Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Knife

  • knife radiosurgery

  • Selected Abstracts

    The police officer's terrorist dilemma: trust resilience following fatal errors

    Mathew P. White
    Suicide attacks have raised the stakes for officers deciding whether or not to shoot a suspect (,Police Officer's Terrorist Dilemma'). Despite high-profile errors we know little about how trust in the police is affected by their response to the terrorist threat. Building on a conceptualisation of lay observers as intuitive signal detection theorists, a general population sample (N,=,1153) were presented with scenarios manipulated in terms of suspect status (Armed/Unarmed), officer decision (Shoot/Not Shoot) and outcome severity (e.g. suspect armed with Bomb/Knife; police shoot suspect/suspect plus child bystander). Supporting predictions, people showed higher trust in officers who made correct decisions, reflecting good discrimination ability and who decided to shoot, reflecting an ,appropriate' response bias given the relative costs and benefits. This latter effect was moderated by (a) outcome severity, suggesting it did not simply reflect a preference for a particular type of action, and (b) preferences for a tough stance towards terrorism indexed by Right-Wing Authoritarianism (RWA). Despite loss of civilian life, failure to prevent minor terror attacks resulted in no loss of trust amongst people low in RWA, whereas among people high in RWA trust was positive when police erroneously shot an unarmed suspect. Relations to alternative definitions of trust and procedural justice research are discussed. Copyright 2007 John Wiley & Sons, Ltd. [source]


    Lionel Tate was 12 years old when he killed 6-year-old Tiffany Eunick. Tiffany had been staying at the Tate home and, by all accounts, got along well with Lionel. The two were playing at "wrestling" when Lionel decided to try out some moves that he had seen on television. He threw Tiffany across the room, inflicting fatal injuries. Despite the boy's tender age, the prosecutor transferred Lionel to criminal court on a charge of first-degree murder, an offense carrying a mandatory penalty of life without parole. The boy was given an opportunity to plead guilty to second-degree murder in return for a sentence of three years incarceration, but he rejected the offer. A jury subsequently convicted him of first-degree murder. At sentencing, the prosecution recommended leniency, which drew an angry response from the judge: If the state believed the boy did not deserve to be sent to prison for life, why hadn't it charged him with a lesser offense? Without any inquiry into the boy's cognitive, emotional, or moral maturity, the judge imposed the mandatory sentence.1 Raymond Gardner was 16 years old when he shot and killed 20-year-old Mack Robinson.2 Raymond lived in a violent urban neighborhood with his mother, who kept close watch over him. He had no prior record. He was an A student and worked part-time in a clothing store to earn money for college. On the day of the shooting, a friend came into the store to tell Raymond that Mack had a beef with him about talking to a girl, and was "looking to get him." The victim was known on the street as "Mack the Knife" because he always carried a small machete and was believed to have stabbed several people. To protect himself on the way home, Raymond took the gun kept under the counter of the shop where he worked. As he neared home, Mack and two other men approached and blocked his path. According to eyewitness testimony, Raymond began shaking, then pulled out the gun and fired. Mack ran into the street and fell. Raymond followed and fired five more shots into the victim's back as he lay dying on the ground. Raymond did not run. He just stood there crying. The prosecutor filed a motion in juvenile court to transfer Raymond on a charge of first-degree murder. The judge ordered a psychological evaluation, which addressed the boy's family and social background, medical and behavioral history, intelligence, maturity, potential for future violence and prospects for treatment. The judge subsequently denied the transfer motion. He found Raymond delinquent and committed him to a private psychiatric treatment facility.3 [source]

    Glomus jugulare tumor: Tumor control and complications after stereotactic radiosurgery

    Robert L. Foote MD
    Abstract Background We evaluated toxicity and long-term efficacy of stereotactic radiosurgery in patients with symptomatic or progressive glomus jugulare tumors. Methods Twenty-five consecutive patients (age, 30,88 years; 17 women, 8 men) who underwent stereotactic radiosurgery with the Leksell Gamma Knife (dose, 12,18 Gy) were prospectively followed. MRI and clinical examinations were performed at 6 months and 1, 2, and 3 years, and then every 2 years. Results None of the tumors increased in size, 17 were stable, and 8 decreased (median imaging follow-up, 35 months; range, 10,113 months). Symptoms subsided in 15 patients (60%); vertigo occurred in 1, but balance improved with vestibular training (median clinical follow-up, 37 months; range, 11,118 months). No other new or progressive neuropathy of cranial nerves V,XII developed. Conclusions Stereotactic radiosurgery can achieve excellent tumor control with low risk of morbidity in the treatment of glomus jugulare tumors. The lower cranial nerves can safely tolerate a radiosurgical dose of 12 to 18 Gy. 2002 Wiley Periodicals, Inc. Head Neck 24: 332,339, 2002; DOI 10.1002/hed.10005 [source]

