03-01

    The objective of this program was to develop a special lid closure for radioactive material shipping containers, typically steel drums. Three closure techniques were designed, fabricated, and proven to be structurally adequate to protect 1000 lb when dropped 30 ft. The three designs were (1) a 6-in. lid extension (skirt), (2) a 6-in. inner lid, and (3) c-clamps used at the container/lid interface. Based upon structural integrity, economic impact, and minimal design change, the 6-in. lid extension is recommended

  16. Primary closure of lawn mower injuries to the foot: a case series.

    Science.gov (United States)

    Goldsmith, Jon R; Massa, Eric G

    2007-01-01

    The standard initial treatment of lawn mower injuries to the foot consists of prompt administration of parenteral antibiotics, debridement of devitalized tissue, irrigation, repair of traumatized vascular structures, and stabilization of osseous fractures. The primary closure of these wounds at the initial operation is a controversial concept. The authors performed a retrospective study of 9 lawn mower injuries in which primary closure was performed. Medical records were evaluated, and 7 patients were reached for follow-up interviews. The hospital courses for this patient population were remarkably lower than those previously reported in the literature. No patient required further admission to the hospital or surgical intervention. The postinjury functional evaluation mean score was 97.6%. The results demonstrate that this treatment method can be an effective means for treating this mutilating injury in the foot.

  17. 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

  18. [Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II].

    Science.gov (United States)

    Parra-Bravo, José Rafael; Osuna-Izaguirre, Manuel Alfredo; Beirana-Palencia, Luisa; Gálvez-Cancino, Franco; Martínez-Monterrosas, Christian; Lazo-Cárdenas, César; Reyes-Vargas, César

    2014-01-01

    In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7kg (range 6-16.3kg). The minimal ductus arteriosus diameter was 2.7mm (1-5mm). Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4mm (3 patients), in 2 patients were used 3-4mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  19. Percutaneous closure of postoperative ventricular septal residual left-to-right shunt with the China made device

    International Nuclear Information System (INIS)

    Qin Yongwen; Zhao Xianxian; Wu Hong; Ding Jijun; Cao Jiang; Zheng Xin

    2007-01-01

    Objective: To evaluate the feasibility and efficacy of percutaneous transcatheter closure of residual ventricular septal defect (VSD)after surgical closure using China made-nitinol VSD device. Methods: Transcatheter closure was attempted in 11 patients (5 males, 6 females)with a residual VSD following surgical closure. The mean residual VSD narrowest diameter was(5.82 ± 2.09) mm (range from 3 to 9 mm)by echocardiography. A 6 F-9 F delivery sheath was advanced across the residual VSD over a guidewire from femoral vein to deploy the occluder under guidance of left ventriculography and transthoracic echocardiography. Results: The left ventriculography showed membranous part aneurism-like residual VSD in 8 patients and funnel type in 3 cases. There were multiple outlet in 5 cases and one outlets in 6 cases, with mean residual VSD narrowest diameter of (6.09 ± 1.58) mm (range from 3 to 9 mm)measured by left ventriculography. The diameter of occluder was (9.18 ± 2.79) mm (range from 8 to 12 mm). Complete closure of the defect was obtained in 10 cases, and another small residual shunt still remained in one case who had four outlets been treated by 2 occluders. No aortic valvular regurgitation occured in all patients except 1 patient presented complete atrioventricular block within 3 days after the procedure and recovered 2 weeks later with intravenous steroids therapy; and no other complications occured. The fluoroscopy time was(16.91 ± 4.23) min (range from 8 to 30 min). During follow-up from 1 m - 4 y, only 1 case showed residual shunt, and the other had no episodes of endocarditis, thromboembolism, hemolysis, infectious endocarditis, displacement of the occluder and aortic valvular regurgitation. Conclusion: Transcatheter closure of postoperative ventricular septal residual left-to-right shunt with China made-nitinol occluder is safe and effective. (authors)

  20. A novel approach for the closure of challenging giant omphalocele

    Directory of Open Access Journals (Sweden)

    Barkat Ali

    2015-11-01

    Full Text Available Omphalocele is a congenital condition characterized by midline defect of the anterolateral abdominal wall whereby intra-abdominal contents covered by peritoneal sac are found herniated. It can be defined by size of defect or visceral contents. There are various ways of surgical management of omphalocele. Giant omphalocele presents particular challenge in reconstructing the abdominal wall. In this regard the use of tissues expansion as an adjunct in an attempt to recreate functional abdominal wall domain has been emerging. We are presenting a case of giant omphalocele that was closed with the help of extra peritoneal inter muscular tissue expanders.The patient was born at 37 weeks to a 33 year old healthy gravida 3, para 0 G3P0 mother via planned cesarean section. There were no prenatal, natal or postnatal complications. The giant omphalocele was diagnosed prenatally on screening Ultrasound. The patient remained in the neonatal intensive care unit for 6 weeks. The sac was large with abdominal contents including the entire liver. The sac was allowed to epithelialize completely over the course of two years. Due to the small size of the abdominal wall defect contents of the sac, loss of abdominal domain and inability of the abdominal cavity to accommodate the liver, we chose for rectangular tissue expander placement at age 30 months. 3 months later the patient was planned for tissue expander removal and abdominal wall closure. The tissue expanders were removed and omphalocele closure was performed. The patient has been followed up at 6 months and without recurrence of hernia.The management of giant omphalocele is technically challenging. Use of tissue expansion helps in recreating functional abdominal wall domain. There is growing evidence in the literature supporting the use of intra-abdominal tissue expansion in the management of giant omphalocele however because of hemodynamic consequences we think that the use of rectangular shaped, extra

  1. Percutaneous closure of patent foramen ovale in patients with presumed paradoxical embolism: periprocedural results and midterm risk of recurrent neurologic events.

