scholarly journals The Effectiveness of a Systematic Algorithm for the Management of Vascular Injuries during the Laparoscopic Surgery

2015 ◽  
Vol 9 (3) ◽  
pp. 138-142 ◽  
Author(s):  
Carlo C. Passerotti ◽  
José A. Cruz ◽  
Sabrina T. Reis ◽  
Marcelo T. Okano ◽  
Ricardo J. Duarte ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Vascular Injury ◽  
Vascular Injuries ◽  
Laparoscopic Complications ◽  
Before And After ◽  
Life Threatening ◽  
Potential Risks ◽  
Time Required ◽  
Training Protocol ◽  
Made In

Objectives: Currently, there is no standardized training protocol to teach surgeons how to deal with vascular injuries during laparoscopic procedures. The purpose of this study is to develop and evaluate the effectiveness of a standardized algorithm for managing vascular injury during laparoscopic nephrectomies. Materials and Methods: The performance of 6 surgeons was assessed during 10 laparoscopic nephrectomies in a porcine model. During the first and tenth operations, an injury was made in the renal vein without warning the surgeon. After the first procedure, the surgeons were instructed on how to proceed in dealing with the vascular injury, according to an algorithm developed by the designers of this study. The performance of each surgeon before and after learning the algorithm was assessed. Results: After learning the algorithm there was a decreased blood loss from 327 ± 403.11 ml to 37 ± 18.92 ml (p = 0.031) and decreased operative time from 43 ± 14.53 min to 27 ± 8.27 min (p = 0.015). There was also improvement in the time to start lesion repair from 147 ± 117.65 sec to 51 ± 39.09 sec (p = 0.025). There was a trend toward improvement in the reaction time to the injury (22 ± 21.55 sec vs. 14 ± 6.39, p = 0.188), the time required to control the bleeding (50 ± 94.2 sec vs. 14 ± 6.95 sec, p = 0.141), and the total time required to completely repair of the vascular injury (178 ± 170.4 sec vs. 119 ± 183.87 sec, p = 0.302). Conclusion: A standardized algorithm may help to reduce the potential risks associated with laparoscopic surgery. Further studies will help to refine and determine the benefits of standardized protocols such as that developed in this study for the management of life-threatening laparoscopic complications.

scholarly journals Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

2020 ◽  
Vol 26 (3) ◽  
pp. 167-172
Author(s):  
Povilas Masionis ◽  
Rokas Bobina ◽  
Valentinas Uvarovas ◽  
Narūnas Porvaneckas ◽  
Igoris Šatkauskas
Keyword(s):  
Surgical Treatment ◽  
Vascular Injury ◽  
Brachial Artery ◽  
Elbow Joint ◽  
Elbow Dislocation ◽  
Vascular Injuries ◽  
Before And After ◽  
Bony Lesions ◽  
High Index Of Suspicion ◽  
Open Injuries

Dislocation of the elbow joint is the second most common dislocation after the shoulder joint. Although this pathology is relatively common, concomitant vascular injuries are rare. We present a case of a patient who sustained a fall on his arm with an outstretched elbow that resulted in a closed simple posterolateral elbow dislocation and delayed thrombosis of the brachial artery followed by two revascularisation surgeries. The physician must always maintain a high index of suspicion for a concomitant vascular injury before and after closed reduction of the elbow joint and have in mind that complete ischemia without any pulsations could be absent because the elbow is surrounded by rich collateral anastomoses. Suspicion should be even stronger in the presence of bony lesions or open injuries. A team of trauma and vascular surgeons has to work hand in hand as surgical treatment with a saphenous graft or direct suture is the first method of choice with the prior requirement of a stable elbow joint.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