    "A Body Oozin' Life": Resurrecting "The Ballad of Mack the Knife"

    Sharon Guthrie

    Sharp Knives and Blunt Instruments: Social Capital in Development Studies

    ANTIPODE, Issue 4 2002
    Anthony Bebbington
    First page of article [source]


    Hideki Toyoda
    A 62-year-old woman was referred to Mie University Hospital, Tsu, Japan, for examination of upper gastrointestinal tract. The conventional endoscopy showed a slightly depressed lesion on the greater curvature at the gastric body. The surface of surrounding non-neoplastic mucosa using magnification endoscopy with acetic acid was gyrus-villous pattern whereas the surface of the lesion was rough. Furthermore, magnification endoscopy using acetic acid and narrow-band imaging system visualized clearer fine surface pattern of carcinoma. The lesion had a rough mucosa with irregularly arranged small pits. The lesion was resected completely by endoscopic mucosal resection with insulated-tip electrosurgical knife. Narrow-band imaging system with acetic acid may be able to visualize not only the capillary pattern but also the fine surface pattern of gastric carcinoma. [source]


    Ichiro Oda
    Background:, Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods:, We reviewed all patients with EGC who underwent ESD using the IT knife at National Cancer Center Hospital in the period between January 2000 and December 2003. Results:, During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions (, 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10,540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment. Conclusion:, The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC. [source]


    Yasushi Sano
    ABSTRACT The goal of endoscopic mucosal resection (EMR) is to allow the endoscopist to obtain tissue or resect lesions not previously amenable to standard biopsy or excisional techniques and to remove malignant lesions without open surgery. In this article, we describe the results of conventional EMR and EMR using an insulation-tipped (IT) electrosurgical knife (submucosal dissection method) for large colorectal mucosal neoplasms and discuss the problems and future prospects of these procedures. At present, conventional EMR is much more feasible than EMR using IT-knife from the perspectives of time, money, complication, and organ preservation. However, larger lesions tend to be resected in a piecemeal fashion; and it is difficult to confirm whether EMR has been complete. For accurate histopathological assessment of the resected specimen en bloc EMR is desirable although further experience is needed to establish its safety and efficacy. Further improvements of in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms. [source]

    Endoscopically managed superficial carcinoma overlying esophageal lipoma

    Shinsuke Usui
    The occurrence of superficial carcinoma over a benign tumor of the esophagus is considered to be rare. Only a few reports have been reported and all of them were treated surgically. We now report one case of superficial carcinoma overlying an esophageal lipoma that was successfully resected endoscopically. The patient was a 61-year-old man who had no symptoms. A submucosal tumor was found at the thoracic esophagus by upper gastrointestinal endoscopy. The top of the tumor was slightly depressed with mild redness and its surface was irregular. This depressed lesion was not stained by iodine. Histological examination of endoscopic biopsy revealed squamous cell carcinoma. To completely remove this tumor in a single fragment, we used an insulation-tipped electrosurgical knife. An en bloc resection of the tumor was completed without complications. [source]

    AAN-EFNS guidelines on trigeminal neuralgia management

    G. Cruccu
    Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence-based recommendations. In patients with TN MRI may be considered to identify patients with structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first-line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain. [source]

    Rubber tree (Hevea brasiliensis) trunk phloem necrosis: aetiological investigations failed to confirm any biotic causal agent