    Science.gov (United States)

    Balbi, Manrico; Casalino, Laura; Gnecco, Giovanni; Bezante, Gian Paolo; Pongiglione, Giacomo; Marasini, Maurizio; Del Sette, Massimo; Barsotti, Antonio

    2008-08-01

    To report our data on selected patients with previous paradoxical embolism who underwent transcatheter patent foramen ovale (PFO) closure. Between July 2001 and July 2007, percutaneous PFO closure was performed on 128 patients (65 women, mean age: 46 +/- 12.8 years). Patent foramen ovale closure was recommended for secondary prevention in patients with previous transient ischemic attacks (52.5%), stroke (46%), or peripheral embolism (1.5%). Implantation was successful in all patients, and at the end of intervention, complete PFO closure was achieved in 70.3% of them. There were no "major" complications (ie, deaths, device embolization or thrombosis, need for cardiac surgery). The overall incidence of complications (mostly hemorrhagic) was 7%. The mean follow-up period was 32 months. Complete closure had been achieved in 78.4% and in 82.5% of patients at the third month of transesophageal echocardiography examination and at the sixth month of transcranial Doppler examination, respectively. There were no recurrent thromboembolic events during the follow-up period. Percutaneous closure of PFO is a feasible procedure, but it is not a risk-free technique. However, in correctly selected patients (ie, large PFO and those at risk for neurologic relapse), nearly complete PFO closure seems to provide protection from future neurologic ischaemic events at midterm follow-up.

  2. Audit of Orthopaedic Surgical Documentation

    Directory of Open Access Journals (Sweden)

    Fionn Coughlan

    2015-01-01

    Full Text Available Introduction. The Royal College of Surgeons in England published guidelines in 2008 outlining the information that should be documented at each surgery. St. James’s Hospital uses a standard operation sheet for all surgical procedures and these were examined to assess documentation standards. Objectives. To retrospectively audit the hand written orthopaedic operative notes according to established guidelines. Methods. A total of 63 operation notes over seven months were audited in terms of date and time of surgery, surgeon, procedure, elective or emergency indication, operative diagnosis, incision details, signature, closure details, tourniquet time, postop instructions, complications, prosthesis, and serial numbers. Results. A consultant performed 71.4% of procedures; however, 85.7% of the operative notes were written by the registrar. The date and time of surgery, name of surgeon, procedure name, and signature were documented in all cases. The operative diagnosis and postoperative instructions were frequently not documented in the designated location. Incision details were included in 81.7% and prosthesis details in only 30% while the tourniquet time was not documented in any. Conclusion. Completion and documentation of operative procedures were excellent in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions.

  3. Biometric parameters in different stages of primary angle closure using low-coherence interferometry.

    Science.gov (United States)

    Yazdani, Shahin; Akbarian, Shadi; Pakravan, Mohammad; Doozandeh, Azadeh; Afrouzifar, Mohsen

    2015-03-01

    To compare ocular biometric parameters using low-coherence interferometry among siblings affected with different degrees of primary angle closure (PAC). In this cross-sectional comparative study, a total of 170 eyes of 86 siblings from 47 families underwent low-coherence interferometry (LenStar 900; Haag-Streit, Koeniz, Switzerland) to determine central corneal thickness, anterior chamber depth (ACD), aqueous depth (AD), lens thickness (LT), vitreous depth, and axial length (AL). Regression coefficients were applied to show the trend of the measured variables in different stages of angle closure. To evaluate the discriminative power of the parameters, receiver operating characteristic curves were used. Best cutoff points were selected based on the Youden index. Sensitivity, specificity, positive and negative predicative values, positive and negative likelihood ratios, and diagnostic accuracy were determined for each variable. All biometric parameters changed significantly from normal eyes to PAC suspects, PAC, and PAC glaucoma; there was a significant stepwise decrease in central corneal thickness, ACD, AD, vitreous depth, and AL, and an increase in LT and LT/AL. Anterior chamber depth and AD had the best diagnostic power for detecting angle closure; best levels of sensitivity and specificity were obtained with cutoff values of 3.11 mm for ACD and 2.57 mm for AD. Biometric parameters measured by low-coherence interferometry demonstrated a significant and stepwise change among eyes affected with various degrees of angle closure. Although the current classification scheme for angle closure is based on anatomical features, it has excellent correlation with biometric parameters.

  4. [Bath Plug Closure Method for Cerebrospinal Fluid Leakage by Endoscopic Endonasal Approach:Cooperative Treatment by Neurosurgeons and Otolaryngologists].

    Science.gov (United States)

    Kawaguchi, Tomohiro; Arakawa, Kazuya; Nomura, Kazuhiro; Ogawa, Yoshikazu; Katori, Yukio; Tominaga, Teiji

    2017-12-01

    Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.

  5. Parents' Attitudes to the Closure of Small Rural Primary Schools

    Science.gov (United States)

    Archbold, A.; Nisbet, J.

    1977-01-01

    Attitudes of 134 parents of children from 10 rural schools threatened with closure, and 56 parents of children from seven schools recently closed, were assessed by interview. Most parents opposed closure, and most gave educational reasons for their attitudes. (Author)

  6. Influence of Timing of Delayed Hard Palate Closure on Articulation Skills in 3-Year-Old Danish Children with Unilateral Cleft Lip and Palate

    Science.gov (United States)

    Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, Stig; Andersen, Helene Søgaard

    2018-01-01

    Background: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims: To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral…

  7. Editor's Choice - Arteriotomy Closure Devices in EVAR, TEVAR, and TAVR : A Systematic Review and Meta-analysis of Randomised Clinical Trials and Cohort Studies

    NARCIS (Netherlands)

    Vierhout, B. P.; Pol, R. A.; El Moumni, M.; Zeebregts, C. J.