1989 göçü sonrası Bulgaristan göçmenlerinin yemek kültüründeki değişim

2017 ◽  
Vol 4 (2) ◽  
pp. 227-245
Author(s):  
Cahit Kahraman ◽  
İlhan Güneş ◽  
Nanae Kahraman
Keyword(s):  
Eating Habits ◽  
Supply And Demand ◽  
Food Culture ◽  
Rapid Progress ◽  
Canned Food ◽  
Product Range ◽  
The World ◽  
Before And After ◽  
Day By Day ◽  
Made In

1989 göçü öncesi, dünyada eşzamanlı olarak gittikçe gelişen ve zenginleşen mutfak kültürü, Bulgaristan Türklerini de etkilemiştir. Pazardaki çeşitlilik arttıkça, yemek alışkanlıkları da değişime uğramıştır. Büyük göçten sadece 30-40 sene evvel kısıtlı imkânlar ile sınırlı sayıda yemek çeşidi üretilirken, alım gücünün artmasıyla yemek kültüründe de hızlı gelişmeler olmuştur. Artan ürün çeşitliliği yemeklere de yansımış, farklı lezzetler mutfaklara girmiştir. Göçmen yemekleri denilince hamur işleri, börek ve pideler akla gelir. Ayrıca, göçmenlerin çok zengin turşu, komposto ve konserve kültürüne sahip oldukları da bilinir. Bu çalışma, 1989 öncesi Bulgaristan’ın farklı bölgelerinde yaşayan Türklerin yemek alışkanlıklarına ışık tutmakla birlikte, göç sonrasında göçmen mutfak kültüründe bir değişiklik oluşup oluşmadığını konu almaktadır. Bu amaçla, 1989 yılında Türkiye’ye göç etmiş 50 kişiye 8 sorudan oluşan anket düzenlenmiştir. Bu verilerden yola çıkarak oluşan bulgular derlenmiş ve yeni tespitler yapılmıştır. Ayrıca, Türkiye’nin farklı bölgelerine yerleşen göçmenler, kendi göçmen pazarlarını kurmuşlardır. Bulgaristan’dan getirilen ürünlerin bu pazarlarda satılması böyle bir arz talebin hala devam ettiğine işaret etmektedir.ABSTRACT IN ENGLISHThe Diversity in Cuisine Culture of the Immigrants from Bulgaria After 1989 MigrationThe Cuisine culture that has been developing and getting rich day by day contemporaneously in the world before 1989 migration has also had an impact on Bulgarian Turks. By the increase in diversity in the market, eating habits have changed. While producing a limited number of food types with limited opportunities just some 30 or 40 years before the ‘Big Migration’, there has been a rapid progress in food culture by the help of the increase in purchase power. Enhancing product range has been reflected in food, and different tastes have entered the cuisines. When we say immigrant, the first things that come to our mind are pastry, flan and pitta bread. Moreover, it is also known that immigrants have a very rich cuisine culture of pickle, stewed fruit, and canned food. This study aims both to disclose the eating habits of Turks living in different regions of Bulgaria before 1989 and to determine whether there has been a difference in immigrant cuisine culture before and after the migration. For this purpose, a questionnaire consisting of 8 questions has been administered to 50 people who migrated to Turkey in 1989. The results gathered from these data have been compiled and new determinations have been made. In addition, immigrants that settled in different regions of Turkey have set their own immigrant markets. The fact that the products brought from Bulgaria are being sold in these markets shows that this kind of supply and demand still continues.

Pilot-scale neutralisation of underground mine water

1996 ◽  
Vol 34 (10) ◽  
pp. 141-149 ◽  
Author(s):  
J. P. Maree ◽  
G. J. van Tonder ◽  
P. Millard ◽  
T. C. Erasmus
Keyword(s):  
Mine Water ◽  
Contact Time ◽  
Pilot Scale ◽  
Underground Water ◽  
Underground Mine ◽  
Economic Feasibility ◽  
Fluidised Bed ◽  
Chemical Composition Of Water ◽  
Before And After ◽  
Time Required