    FOREST PATHOLOGY, Issue 1 2007
    F. Pellegrin
    Summary Trunk phloem necrosis (TPN) is currently a main constraint in rubber (Hevea brasiliensis) plantations. The apparent spread of the disease, from tree to tree along the planting line, strongly supported the implication of a pathogen that could be transmitted mechanically via the tapping knife. In order to detect a causal agent of the disease, studies focusing on characterization of the known mechanically transmitted pathogens (e.g. viroids, cryptic viruses or phytoplasma) were initiated. RNA strands of low molecular weight (200,400 and >500 bp) displaying structural similarities with viroids and viral dsRNAs were observed in various tested samples. However, attempts to show the potential role of these RNA molecules in the spread of the disease failed. First of all, there was no significant or reproducible correlation between the health status of the rubber trees sampled and these RNA molecules. Moreover, no sequence homology with known pathogens could be found when randomly amplified cDNA fragments isolated from trees presenting the disease symptoms were sequenced. In conclusion, the aetiological investigations, in order to show the presence of a pathogen responsible of the TPN disease, were non-conclusive, which tends to disprove the hypothesis of a biotic causal agent. [source]

    The effect of cutting and fish-orientation systems on the deheading yield of carp

    Andrzej Dowgiallo
    Summary Applied research into carp-deheading yield indicated that the V-cut with two circular knives averaged 77.9%; the V-cut with one cup-type knife , 75.6%, and the straight cut at a 79 angle to the fish backbone , 77.4%. The yield averages for deheaded and gutted carp were 63.6%, 62.4% and 62.9%, respectively. Standard analysis of variance demonstrated that there were no statistically significant differences between the mean yields of these three deheading systems. Furthermore, the potential influence of the fish-orientation system in close connection with the cutting systems on the deheading yield was analysed. This indicated that, with the same yields, the straight-cutting system simplifies the precise orientation of the fish in relation to the cutting knives. [source]

    Cross-sectional study of violence in emerging adulthood

    Robert F. MarcusArticle first published online: 9 DEC 200
    Abstract Theories of emerging adulthood, the evolutionary perspective, and the presence of turning points in the lives of 19,25-year olds were examined in relation to serious perpetrated violence for a cross-sectional sample of men and women (n=14,098) from the National Longitudinal Study of Adolescent Health (Add Health), Wave III. Perpetrated, self-reported violence included armed robbery, gang fighting, using a weapon in a fight, pulling a knife or gun on someone, or shooting or stabbing someone. Results showed that 11.3% of emergent adults had perpetrated at least one of these behaviors in the past year. Hierarchical logistic regression analysis partially supported the three theories for both men and women, beyond the contribution of violence in adolescence. The presence of Wave III violence was more likely given the unique contributions of unmarried status and economic risk. Moreover, and consistent with the theory of emerging adulthood, both sensation seeking and depression declined with age and contributed to the acknowledgement of Wave III violence, beyond the contribution of controls for Wave I violence (6 years earlier), demographics, age, gender, unmarried status, and economic risk. Findings of age-related declines and gender differences in prevalence rates were consistent with previous research on nationally representative samples, and with the predictions of the three theories. Aggr. Behav. 35:188,202, 2009. 2008 Wiley-Liss, Inc. [source]


    ABSTRACT The present paper demonstrates that a nonstntggling slaughter method can delay degradation of type V collagen in meat of chub mackerel Scomber japonicus and softening of the meat during postharvest chilled storage. The fish were slaughtered by piercing a knife into nape (nonstruggling method) or by leaving on ground (struggling method) and then stored in an ice box. Sensory study revealed that the postharvest softening of the meat was moderated at 4 and 8 h by the non-struggling slaughter method in comparison with the struggling method. On the basis of the specific solubilization of type V collagen and reduced tyrosine content in it, a cleavage of the nonhelical regions (telopeptides) of the type V collagen occurred during the chilled storage in the fish slaughtered by the struggling method. The degradation of type V collagen was also slower in the meat of the fish slaughtered by the nonstruggling method, which can be directly linked to the moderation of the postharvest softening. [source]

