scholarly journals Clinical Significance and Prognostic Value of Preoperative Angiographic Assessment in Infrainguinal Arterial Reconstructions

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
M. Cheshmedzhiev ◽  
E. Jordanov ◽  
M. Yordanov ◽  
N. Kovacheva
Keyword(s):  
Blood Flow ◽  
Operation Time ◽  
Distal Anastomosis ◽  
Practical Implementation ◽  
Morphological Identification ◽  
Orientation Measurement ◽  
Run Off ◽  
Collateral Vessels

Objective. To assess the practical implementation of the modified Schwierz T. system for angiographic scoring of the arteries below the distal anastomosis (run-off) after infrainguinal reconstructions. Methods. We used the modified Schweierz T. score, which is readily practically applied in each patient for assessment of the run-off segment, independently from the planned level of distal anastomosis. 97 consequently treated patients who underwent infrainguinal arterial reconstructions were followed up during a 12-month period, and we retrospectively compared the results of two groups—48 of failed and 49 of patent bypasses; as for the long term patency there were some discrepancies with the expected good results. Measurements of the flow volume were performed below distal anastomoses in peripheral bypass operations with flowmeter VeriQ, Medistim, Oslo, Norway. Flowmetry was performed before and after a 5-minute infusion of Prostavasin or Ilomedin, causing peripheral vasodilatation. The resulting values were averaged and compared to the beforehand calculated according to the Schwierz score minimal expected flow. Results. Schwierz score gives orientation immediately after the reconstruction about the early patency of the bypass. Control angiographies and revisions in cases with inadequate minute blood flow identify some mistakes, the correction of which (if possible) in one operation time improves the results and the early patency. 9% of the failed bypasses in the first month had blood flow above the expected and 37% of the failed bypasses in the eighth month had flow above the expected. Mismatch in the patent bypasses was observed in 6%, probably due to subjective underestimation of some collateral vessels. Conclusion. Quantification of the distal flow is very important. The suggested model of assessment must determine as exactly as possible minimal flow to be reached at the end of the operation. We consider the preoperative angiographically calculated expected blood flow, good additional criteria for the quality of the newly constructed bypass. Intraoperative registration of low blood flow has the significance of screening for further assessment through intraoperative arteriography for the morphological identification of the cause. Having in mind the subjective nature of the angiographic scoring system and its dependence on the quality of the image, we consider the preoperative angiographic estimated expected volume of flow referring to the early patency adequate and inappropriate for long term prediction, but useful as an accessory orientation measurement of the state of the run-off arteries and the result of the surgery.

Development of the Urban Environment Based on the Optimization of Management Decision-Making

2020 ◽  
Vol 26 (3) ◽  
pp. 322-327
Author(s):  
V. M. Medvedev
Keyword(s):  
Decision Making ◽  
Urban Environment ◽  
Management Decision ◽  
Practical Implementation ◽  
Management Decisions ◽  
Environment Management ◽  
Management Decision Making ◽  
High Level

The presented study identifies approaches to decision-making aimed at the optimal development of the urban environment.Aim. The study aims to develop proposals for improving methodological approaches aimed at the development of the urban environment and for using these approaches in the preparation of the corresponding management decisions.Tasks. The author assesses the problem of urbanization and shows how it affects the need to modernize the urban environment; formulates the principles of optimization of management decision-making aimed at the development of the urban environment; evaluates the possibility of the practical implementation of these principles (through the example of the federal city of St. Petersburg).Methods. This study uses strategic analysis, systems and case-based approach, comparative and retrospective analysis.Results. The practical aspects of designing the processes and approaches to urban environment management are examined. The efficiency of management is shown to depend largely on the optimization of management decisions that could improve the effectiveness of individual services aimed at the formation and development of a modern urban environment in the long term. The study describes the successful experience of St. Petersburg in developing the complex of urban environment management services.Conclusions. Improving urban environment management is an important aspect of increasing the population’s quality of life. As evidenced by St. Petersburg’s experience, to achieve a high level of comfort in the urban environment it is necessary to actively use the principles of consistency, innovation, and public participation in decision-making. The author recommends normative consolidation of these principles and their more active practical application in the management of Russian cities.