    Objectives: Cardiac and vascular surgery benefit from percutaneous interventions. Arteriotomy closure devices (ACDs) enable minimally invasive access to the common femoral artery (CFA). The objective of this review was to assess the differences between ACDs and surgical cut down (SCD) of the CFA

  8. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2007-01-01

    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count (ρ > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE

  9. Transcatheter closure of large atrial septal defects with deficient aortic or posterior rims using the "Greek maneuver". A multicenter study.

    Science.gov (United States)

    Thanopoulos, Basil D; Dardas, Petros; Ninios, Vlasis; Eleftherakis, Nicholaos; Karanasios, Evangelos

    2013-10-09

    We report a modification ("Greek maneuver") of the standard atrial septal defect (ASD) closure technique using the Amplatzer septal occluder (ASO) to facilitate closure of large ASDs with deficient aortic or posterior rims. 185 patients (median 10.8, range 3 to 52 years) with large ASDs (mean diameter 26±7 mm, range 20-40 mm) with a deficient aortic (134 patients) or posterior (51 patients) rim underwent catheter closure with the ASO using the "Greek maneuver" under transesophageal guidance. The Greek maneuver is applied when protrusion of the aortic edge of the deployed left disk of the device in to the right atrium is detected by echo. To circumvent this left disk is recaptured and the whole delivery system is pushed inward and leftward into the left atrium where the left disk and the 2/3 of right disk are simultaneously released. This maneuver forces the left disk to become parallel to the septum preventing the protrusion of the device into the right atrium. The ASO was successfully implanted and was associated with complete closure in 175/185 (95%) of the patients. There were no early or late complications related to the procedure during a follow-up period ranging from 6 months to 7 years. The "Greek maneuver" is a simple quite useful trick that facilitates closure of large ASDs associated with or without deficient aortic or posterior rims. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. 2-Octyl Cyanoacrylate (Dermabond® skin adhesive versus polyglactin for skin closure in endoscopic radial artery harvesting

    Directory of Open Access Journals (Sweden)

    Ahmed Mostafa Omran

    2018-03-01

    Full Text Available Background: As the goal of endoscopic conduit harvesting is to decrease pain and better cosmetic appearance, and as the optimal choice of skin closure after endoscopic radial artery harvesting (ERAH has not yet been determined, we started this study with an aim to compare wound complications, patient satisfaction and scar healing between glue (Dermabond versus polyglactin intra-cuticular suture for skin closure after ERAH. Methods: This observational study was done at Al Dabbous Cardiac Center, Kuwait, from January 2017 till October 2017 enrolling 40 patients divided into two equal groups (Dermabond group and sutures group. Inclusion criterion was patients underwent coronary artery bypass grafting (CABG using ERAH, while open technique for radial artery harvesting and Negro race are considered as exclusion criteria. Demographic data were collected, (gender, age, race, body mass index (BMI, preoperative medication and albumin level, as well as diabetes or peripheral vascular disease. Operatively, wound closure time was calculated for all patients. Postoperatively: Cosmetic appearance was assessed using the Hollander scale. Patient satisfaction was recorded at week 6–8 weeks. Results: Demographic and preoperative data were comparable; Dermabond group showed shorter closure time, better scar pigmentation, shape and patient satisfaction. Pain, scar size, infection and hematoma showed no statistical difference. Conclusion: Dermabond can be used safely in closure of skin after ERAH. The excellent results in the small wound of ERAH encouraged us to use it in larger wounds. Keywords: Dermabond, Wound, ERAH, Skin adhesive, OCA

  11. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  12. 300 Area Process Trenches Closure Plan

    International Nuclear Information System (INIS)

    Luke, S.N.

    1994-01-01

    Since 1987, Westinghouse Hanford Company has been a major contractor to the US Department of Energy, Richland Operations Office and has served as co-operator of the 300 Area Process Trenches, the waste management unit addressed in this closure plan. For the purposes of the Resource Conservation and Recovery Act, Westinghouse Hanford Company is identified as ''co-operator.'' The 300 Area Process Trenches Closure Plan (Revision 0) consists of a Resource Conservation and Recovery Act Part A Dangerous Waste Permit Application, Form 3 and a Resource Conservation and Recovery Act Closure Plan. An explanation of the Part A Permit Application, Form 3 submitted with this document is provided at the beginning of the Part A Section. The closure plan consists of nine chapters and six appendices. The 300 Area Process Trenches received dangerous waste discharges from research and development laboratories in the 300 Area and from fuels fabrication processes. This waste consisted of state-only toxic (WT02), corrosive (D002), chromium (D007), spent halogenated solvents (F001, F002, and F003), and spent nonhalogented solvent (F005). Accurate records are unavailable concerning the amount of dangerous waste discharged to the trenches. The estimated annual quantity of waste (item IV.B) reflects the total quantity of both regulated and nonregulated waste water that was discharged to the unit

  13. Downstreamness: A concept to analyse basin closure

    NARCIS (Netherlands)

    van Oel, P.R.; Krol, Martinus S.; Hoekstra, Arjen Ysbert

    2011-01-01

    In many places in the world, increasing water demands have led to the development of infrastructure for freshwater storage and irrigation. Especially in water-scarce regions, this development has led to a growing number of concerns about basin closure. These concerns ask for a structured approach

  14. Scale separation closure and Alfven wave turbulence

    International Nuclear Information System (INIS)

    Chen, C.Y.; Mahajan, S.M.