    Screening Adolescents in the Emergency Department for Weapon Carriage

    Rebecca M. Cunningham MD
    Abstract Objectives:, The objective was to describe the prevalence and correlates of past-year weapon involvement among adolescents seeking care in an inner-city emergency department (ED). Methods:, This cross-sectional study administered a computerized survey to all eligible adolescents (age 14,18 years), 7 days a week, who were seeking care over an 18-month period at an inner-city Level 1 ED. Validated measures were administered, including measures of demographics, sexual activity, substance use, injury, violent behavior, weapon carriage, and/or weapon use. Zero-inflated Poisson (ZIP) regression models were used to identify correlates of the occurrence and past-year frequency of these weapons variables. Results:, Adolescents (n = 2069, 86% response rate) completed the computerized survey. Fifty-five percent were female; 56.5% were African American. In the past year, 20% of adolescents reported knife or razor carriage, 7% reported gun carriage, and 6% pulled a knife or gun on someone. Although gun carriage was more frequent among males, females were as likely to carry a knife or pull a weapon in the past year. Conclusions:, One-fifth of all adolescents seeking care in this inner-city ED have carried a weapon. Understanding weapon carriage among teens seeking ED care is a critical first step to future ED-based injury prevention initiatives. ACADEMIC EMERGENCY MEDICINE 2010; 17:168,176 2010 by the Society for Academic Emergency Medicine [source]

    Vitreous cryo-sectioning of cells facilitated by a micromanipulator

    Summary Sectioning vitrified cells and tissues for cryo-electron microscopy is more challenging than room-temperature sectioning of plastic-embedded samples. As the sample must be kept very cold (<,130 C) and because there is no liquid upon which the sections can float as they are cut, transferring the sections from the knife edge to a grid is one of the more difficult steps in the process. We employed a micromanipulator to hold and control the cryo-sections as they come off the knife. This allows slower cutting speeds than are typically used in vitreous cryo-sectioning and contributes to better control during cutting, which facilitates repeatable placement of a ribbon of sections onto a grid. The ribbon is kept under tension during the entire cutting process, which may decrease folding and/or compression, features that are inherent to vitreous sections. Furthermore, the added control afforded by this technique makes it easier for multiple ribbons to be placed on a single grid, thereby increasing the number of sections that can be examined and imaged during a microscopy session. It even allows for serial cryo-electron microscopy. As such, this approach is an advance in the cryo-microtomy of vitreous sections. [source]

    Penetrating injuries in children: Is there a message?

    AJA Holland
    Objectives: To determine the frequency, management and outcome of penetrating trauma in children. Methods: A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded. Results: Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades. Conclusions: Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors. [source]

    Characterization of ultrasound extrudated and cut citric acid/paracetamol blends

    P. Hoppu
    Abstract The purpose of the present work was to study the effect of ultrasound extrusion and cutting on the physical stability of a viscous and sticky supercooled melt containing (50/50, w/w, %) citric acid anhydrate and paracetamol. Samples were extrudated at temperatures of 50, 60, and 70C using power levels of 0, 50, 100, and 150 W. Similarly, extrudates prepared at 60C were cut at temperatures ranging from 25,60C with an ultrasound knife in the range 0, 50, and 100 W. The characterization methods used were: high performance liquid chromatography, differential scanning calorimetry, Karl Fischer titration, X-ray powder diffraction, Fourier transform infrared microscopy, optical- and stereomicroscopy. There was no physical difference in extrudates or cut surfaces whether processed with or without ultrasound. During 1-year aging time in dry conditions, all the samples were observed to crystallize slowly and ultrasound processing did not enhance the crystallization. Ultrasound thus holds some promise for processing of viscous and sticky pharmaceuticals, provided the material is physically stable enough to withstand mechanical and thermal stress. Processing of sticky and viscous material would be difficult without ultrasound with the methods currently used in pharmaceutical industry. 2008 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 98:2140,2148, 2009 [source]

    Newspaper coverage of a violent assault by a mentally ill person

    C. STARK mbchb mph msc mrcpsych ffph
    The media is an important source of public information on mental ill-health. A man with a serious psychiatric illness attacked a minister with a knife at a Remembrance Sunday service in a remote, rural part of the Highlands, inflicting a severe facial wound. We aimed to identify lessons for the National Health Service (NHS) from the media coverage of the incident and of a subsequent court case and NHS Highland inquiry and in addition to explore how newspaper reporters approached reporting such incidents. We searched local and regional, national Scottish, and the Scottish editions of three UK newspapers for relevant coverage. We also conducted structured telephone interviews with eight reporters who had attended the inquiry press conference. Most of the media coverage was associated with the assault and the court case, rather than the inquiry results. Only three of 10 inquiry recommendations were mentioned in any reports. Coverage largely dealt with identified shortfalls, rather than proposed solutions. The NHS had made little comment in advance of the announcement of the inquiry results. Most of the newspaper coverage had already occurred. The NHS therefore limited its opportunity to influence newspaper coverage. The interpretation of the results is limited by the size of the study, but the coverage of such events forms part of the discourse on mental health in the media episodes and may have some affect on public perception of mental health issues. We conclude that, without providing confidential information, the NHS should take a more active stance in providing information on the nature and treatment of mental illness in such instances, even in advance of court cases. [source]