Online monitoring of OUR, KLa and OTE indicators: practical implementation in full-scale industrial WWTPs

2009 ◽  
Vol 60 (2) ◽  
pp. 459-466 ◽  
Author(s):  
I. Irizar ◽  
J. A. Zambrano ◽  
D. Montoya ◽  
M. De Gracia ◽  
R. García
Keyword(s):  
Industrial Wastewater ◽  
Treatment Plant ◽  
Theoretical Background ◽  
Full Scale ◽  
Practical Implementation ◽  
Short Term ◽  
Oxygen Transfer Efficiency ◽  
Term Data

Based on on/off aeration strategies, this paper describes all the steps involved in the development and implementation of three identification algorithms aimed at monitoring the oxygen uptake rate (OUR), the oxygen mass-transfer coefficient (KLa), and oxygen transfer efficiency (OTE) in aerated biological reactors. Firstly, a detailed explanation of the theoretical background behind every algorithm is given. In addition, practical issues have also been taken into account in order to guarantee the quality of estimations. Finally, the three algorithms have been implemented and validated in a full-scale industrial wastewater treatment plant with satisfactory results. Although short-term noise has been observed in the estimated data (especially at high OURs), the medium and long-term data trajectories have been correctly reproduced.

Cardiac massage and blood flow management during cardiac arrest

2016 ◽  
Author(s):  
Gavin D. Perkins
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Essential Element ◽  
Coronary Perfusion Pressure ◽  
Cardiac Massage ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Term Survival

When cardiac arrest occurs, blood flow to the vital organs diminishes rapidly. Chest compressions are an essential element of cardiopulmonary resuscitation (CPR), yet they achieve, at best, one-third of the normal cardiac output. The speed of initiating CPR, as well as its quality is critical to patient outcomes. Optimal chest characteristics of compressions are defined as pushing hard (depth > 5 cm) and fast (compression rate 100–120/min). Pressure should be released fully between sequential chest compressions and interruptions in chest compressions should be minimized. Even short interruptions in CPR around the time of attempted defibrillation can be harmful. CPR feedback and prompt devices can be used to monitor the quality of CPR. Studies have shown these devices can improve the quality of CPR, but do not improve overall survival. Mechanical chest compression devices may be usefully deployed when it is difficult or unsafe to perform manual CPR, but there is no evidence that the routine deployment of these devices improves outcome. Vasoactive drugs improve coronary perfusion pressure and increase the chances of return of spontaneous circulation. However, there is no definitive evidence that they improve long-term survival. Recent data have raised the possibility that adrenaline may worsen long-term outcomes.

scholarly journals Long-Term Followup with Evaluation of the Surgical and Functional Results of the Ileal Pouch Reservoir in Restorative Proctocolectomy for Ulcerative Colitis

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Ola Røkke ◽  
Knut Iversen ◽  
Torill Olsen ◽  
Sølvi-Mai Ristesund ◽  
Geir Egil Eide ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Loop Ileostomy ◽  
Operation Time ◽  
Functional Results ◽  
Late Complications ◽  
Initial Time

Aims. Evaluate the early and long term surgical and functional results of the ileal pouch-reservoir (IPAA) in patients with intractable ulcerative colitis. Material and Methods. Followup of 134 consecutive patients with W-or J-ileal pouch by diseases-specific and general health (SF-36) questionnaire. In the first 44 patients, early and late followup was performed. Results. Followup was performed 7.4 years (0.5–17 years) after construction of W () and J () ileal pouch, which had similar results. There were 14.9% early and 43.6% late complications with 12.7% early and 19.5% late reoperations. Protecting loop-ileostomy used in 54 patients (43.9%), did not protect against complications. Thirteen reservoirs (9.8%) were resected () or deactivated () due to functional failure. Operation time, postoperative complications and pouchitis were determinators for reservoir failure and reduced quality of life. The functional results at followup of 44 patients at 2.5 years (0.8–6.7 years) and 11.5 years (8.2–19.2 years) were remarkably similar. Conclusions. IPAA is a good option for most patients when medication fails. 10% experience failure with inferior quality of life. Protective stoma will not reduce failure rates. After an initial time period, reservoir function will not change over time.

Hemodynamics of End-to-End Femoral Bypass Graft

2004 ◽  
Author(s):  
Aike Qiao ◽  
Teruo Matsuzawa
Keyword(s):  
Blood Flow ◽  
Shear Stress ◽  
Wall Shear Stress ◽  
Femoral Artery ◽  
Bypass Graft ◽  
Distal Anastomosis ◽  
Geometry Configuration ◽  
Temporal And Spatial ◽  
End To End