    1985-04-01

    Based on the concept of scale separation between coherent response function and incoherent source for renormalized turbulence theories, a closure scheme is proposed. A model problem dealing with shear-Alfven wave turbulence is numerically solved; the solution explicitly shows expected turbulence features such as frequency shift from linear modes, band-broadening, and a power law dependence for the turbulence spectrum

  15. Opening up closure. Semiotics across scales

    Science.gov (United States)

    Lemke

    2000-01-01

    The dynamic emergence of new levels of organization in complex systems is related to the semiotic reorganization of discrete/continuous variety at the level below as continuous/discrete meaning for the level above. In this view both the semiotic and the dynamic closure of system levels is reopened to allow the development and evolution of greater complexity.

  16. Individual Consequences of Plant Closures and Cutbacks

    DEFF Research Database (Denmark)

    Andersen, Steen

    1991-01-01

    This thesis describes the segment of unemployment which has its origin in major closures and cutbacks. The argument for this is to make it possible to describe and to analyse a flow into and a flow out of a population of unemployed. Given a major dismissal the following questions are to be answer...

  17. Hexone Storage and Treatment Facility closure plan

    International Nuclear Information System (INIS)

    1992-11-01

    The HSTF is a storage and treatment unit subject to the requirements for the storage and treatment of dangerous waste. Closure is being conducted under interim status and will be completed pursuant to the requirements of Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and WAC 173-303-640. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. The known hazardous/dangerous waste remaining at the site before commencing other closure activities consists of the still vessels, a tarry sludge in the storage tanks, and residual contamination in equipment, piping, filters, etc. The treatment and removal of waste at the HSTF are closure activities as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and WAC 173-303

  18. Synthesis of azaphenanthridines via anionic ring closure

    DEFF Research Database (Denmark)

    Hansen, Henriette Møller; Lysén, M.; Begtrup, M.

    2005-01-01

    A new and convergent synthesis of azaphenanthridines via an anionic ring closure is reported. Ortho-lithiation/in situ borylation of cyanopyridines produces the corresponding cyanopyridylboronic esters, which undergo a Suzuki-Miyaura cross-coupling to give the key intermediates. Addition of lithium...

  19. Spontaneous closure of traumatic CSF otorrhoea following ...

    African Journals Online (AJOL)

    We present a 40 year-old male who sustained a head injury with left cerebrospinal fluid otorrhoea following a road traffic accident. Plain radiograph revealed a defect in the temporal bone extending in to the tympanomastoid area. Patient was managed conservatively with closure of the fistula and resolution of the leakage ...

  20. A Quick Guide to Paravalvular Leak Closure

    Science.gov (United States)

    Gafoor, Sameer; Franke, Jennifer; Bertog, Stefan; Lam, Simon; Vaskelyte, Laura; Hofmann, Ilona; Matic, Predrag

    2015-01-01

    Paravalvular leak (PVL) is a seldomly covered aspect of structural heart disease. However, this is a condition that frequently presents after valvular replacement. This article will cover the diagnosising and treating PVL (i.e. imaging, access, and device selection). In addition, specific aspects of aortic and mitral PVL closure will be covered in this review. PMID:29588686

  1. Flower opening and closure: a review

    NARCIS (Netherlands)

    Doorn, van W.G.; Meeteren, van U.

    2003-01-01

    Flower opening and closure are traits of a reproductive syndrome, as it allows pollen removal and/or pollination. Various types of opening can be distinguished such as nocturnal and diurnal and single or repetitive. Opening is generally due to cell expansion. Osmotic solute levels increase by the

  2. Automatically closing swing gate closure assembly

    Science.gov (United States)

    Chang, Shih-Chih; Schuck, William J.; Gilmore, Richard F.

    1988-01-01

    A swing gate closure assembly for nuclear reactor tipoff assembly wherein the swing gate is cammed open by a fuel element or spacer but is reliably closed at a desired closing rate primarily by hydraulic forces in the absence of a fuel charge.

  3. Surgical managements of radiation enteritis

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Tsuguo; Naito, Kazuyo; Noomi, Shinppachiro; Kurioka, Hideaki; Yamagishi, Hisakazu (Kyoto Prefectural Univ. of Medicine (Japan))

    1983-02-01

    Radiation injury to the digestive tract was surgically treated in 22 cases. Six of them died shortly after surgery. Major symptoms were ileus or perforative peritonitis in 20 of the 22 cases, and surgery was performed for ileal lesion in 18 cases, indicating the significance of lesions in the small intestine. Seven patients underwent resection of the injured portion of the intestinal tract and anastomotic reconstruction in one stage, but 3 of them died from rupture of sutures. It was highly probable that anastomosis was made using an injured portion of the intestine. Intraoperative judgement of intestinal injury is made by palpation and inspection. If judgement is difficult, an artificial anus should be constructed first, and anastomotic reconstruction should be done in the 2nd stage. Since delayed injury of this disease is an ischemic change due to vascular obliteration, conservative therapy never leads to complete recovery, but active resection and anastomosis seem to produce a satisfactory result.

  4. Surgical managements of radiation enteritis

    International Nuclear Information System (INIS)

    Tanaka, Tsuguo; Naito, Kazuyo; Noomi, Shinppachiro; Kurioka, Hideaki; Yamagishi, Hisakazu

    1983-01-01

    Radiation injury to the digestive tract was surgically treated in 22 cases. Six of them died shortly after surgery. Major symptoms were ileus or perforative peritonitis in 20 of the 22 cases, and surgery was performed for ileal lesion in 18 cases, indicating the significance of lesions in the small intestine. Seven patients underwent resection of the injured portion of the intestinal tract and anastomotic reconstruction in one stage, but 3 of them died from rupture of sutures. It was highly probable that anastomosis was made using an injured portion of the intestine. Intraoperative judgement of intestinal injury is made by palpation and inspection. If judgement is difficult, an artificial anus should be constructed first, and anastomotic reconstruction should be done in the 2nd stage. Since delayed injury of this disease is an ischemic change due to vascular obliteration, conservative therapy never leads to complete recovery, but active resection and anastomosis seem to produce a satisfactory result. (Chiba, N.)