    The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case,control study

    T. Toyonaga
    Aliment Pharmacol Ther 2010; 32: 908,915 Summary Background, Endoscopic submucosal dissection (ESD) using short needle knives is safe and effective, but bleeding is a problem due to low haemostatic capability. Aim, To assess the performance of a novel ball-tipped needle knife (Flush knife-BT) for ESD with particular emphasis on haemostasis. Methods, A case,control study to compare the performance for ESD of 30 pairs of consecutive early gastrointestinal lesions (oesophagus: 12, stomach: 32, colorectum: 16) with standard Flush knife (F) vs. Flush knife-BT (BT). Primary outcome was efficacy of intraprocedure haemostasis. Secondary outcomes included procedure time, procedure speed (dividing procedure time into the area of resected specimen), en bloc resection rate and recurrence rate. Results, Median intraoperative bleeding points and bleeding points requiring haemostatic forceps were smaller in the BT group than in the F group (4 vs. 8, P < 0.0001, 0 vs. 3, P < 0.0001). There was no difference between groups for procedure time; however, procedure speed was shorter in the BT group (P = 0.0078). En bloc and en bloc R0 resection rates were 100%, with no perforation or post-operative bleeding. No recurrence was observed in either group at follow-up 1 year postprocedure. Conclusions, Ball-tipped Flush knife (Flush knife-BT) appears to improve haemostatic efficacy and dissection speed compared with standard Flush knife. [source]

    Effects of cassava processing methods on antinutritional components and health status of children,

    Omorogieva Ojo
    Abstract This study was conducted to evaluate cassava processing methods in Nigeria, its antinutritional components and the possible impact on the health status of children. The traditional method of cassava processing involved peeling of cassava tubers with a knife, manual grating, dewatering with logs of wood and/or stones, sieving with a cane-woven sieve and frying in a local metal fryer on a wood fire. In contrast, the modern method involved the use of knives for peeling, a mechanical grater, a hydraulic press for dewatering, iron sieves for sieving and an improved metal fryer for frying on a coal fire. The products of both methods included gari (accounting for 70% of Nigeria's total cassava consumption) and lafun. The intake of gari and other foods in 129 3,5-year-old children in Benin City, Nigeria was also assessed based on a food frequency questionnaire. The children were classified into normal and protein-deficient groups using lower/middle/upper-arm circumference and clinical features of malnutrition. Based on the number of households in villages around Benin City who were involved in cassava processing, 90% used the traditional processing method compared with 10% using the modern method, although the latter controlled the commercial production and sale of gari. There were significantly (P,<,0.05) higher intakes of protein and energy in normal compared with protein-deficient children, but the latter group obtained higher percentages of protein and energy from gari. In addition, the correlation between the amount of gari consumed and clinical scores of malnutrition was low (R2,<,0.2). This may be due to the children consuming gari from both methods and also from different sources. The average gari intake for these children was 320,g,day,1 and HCN levels may be as high as 10.24,mg,day,1. Some children who are exposed to these levels with poor nutritional status and lack of access to food varieties may develop sublethal effects in the short term. The higher protein intake by the normal children may also reduce the toxicity of HCN. We conclude that methods of processing cassava have profound effects on HCN retention and chemical composition of cassava products. In addition, the modern processing method is more efficient than the traditional method, with significantly reduced processing losses, labour input and levels of HCN. The HCN content in combination with the quantity and quality of protein in the diet has significant impact on the health status of children. Therefore, in susceptible children with poor nutritional status who consume inadequately processed cassava products with limited food choice, these may predispose them to the effects of HCN and thiocyanate. 2002 Society of Chemical Industry [source]

    Cryo-sectioning and chemical-fixing ultramicrotomy techniques for imaging rubber latex particle morphology