Traditionally acid mine water is neutralised with lime (Ca(OH)2). Limestone (CaCO3) is a cheaper alternative for such applications. This paper describes an investigation aimed at demonstrating that underground mine water can be neutralised with limestone in a fluidised-bed. The contact time required between the limestone and the acid water, chemical composition of water before and after treatment, and economic feasibility of the fluidised bed neutralisation process are determined. A pilot plant with a capacity of 10k1/h was operated continuously underground in a gold mine. The underground water could be neutralised effectively using the limestone process. The pH of the water was increased from less than 3 to more than 7, the alkalinity of the treated water was greater than 120 mg/l (as CaCO3) and the contact time required between mine water and limestone was less than 10 min (the exact contact time depends on the limestone surface area). Chemical savings of 56.4% can be achieved compared to neutralisation with lime.

scholarly journals Many faces of acute bowel ischemia: overview of radiologic staging

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Amir H. Davarpanah ◽  
Afshar Ghamari Khameneh ◽  
Bardia Khosravi ◽  
Ali Mir ◽  
Hiva Saffar ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Bowel Ischemia ◽  
Management Approach ◽  
Final Decision ◽  
Imaging Findings ◽  
Life Threatening ◽  
Imaging Signs ◽  
Late Stages ◽  
Underlying Pathophysiology ◽  
Made In

AbstractAcute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

scholarly journals Closing the knowledge gap in pelvic neuroanatomy: assessment of a cadaveric training program

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ioana Marcu ◽  
Adrian Balica ◽  
Jeffrey A. Gavard ◽  
Eugen C. Campian ◽  
Gustavo Leme Fernandes ◽  
...  
Keyword(s):  
Cohort Study ◽  
Laparoscopic Surgery ◽  
Training Program ◽  
Knowledge Test ◽  
Educational Facility ◽  
Before And After ◽  
Baseline Knowledge ◽  
The Mean ◽  
Level Of Training ◽  
Dissection Method

Abstract Background The objective of this study is to characterize participants in a laparoscopic cadaveric neuroanatomy course and assess knowledge of pelvic neuroanatomy before and after this course. Methods This is a survey-based cohort study with a setting in a university educational facility. The participants are surgeons in a multiday laparoscopic cadaveric pelvic neuroanatomy course. Participants completed a precourse survey, including demographics and comfort with laparoscopic surgery. They then completed an identical precourse and postcourse anatomic knowledge test. Main outcomes are scores on the anatomic knowledge test precourse and postcourse. Results 44 respondents were included: 25 completed fellowship, 15 completed residency, 2 were residents, and 2 were fellows. Participants were on average 11.09 years post training, with an average of 8.67 years from training if they completed fellowship and 18.62 years if they completed residency only. 22 of 42 respondents strongly agreed or agreed they are comfortable performing complex laparoscopic hysterectomies. The average precourse score was 32.18/50 points and the mean difference score (MDS, defined as mean of Postcourse scores minus Precourse scores) was 9.80, showing significant improvement (p <  0.001). Precourse and MDS scores were not significantly different when comparing country of practice, level of training, or time since training. Conclusion Baseline knowledge of pelvic neuroanatomy was similar among groups when comparing fellowship status, place of training, or time since training. There was significant improvement in knowledge after training in this dissection method. This course garnered interest from surgeons with broad training backgrounds.

scholarly journals Inadvertent arterial & venous injury by bone marrow biopsy needle: case report on rescue embolization techniques

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Chris Siu-Chun Tsai ◽  
Simon Chun-Ho Yu
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Vascular Injury ◽  
Iliac Artery ◽  
Morbidity And Mortality ◽  
Biopsy Needle ◽  
Venous Injury ◽  
Patient Morbidity ◽  
Internal Iliac ◽  
Life Threatening