  5. Management of low anal fistula: fistulectomy alone versus fistulectomy with primary closure

    International Nuclear Information System (INIS)

    Shahid, M.; Malik, S.; Ahmed, Z.

    2017-01-01

    To compare fistulectomy with primary closure of the wound and fistulectomy alone in the treatment of low anal fistula in terms of healing time. Study Design: Randomized control trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital (CMH) Rawalpindi, from Nov 2006 to May 2007. Material and Methods: Total 60 patients of low anal fistula were enrolled in this study after informed consent and ethical approval. Patients were divided in two groups (A and B) each containing 30 patients. Patient of group A underwent fistulectomy alone whereas patients of group B underwent fistulectomy with primary closure of wound. All the patients were followed two weekly for 06 weeks. On each visit, healing was assessed by naked eye examination of epithelialization and noted on a Proforma. SPSS 17 was used to analyze the results. A p-value of <0.005 was considered statistically significant. Results: At 02 weeks after surgery, none of the patient in group A and 6.6% of group B patients showed wound healing, p-value was not significant i.e. 0.492. At 04 weeks after surgery, 23.3% of group A and 86.6% of group B patients showed wound healing p-value <0.001. At 06 weeks after surgery, 93.3% of group A and 100% of group B patients showed wound healing, p-value was not significant i.e. 0.492. Healing of wound was found more rapid in group B patients who underwent fistulectomy with primary closure of wound. Conclusion: Fistulectomy with primary repair was a better treatment as compared to fistulectomy alone in terms of healing time of wound. (author)

  6. Fallopian Tube Herniation: An Unusual Complication of Surgical Drain

    OpenAIRE

    Sharma, Lipi; Singh, Alpana; Bhaskaran, Sruthi; Radhika, A. G.; Radhakrishnan, Gita

    2012-01-01

    Background. Surgical drains have been used since time immemorial, but their use is not without complications. By presenting this case we aim to describe an uncommon complication of herniation of fallopian tube following the simple procedure of surgical drain removal. Case Presentation. This case describes a 23-year G2P1L1 who underwent an emergency cesarean section for obstructed labor with intraperitoneal drain insertion. The patient had an uneventful postoperative period, drain was removed ...

  7. Porcine wet lab improves surgical skills in third year medical students.

    Science.gov (United States)

    Drosdeck, Joseph; Carraro, Ellen; Arnold, Mark; Perry, Kyle; Harzman, Alan; Nagel, Rollin; Sinclair, Lynnsay; Muscarella, Peter

    2013-09-01

    Medical students desire to become proficient in surgical techniques and believe their acquisition is important. However, the operating room is a challenging learning environment. Small group procedural workshops can improve confidence, participation, and performance. The use of fresh animal tissues has been rated highly among students and improves their surgical technique. Greater exposure to surgical procedures and staff could positively influence students' interest in surgical careers. We hypothesized that a porcine "wet lab" course for third year medical students would improve their surgical skills. Two skills labs were conducted for third year medical students during surgery clerkships in the fall of 2011. The students' surgical skills were first evaluated in the operating room across nine dimensions. Next, the students performed the following procedures during the skills lab: (1) laparotomy; (2) small bowel resection; (3) splenectomy; (4) partial hepatectomy; (5) cholecystectomy; (6) interrupted abdominal wall closure; (7) running abdominal wall closure; and (8) skin closure. After the skills lab, the students were re-evaluated in the operating room across the same nine dimensions. Student feedback was also recorded. Fifty-one participants provided pre- and post-lab data for use in the final analysis. The mean scores for all nine surgical skills improved significantly after participation in the skills lab (P ≤ 0.002). Cumulative post-test scores also showed significant improvement (P = 0.002). Finally, the student feedback was largely positive. The surgical skills of third year medical students improved significantly after participation in a porcine wet lab, and the students rated the experience as highly educational. Integration into the surgery clerkship curriculum would promote surgical skill proficiency and could elicit interest in surgical careers. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Primary closure after carotid endarterectomy is not inferior to other closure techniques.

    Science.gov (United States)

    Avgerinos, Efthymios D; Chaer, Rabih A; Naddaf, Abdallah; El-Shazly, Omar M; Marone, Luke; Makaroun, Michel S

    2016-09-01

    Primary closure after carotid endarterectomy (CEA) has been much maligned as an inferior technique with worse outcomes than in patch closure. Our purpose was to compare perioperative and long-term results of different CEA closure techniques in a large institutional experience. A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. Closure technique was used to divide patients into three groups: primary longitudinal arteriotomy closure (PRC), patch closure (PAC), and eversion closure (EVC). End points were perioperative events, long-term strokes, and restenosis ≥70%. Multivariate regression models were used to assess the effect of baseline predictors. There were 1737 CEA cases (bilateral, 143; mean age, 71.4 ± 9.3 years; 56.2% men; 35.3% symptomatic) performed during the study period with a mean clinical follow-up of 49.8 ± 36.4 months (range, 0-155 months). More men had primary closure, but other demographic and baseline symptoms were similar between groups. Half the patients had PAC, with the rest evenly distributed between PRC and EVC. The rate of nerve injury was 2.7%, the rate of reintervention for hematoma was 1.5%, and the length of hospital stay was 2.4 ± 3.0 days, with no significant differences among groups. The combined stroke and death rate was 2.5% overall and 3.9% and 1.7% in the symptomatic and asymptomatic cohort, respectively. Stroke and death rates were similar between groups: PRC, 11 (2.7%); PAC, 19 (2.2%); EVC, 13 (2.9%). Multivariate analysis showed baseline symptomatic disease (odds ratio, 2.4; P = .007) and heart failure (odds ratio, 3.1; P = .003) as predictors of perioperative stroke and death, but not the type of closure. Cox regression analysis demonstrated, among other risk factors, no statin use (hazard ratio, 2.1; P = .008) as a predictor of ipsilateral stroke and severe (glomerular filtration rate <30 mL/min/1.73 m(2)) renal insufficiency (hazard ratio, 2.6; P