In the conventional femoral bypassing operation, side-to-end (STE) configuration at the proximal anastomosis and end-to-side (ETS) configuration at the distal anastomosis are usually employed. With these configurations, blood flow from the bypass graft at the distal anastomosis strongly strikes on the floor of the host artery opposite the anastomosis. This will result in the violent variations of hemodynamics in the vicinity of distal anastomosis, and further bring about anastomotic intimal hyperplasia (IH) and restenosis. Consequently, the effectiveness of bypassing surgery is compromised in the medium and long term by the development of these pathological changes. It is widely accepted that hemodynamics is close correlated to the geometry configuration of femoral bypass graft. It is verified that flow field at the distal junction has more influences on the pathogenesis and its aftereffects are more critical because the development of IH and restenosis is prone to occur in that region and endangers the patency of subsequent arteries. Nonuniform hemodynamics, characterized by nonuniform Wall Shear Stress (WSS) and large sustained Wall Shear Stress Gradients (WSSG), is also commonly considered as one of the most important causes among the numerous complex physiological and biomechanical factors. Purpose of the present study is to investigate an alternative geometry configuration to improve the hemodynamics at the vicinity of distal anastomosis and increase the medium and long term patency rate of bypass graft surgery. According to the clinical observation, the stenosed host artery may become fully stenosed after bypassing surgery and the bypass graft is the only way to restore normal blood flow to ischemic limbs. The authors presented a modified bypassing configuration with an end-to-end (ETE) conjunction at the distal anastomosis. In this new model, the proximal graft is arc-shaped with STE junction and the distal graft is sinusoid-shaped with ETE junction. The bypass graft is of the same diameter of d = 8mm as the host femoral artery, so the graft can be connected with the femoral artery smoothly at the distal junction. The polytetrafluoroethylene (PTFE) is employed as the graft material. The blood is assumed to be an isotropic, homogeneous, incompressible, Newtonian continuum having a constant density and viscosity. The vessel walls are assumed to be rigid and impermeable. The blood flow is assumed to be physiologically pulsatile laminar flow. The mean Reynolds number is Rem = 204.7, Womersley number is α = 6.14. The boundary conditions include: the physiologically pulsatile entrance velocities at the inlet section, the no-slip boundary condition on the wall, the symmetric condition in the centerline plane of femoral and graft, and the outlet pressure condition with a reference pressure P = 0 at the exit section. Three-dimensional idealized femoral bypass graft model is developed and discretized. The blood flow in the proposed model is simulated with computational fluid dynamics (CFD) method using the finite element analysis. The temporal and spatial distributions of hemodynamics such as flow patterns and WSS in the vicinity of distal anastomosis during the cardiac cycle were analyzed. Especially, the emphasis here was on the analysis of WSS, the temporal and spatial WSSG and the Oscillating Shear Index (OSI). The simulation results indicated that: (1) the ETE model is featured with small secondary flow; (2) WSS at the distal anastomosis is uniform, WSSG is small, and OSI of the ETE model has not much changes compared with ETS graft. The present study showed that the femoral bypassing configuration with ETE bypass graft was of more favorable hemodynamics, and it could consequently improve the flow conditions and decrease the probability of IH and restenosis. With the consideration of that numerical simulation was proved to be of great help and guidance meaning for the biofluidmechanics research and the biomedical engineering, the results of the present study can be applied to medical device design and clinical treatment planning in addition to the application of computational methods to cardiovascular disease research.

Thinking Beyond Language: Intervention for Severe Aphasia

2009 ◽  
Vol 19 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Nina Simmons-Mackie
Keyword(s):  
Quality Of Life ◽  
Communication Training ◽  
Language Intervention ◽  
Specific Training ◽  
Environmental Support ◽  
Total Communication ◽  
Communication Partners

Abstract Purpose: This article addresses several intervention approaches that aim to improve life for individuals with severe aphasia. Because severe aphasia significantly compromises language, often for the long term, recommended approaches focus on additional domains that affect quality of life. Treatments are discussed that involve increasing participation in personally relevant life situations, enhancing environmental support for communication and participation, and improving communicative confidence. Methods: Interventions that have been suggested in the aphasia literature as particularly appropriate for people with severe aphasia include training in total communication, training of communication partners, and activity specific training. Conclusion: Several intervention approaches can be implemented to enhance life with severe aphasia.

Communication Disordered: Program Implementation in Long-Term Care

2016 ◽  
Vol 1 (15) ◽  
pp. 64-67
Author(s):  
George Barnes ◽  
Joseph Salemi
Keyword(s):  
Program Implementation ◽  
Long Term Care ◽  
Family Satisfaction ◽  
Regulatory Compliance ◽  
Care Staff ◽  
Term Care ◽  
Staff Members ◽  
Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

Long term follow-up in quality of life after mitral valve surgery

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
I Kammerer ◽  
M Höhn ◽  
AH Kiessling ◽  
S Becker ◽  
FU Sack
Keyword(s):  
Quality Of Life ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Long Term Follow Up
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