Abstract Background Bone marrow biopsy is a common medical procedure for diagnosis and characterization of haematological diseases. It is generally regarded as a safe procedure with low rate of major complications. Inadvertent vascular injury is however an uncommon but important complication of bone marrow biopsy procedure. The knowledge of a safe and effective embolization method is crucial for interventional radiologists to reduce significant patient morbidity and mortality, shall such inadvertent vascular injury occurs. Case presentation Bedside bone marrow biopsy was performed for an elderly gentleman to evaluate for his underlying acute leukaemia. Biopsy needle inadvertently injured the internal iliac artery and vein during the procedure. Coil embolization was carefully performed across injured arterial segment via the culprit biopsy needle until contrast cessation. Concomitant venous injury was subsequently confirmed on angiography when the needle was withdrawn for a short distance from the iliac artery. This venous injury was tackled by further withdrawing the biopsy needle to distal end of the bone marrow tract for tract embolization with coils and gelatin sponges. High caution was made to avoid coil dislodgement into the iliac vein, to prevent pulmonary embolism. Patient was clinically stable throughout the procedure. Post-procedure contrast CT shows no pelvic haematoma or contrast extravasation. Conclusions This case illustrates rescue embolization techniques for rare life-threatening concomitant internal iliac arterial and venous injuries by a bone marrow biopsy needle. Interventional radiologists can play an important role in carrying out precise embolization to avoid significant patient morbidity and mortality in the case of life-threatening haemorrhage.

scholarly journals Effect of an Endurance and Strength Mixed Circuit Training on Regional Fat Thickness: The Quest for the “Spot Reduction”

2021 ◽  
Vol 18 (7) ◽  
pp. 3845
Author(s):  
Antonio Paoli ◽  
Andrea Casolo ◽  
Matteo Saoncella ◽  
Carlo Bertaggia ◽  
Marco Fantin ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Subcutaneous Adipose Tissue ◽  
Subcutaneous Fat ◽  
Circuit Training ◽  
Reduced Body ◽  
Before And After ◽  
Traditional Resistance Training ◽  
Subcutaneous Abdominal Adipose Tissue ◽  
Subcutaneous Adipose ◽  
Training Protocol

Accumulation of adipose tissue in specific body areas is related to many physiological and hormonal variables. Spot reduction (SR) is a training protocol aimed to stimulate lipolysis locally, even though this training protocol has not been extensively studied in recent years. Thus, the present study sought to investigate the effect of a circuit-training SR on subcutaneous adipose tissue in healthy adults. Methods: Fourteen volunteers were randomly assigned to spot reduction (SR) or to a traditional resistance training (RT) protocol. Body composition via bioimpedance analysis (BIA) and subcutaneous adipose tissue via skinfold and ultrasound were measured before and after eight weeks of training. Results: SR significantly reduced body mass (p < 0.05) and subcutaneous abdominal adipose tissue (p < 0.05). Conclusions: circuit-training SR may be an efficient strategy to reduce in a localized manner abdominal subcutaneous fat tissue depot.

Coronary Care in a General Hospital

1971 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Gavin Shaw ◽  
Bernard Groden ◽  
Evelyn Hastings
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
First Year ◽  
Duration Of Stay ◽  
Before And After ◽  
The Mean ◽  
Coronary Care ◽  
Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

SERIAL ESTIMATION OF PLASMA RENIN CONCENTRATION DURING PREGNANCY AND AFTER PARTURITION

1966 ◽  
Vol 35 (4) ◽  
pp. 373-378 ◽  
Author(s):  
J. J. BROWN ◽  
D. L. DAVIES ◽  
P. B. DOAK ◽  
A. F. LEVER ◽  
J. I. S. ROBERTSON
Keyword(s):  
Pregnant Women ◽  
Plasma Renin ◽  
Plasma Renin Concentration ◽  
Before And After ◽  
Normal Women ◽  
Made In

SUMMARY Plasma renin concentration has been measured in normal women at intervals throughout pregnancy. Further measurements have been made in the days and hours before and after delivery of the foetus and placenta. Plasma renin was consistently raised in the majority of pregnant women and did not change markedly until 24 hr. or more after delivery. The significance of these findings is discussed.

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