  9. Two Techniques of Intestinal Wall Suture in Surgical Treatment of Ileus in Dogs and the Importance of Omentalisation

    Directory of Open Access Journals (Sweden)

    M. Crha

    2008-01-01

    Full Text Available Model experimental studies focused on the intestinal suture techniques in relation to healing, postoperative narrowing of the intestinal lumen or adhesion formation can not comprise a number of clinical factors (foreign body presence in the intestine, haematological abnormalities, septic peritonitis, different age of patients, etc. that under clinical practice conditions may have an effect on the healing of the intestinal suture. The aim of this clinical study was to confirm in a group of dogs surgically treated for small bowel obstruction, whether different techniques of its wall suture may affect the frequency of possible dehiscence occurrence. This study compares two different techniques of intestinal wall suture in relation to postoperative dehiscence of the intestinal wall closure. Based on the clinical observation with regard to the risk of postoperative dehiscence and possible complications in form of adhesions, also the importance of omentalisation in the suture of small bowel was evaluated. No significant difference was demonstrated (p > 0.05 in the frequency of postoperative dehiscence at the site of the intestinal wall closure between the two-layer inverting and singlelayer appositional techniques of suture. Likewise, no significant difference was demonstrated (p > 0.05 in the frequency of dehiscence of intestinal wall suture between patients that underwent intestinal suture omentalisation and those whose intestinal wall suture was not complemented with omentalisation. Based on the results of this clinical study it may be stated that both manual single-layer approximation technique and two-layer inverting technique of the intestinal wall suture are equally safe from the viewpoint of possible dehiscence, and it depends on the surgeon's preference, which one of the said techniques he or she chooses. Concurrently it may be assumed that an exactly performed suture of the intestinal wall does not necessarily require omentalisation.

  10. The Rising Rate of Rural Hospital Closures.

    Science.gov (United States)

    Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

    2016-01-01

    Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

  11. 9 CFR 318.301 - Containers and closures.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Containers and closures. 318.301... Canning and Canned Products § 318.301 Containers and closures. (a) Examination and cleaning of empty containers. (1) Empty containers, closures, and flexible pouch roll stock shall be evaluated by the...

  12. Crack closure and sequential effects in fatigue: A literature survey

    Science.gov (United States)

    Holmgren, M.

    A literature survey of the phenomenon of crack closure is reported here. The state of the art is reviewed and several empirical formulas for determining the crack closure are compared with each other. Their properties, advantages and disadvantages are briefly discussed. Experimental techniques for determining the crack closure stress are presented and experimental data from the literature are reported.

  13. 40 CFR 267.143 - Financial assurance for closure.

    Science.gov (United States)

    2010-07-01

    ...), utilizing the certificate of insurance for closure specified at 40 CFR 264.151(e). (f) Corporate financial... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Financial assurance for closure. 267... PERMIT Financial Requirements § 267.143 Financial assurance for closure. The owner or operator must...

  14. Permanent Closure of the TAN-664 Underground Storage Tank

    Energy Technology Data Exchange (ETDEWEB)

    Bradley K. Griffith

    2011-12-01

    This closure package documents the site assessment and permanent closure of the TAN-664 gasoline underground storage tank in accordance with the regulatory requirements established in 40 CFR 280.71, 'Technical Standards and Corrective Action Requirements for Owners and Operators of Underground Storage Tanks: Out-of-Service UST Systems and Closure.'

  15. Numerical approximation of the Boltzmann equation : moment closure

    NARCIS (Netherlands)

    Abdel Malik, M.R.A.; Brummelen, van E.H.

    2012-01-01

    This work applies the moment method onto a generic form of kinetic equations to simplify kinetic models of particle systems. This leads to the moment closure problem which is addressed using entropy-based moment closure techniques utilizing entropy minimization. The resulting moment closure system

  16. Comparison of two neonatal indomethacin protocols: efficacy and outcome for patent ductus arteriosus closure.

    Science.gov (United States)

    Rosito, G; Sum, K; Chorne, N

    2010-10-01

    Indomethacin, a non-selective inhibitor of prostaglandin synthesis, is the gold standard treatment for patent ductus arteriosus (PDA). Indomethacin has been shown to permanently close the ductus and when given prophylactically, it reduces the incidence of PDA (1, 2). This study compares PDA closure and surgical ligation rates between patients using two different indomethacin administration protocols. This is a retrospective comparison analysis of 72 neonates, who received one of two indomethacin administration protocols. Our previous protocol suggested an initial dose of 0·2 mg/kg followed by two 0·1 mg/kg, with doses infused over 4 h and a 24-h dosing interval. A new potentially more useful protocol using the same mg/kg dose regimen but with doses infused over 30 min and a 12-h dosing interval, was evaluated. Each neonate was allowed three courses of treatment before surgical ligation was performed for persistent PDA. There were no statistically significant differences between the two protocol groups when comparing percentages of neonates with gestational age≤28 weeks, birth weight≤1000 g, male gender or receiving indomethacin for the indication of PDA prophylaxis vs. treatment. There was a trend towards a higher PDA closure rate and subsequently a lower PDA ligation rate in the new protocol when compared with the previous protocol. In this small population of premature neonates, there was a trend, but no significant difference, towards increasing PDA closure and lower surgical ligation rates in neonates given indomethacin with more frequent dosing and shorter infusion time. A well-powered randomized controlled trial is now needed. Copyright © 2010 The Authors. JCPT © 2010 Blackwell Publishing Ltd.

  17. Tools for Closure Project and Contract Management: Development of the Rocky Flats Integrated Closure Project Baseline

    International Nuclear Information System (INIS)

    Gelles, C. M.; Sheppard, F. R.

    2002-01-01

    This paper details the development of the Rocky Flats Integrated Closure Project Baseline - an innovative project management effort undertaken to ensure proactive management of the Rocky Flats Closure Contract in support of the Department's goal for achieving the safe closure of the Rocky Flats Environmental Technology Site (RFETS) in December 2006. The accelerated closure of RFETS is one of the most prominent projects within the Department of Energy (DOE) Environmental Management program. As the first major former weapons plant to be remediated and closed, it is a first-of-kind effort requiring the resolution of multiple complex technical and institutional challenges. Most significantly, the closure of RFETS is dependent upon the shipment of all special nuclear material and wastes to other DOE sites. The Department is actively working to strengthen project management across programs, and there is increasing external interest in this progress. The development of the Rocky Flats Integrated Closure Project Baseline represents a groundbreaking and cooperative effort to formalize the management of such a complex project across multiple sites and organizations. It is original in both scope and process, however it provides a useful precedent for the other ongoing project management efforts within the Environmental Management program

  18. Electrical velocimetry for non-invasive monitoring of the closure of the ductus arteriosus in preterm infants.

    Science.gov (United States)

    Rodríguez Sánchez de la Blanca, Ana; Sánchez Luna, M; González Pacheco, N; Arriaga Redondo, M; Navarro Patiño, N

    2018-02-01

    Closure of a patent ductus arteriosus (PDA) in preterm infants modifies cardiac output and induces adaptive changes in the hemodynamic situation. The present study aims to analyze those changes, through a non-invasive cardiac output monitor based on blood electrical velocimetry, in preterm babies. A prospective observational study of preterm infants with a gestational age of less than 28 weeks, and a hemodynamic significant PDA, requires intravenous ibuprofen or surgical closure. All patients were monitored with electrical velocimetry before treatment and through the following 72 h. Two groups were defined, ibuprofen and surgical closure. Variations of cardiac output were analyzed from the basal situation and at 1, 8, 24, 48, and 72 h on each group. During a 12-month period, 18 patients were studied. The median gestational age in the ibuprofen group (12/18) was 26 +5  weeks (25 +5 -27 +3 ) with a median birth weight of 875 (670-1010) g. The cardiac output index (CI) value was 0.29 l/kg/min (0.24-0.34). Among the patients with confirmed ductus closure (50%), a significant CI decrease was shown (0.24 vs 0.29 l/kg/min; P 0.03) after 72 h (three ibuprofen doses). A statistically significant decrease in systolic volume (SVI) was found: 1.62 vs 1.88 ml/kg, P 0.03 with a decrease in contractility (ICON), 85 vs 140, P 0.02. The gestational age in the surgical group (6/18) was 25 +2  weeks (24-26 +3 ) with a median weight of 745 (660-820) g. All patients in this group showed a decrease in the immediate postoperative CI (1 h after surgery) 0.24 vs 0.30 l/kg/min, P 0.05, and a significant decrease in contractility (ICON 77 vs 147, P 0.03). In addition, a no statistically significant decrease in SVI (1.54 vs 1.83 ml/kg, P 0.06), as well as an increase in systemic vascular resistance (10,615 vs 8797 dyn/cm 2 , P 0.08), were detected. This deterioration was transient without significant differences in the remaining periods of time evaluated. The surgical closure

  19. Epilepsy with temporal encephalocele: Characteristics of electrocorticography and surgical outcome.

    Science.gov (United States)

    Panov, Fedor; Li, Yi; Chang, Edward F; Knowlton, Robert; Cornes, Susannah B

    2016-02-01

    Temporal lobe encephaloceles (TEs) are increasingly identified in patients with epilepsy due to advances in neuroimaging. Select patients become seizure-free with lesionectomy. In practice, however, many of these patients will undergo standard anterior temporal lobectomy. Herein we report on the first series of patients with refractory temporal lobe epilepsy (TLE) with encephalocele to undergo chronic or intraoperative electrocorticography (ECoG) in order to characterize the putative epileptogenic nature of these lesions and help guide surgical planning. This retrospective study includes nine adult patients with magnetic resonance imaging/computed tomography (MRI/CT)-defined temporal encephalocele treated between 2007 and 2014 at University of California San Francisco (UCSF). Clinical features, ECoG, imaging, and surgical outcomes are reviewed. Six patients underwent resective epilepsy surgery. Each case demonstrated abnormal epileptiform discharges around the cortical area of the encephalocele. Two underwent tailored lesionectomy and four underwent lesionectomy plus anterior medial temporal resection. Postoperatively, five patients, including both with lesionectomy only, had Engel class Ia surgical outcome, and one had a class IIb surgical outcome. The role of TE in the pathogenesis of epilepsy is uncertain. ECoG can confirm the presence of interictal epileptiform discharges and seizures arising from these lesions. Patients overall had a very good surgical prognosis, even with selective surgical approaches. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  20. Revisit to Grad's Closure and Development of Physically Motivated Closure for Phenomenological High-Order Moment Model

    International Nuclear Information System (INIS)

    Myong, R. S.; Nagdewe, S. P.

    2011-01-01

    The Grad's closure for the high-order moment equation is revisited and, by extending his theory, a physically motivated closure is developed for the one-dimensional velocity shear gas flow. The closure is based on the physical argument of the relative importance of various terms appearing in the moment equation. Also, the closure is derived such that the resulting theory may be inclusive of the well established linear theory (Navier-Stokes-Fourier) as limiting case near local thermal equilibrium.

  1. Surgical treatment of radiation enteritis

    Energy Technology Data Exchange (ETDEWEB)

    Cross, M.J.; Frazee, R.C. (Department of General Surgery, Scott and White Memorial Hospital, Temple TX (United States))

    1992-02-01

    Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting.

  2. Surgical treatment of radiation enteritis

    International Nuclear Information System (INIS)

    Cross, M.J.; Frazee, R.C.

    1992-01-01

    Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting

  3. Stoma-Closure-Induced Fulminant Pseudomembranous Colitis Recovered by Adjunctive Intracolic Vancomycin with Postural Change

    Directory of Open Access Journals (Sweden)

    Yozo Suzuki

    2010-05-01

    Full Text Available A 67-year-old man with a history of low anterior resection and diverting loop transverse colostomy for rectal carcinoma developed fulminant pseudomembranous colitis after stoma closure. Oral administration of vancomycin at 0.5 g every 6 h and colonoscopy with intracolic vancomycin administration was unsuccessful, but continuation of intracolic vancomycin with postural change resulted in dramatic recovery. Postural change may extend the efficacy of intracolic vancomycin, and intracolic vancomycin should be considered as an option between conventional therapy and surgical intervention for pseudomembranous colitis.

  4. [An approach to vacuum-assisted closure therapy using the S-B Vac].

    Science.gov (United States)

    Nagayoshi, Yasuhiro; Kiyosawa, Jun; Mikami, Naofusa; Mizuno, Fumito; Noguchi, Yasuhisa; Kobata, Takashi; Yokote, Jun; Hida, Kenji; Shikata, Hiroo; Akita, Toshiaki

    2010-09-01

    Vacuum-assisted closure (VAC) therapy is increasingly applied for patients with wound dehiscence or mediastinitis caused by surgical site infection (SSI) after open-heart surgery. We have used wall suction for such cases in the past. But this method was an obstacle for improvement of the quality of life (QOL) of the patient. Since the S-B Vac is portable, this equipment may allow wound healing without decreasing QOL. Here, we report a case in which VAC therapy was performed using the S-B Vac.

  5. Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen

    NARCIS (Netherlands)

    Boele van Hensbroek, Pieter; Wind, Jan; Dijkgraaf, Marcel G. W.; Busch, Olivier R. C.; Goslings, J. Carel

    2009-01-01

    Background This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure

  6. Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

    Science.gov (United States)

    Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

    2018-02-01

    Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

  7. Surgical management of spasmodic torticollis

    Directory of Open Access Journals (Sweden)

    Wael Fouad

    2011-12-01

    Full Text Available Introduction: Spasmodic torticollis (ST is a neuromuscular disorder characterized by uncontrolled clonic and intermittently tonic spasm of the neck muscles. Objective: This retrospective study was done to study clinical picture and to evaluate the surgical results of different surgical procedures in 11 patients who had spasmodic torticollis. Methods: The male to female ratio was 1–2 (4 males and 7 females and their ages ranged from 18 to 65 years. The X-ray of the cervical spine was performed before the operation to exclude cervical disorders that can cause symptoms similar to spasmodic torticollis. MRI of the head and neck was performed in all patients, without finding significant brain lesions. Electromyography of the cervical muscles was performed preoperatively and postoperatively. All cases underwent surgery in the form of variable combinations of ventral rhizotomy of C1, C2+ selective peripheral denervation of neck muscles involved according to the type of torticollis. Mean postoperative follow up period was 24 months. Results: There was no operative mortality. As regards the morbidity, one patient had deficiency of shoulder elevation that was transient and improved after 3 months; one patient had wound infection that responded well to antibiotics after culture and sensitivity. Postoperative dysphagia was found in two cases that improved in one of them after two months. At the last follow up examination period, excellent results were obtained in 55% of patients, good results in 18% of patients, fair results in 18% of patients, and poor results in 9% of cases. Conclusion: There is no standard surgical procedure for treatment of ST; this is adapted to each patient according to type of torticollis. Better results were obtained in simple torticollis (excellent results in 100%, than in complex type (excellent and good results in 33.3%. Keywords: Focal dystonia, Spasmodic torticollis, Anterior rhizotomy, Selective denervation

  8. Assessment of consistent two-equation closure for forest flows

    DEFF Research Database (Denmark)

    Sogachev, Andrey; Cavar, Dalibor; Bechmann, Andreas

    of grid turbulence and wall-bounded flow, the closure suggested is also valid for homogeneous shear flows commonly observed inside tall vegetative canopies. The present work assess the plant drag closure by comparing results of two different CFD models against observations derived over the forested area...... and can be applied for any twoequation closure. Results derived by different CFD models with k-epsilon and k-omega closure are similar and in good comparison with observations. Overall, numerical results show that the closure performs well, opening new possibilities for application to tasks related...... to the atmospheric boundary layer—where it is important to adequately account for the influences of vegetation....

  9. [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.

  10. Resource utilization in surgery after the revision of surgical fee schedule in Japan.

    Science.gov (United States)

    Nakata, Yoshinori; Yoshimura, Tatsuya; Watanabe, Yuichi