    Nadaraja Subramaniam
    Abstract Two methods adapted from biological microscopy are described for a new application in imaging the morphology of rubbery latex particles. In the first method, a drop of latex is frozen in liquid nitrogen, sectioned with a diamond knife and vapour-stained with osmium tetroxide, then viewed by transmission electron microscopy. When applied to latexes made by emulsion polymerization of methyl methacrylate in a natural rubber latex seed, inclusions are clearly visible. A chemical fixation method is then described for imaging the morphology of such rubbery latex particles. Glutaraldehyde is added to the latex, followed by osmium tetroxide. The sample is then dehydrated in ethanol, epoxy resin added, and the sample cured, ultramicrotomed, and imaged with transmission electron microscopy. An inclusion morphology is again clearly seen. Microsc. Res. Tech. 63:111,114, 2004. 2004 Wiley-Liss, Inc. [source]

    Successful Treatment of Laryngeal Stenosis in Laryngo-Onycho-Cutaneous Syndrome with Topical Mitomycin C

    M.R.C.S., P. Seamus Phillips B.M.
    It affects the skin, nails, and larynx. Laryngeal involvement may cause lethal airway obstruction, and has in the past proved very difficult to treat. Mitomycin C is an antibiotic that acts as an alkylating agent, inhibiting DNA synthesis. It reduces fibroblast proliferation, and has previously been used to treat choanal atresia and laryngeal stenosis. We report an 18-year-old man with complete transglottic laryngeal stenosis secondary to laryngo-onycho-cutaneous syndrome. An airway was established by dissection with a bougie and sickle knife, and was initially maintained by the upper limb of a Montgomery T-tube. Laryngeal granulation tissue present on removal of the T-tube was treated with topical mitomycin C (2 mg/mL) applied for 4 minutes on two occasions with an interval of 1 month. A year later, the airway remained patent, with no granulation tissue. [source]

    Optical properties of highly transparent polypropylene cast films: Influence of material structure, additives, and processing conditions

    Katharina Resch
    Polypropylene homopolymers and ethylene/propylene-random-copolymers formulated with and without anti-blocking additives were extruded to cast films with an industrial scale extruder equipped with a soft box, a specific air knife that expels a higher volume of air at lower velocity. The films were analyzed as to their optical properties haze and clarity. A comprehensive topographical characterization was performed using atomic force microscopy (AFM) and confocal microscopy. To obtain morphological information on a nanometer scale AFM phase imaging, micro-thermal analysis and small angle X-ray scattering (SAXS) were done. A significant effect of additives and processing conditions on the film topography and the optical properties was revealed. The films without anti-blocking and antacid aids showed the best optical properties and lowest vertical roughness fluctuations. In contrast, the addition of anti-blocking and antacid aids reduced the optical properties associated with an increase in surface roughness. While for films without anti-blocking aids an enhanced soft box condition resulted in lower vertical fluctuations of roughness and better optical properties, the behavior was in reverse for films with anti-blocking aid. By means of SAXS crystalline lamellae with a thickness of about 2.5 nm were detected. High-resolution phase imaging AFM yielded thicker crystal lamellae on the film surface. POLYM. ENG. SCI., 46:520,531, 2006. 2006 Society of Plastics Engineers. [source]

    Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, Japan

    Article first published online: 28 AUG 200
    Inpatient treatment of obsessive,compulsive disorder in a child and adolescent psychiatry ward M. USAMI National Center of Neurology and Psychiatry, Kohnodai Hospital, Chiba, Japan This is a case report of a 13-year-old-boy (2nd grade in junior high school). His father had poor communication; his mother was a very fragile woman. The boy had been overprotected by his parents, as long as he responded to their expectations. He did not have any other siblings. He played well with his friends since he was young, and did not have problems until the 1st term (from April to July) of 1st grade in junior high school. However, in September he started to have difficulties going well with his friends, and going to school. He spent most of his time in his room, and began to repeat checking and hand-washing frequently. Even at midnight, he forced his mother to touch the shutter from outside of the house for many times. He also ritually repeated to touch his mother's body, after he licked his hands, for over an hour. He became violent, when his parents tried to stop him. In April, year X, his parents visited our hospital for the first time. From then, his mother could not tolerate her son's coerciveness any longer. His father explained to the boy that ,your mother has been hospitalized', and she started to live in the next room to the boy's without making any noise. After 3 months he noticed that his mother was not hospitalized, and he got very excited. He was admitted to our hospital with his family and relatives, in October, year X. At the initial stage of hospitalization he showed distrust and doubt towards the therapist and hospital. He had little communication with other boys and did not express his feelings. Therefore, there was a period of time where he seemed to wonder whether he could trust the treatment staff or not. During his interviews with his therapist he repeated only ,I'm okay' and did not show much emotional communication. For the boy, exposing himself was equivalent to showing his vulnerability and incompleteness. Therefore, the therapist considered that he was trying to denying his feelings to avoid this. The therapist set goals for considering his own feelings positively and expressing them appropriately. Also, the therapist carried out behavioral restrictions towards him. He hardly had any emotional communication with the staff, and his peer relationship in the ward was superficial. Therefore, he gradually had difficulty spending his time at the end of December On the following day in which he and the therapist decided to return to his house for the first time, he went out of the ward a few days before without permission. From thereon it was possible for him to share feelings such as hostility and aggression, dependence and kindness with the therapist. The therapist changed his role from an invasive one to a more protective one. Then, his unsociability gradually faded. He also developed good peer relationships with other boys in the ward and began to express himself feeling appropriately. He was also able to establish appropriate relations with his parents at home, and friends of his neighborhood began to have normal peer relationships again. During childhood and adolescence, boys with obsessive,compulsive disorder are known to have features such as poor insight and often involving their mothers. We would like to present this case, through our understanding of dynamic psychiatry throughout his hospitalization, and also on the other therapies that were performed. Psychotherapy with a graduate student that discontinued after only three sessions: Was it enough for this client? N. KATSUKI Sophia University, Tokyo, Japan Introduction: Before and after the psychotherapy, SWT was administrated in this case. Comparing these two drawings, the therapist was provided with some ideas of what kind of internal change had taken place inside this client. Referring to the changes observed, we would like to review the purposes and the ways of the psychotherapy, as well as the adequacy of the limited number of the sessions (vis-a-vis result attained.) Also we will discuss later if any other effective ways could be available within the capacities of the consulting system/the clinic in the university. Case: Ms. S Age 24 years. Problems/appeal: (i) awkwardness in the relationship with the laboratory colleagues; (ii) symptoms of sweating, vomiting and quivering; and (iii) anxiety regarding continuing study and job hunting. Diagnosis: > c/o PTSD. Psychotherapeutic setting: At the therapy room in the clinic, placed at the university, 50 min-session; once a week; paralleled with the medical treatment. Process: (1) Since she was expelled from the study team in the previous year, it has become extremely difficult for her to attend the laboratory (lab) due to the aforementioned symptoms. She had a feeling of being neglected by the others. When the therapist suggested that she compose her mental confusions in the past by attending the therapy room, she seemed to be looking forward to it, although she said that she could remember only a few. (2) She reported that she overdosed on sedatives, as she could not stop irritating. She was getting tough with her family, also she slashed the mattress of her bed with a knife for many times. She complained that people neither understood nor appreciated her properly. and she said that she wanted revenge on the leader of the lab by punishing him one way or other. (3) Looking back the previous session, she said ,I had been mentally mixed up at that time, but I feel that now I can handle myself, as I stopped the medication after consulting the psychiatrist. According to what she said, when she disclosed the occurrences in the lab to her mother, she felt to be understood properly by her mother and felt so relieved. and she also reported that she had been sewing up the mattress which she slashed before, without any reason. She added, " although I don't even know what it means, I feel that this work is so meaningful to me, somehow". Finally, she told that she had already made her mind to cope with the situation by herself from now on, although it might result in a flinch from the real solution. Situations being the above, the session was closed. Swt: By the remarkable changes observed between the two drawings, the meanings of this psychotherapy and its closure to the client would be contemplated. Question of how school counselors should deal with separation attendant on students' graduation: On a case in which the separation was not worked through C. ASAHARA Sophia University, Tokyo, Japan Although time limited relationship is one of the important characteristics in school counseling, the question of separation attendant on it has not been much discussed based on specific cases. This study focuses on the question of separation through looking at a particular case, in which the separation was not worked through, and halfway relationship continued even after the student's graduation and the counselor's resignation. I was a part time school counselor at a junior high school in Tokyo. The client was a 14-year-old female student, who could not go to her classroom, and spent a few hours in a sick bay when she came to school. She was in the final grade and there was only half a year left before graduation when we first met, and we started to see each other within a very loose structure. As her personality was hyper-vigilant and defensive, it took almost 2 months before I could feel that she was nearer. Her graduation was the first occasion of separation. On that occasion, I found that there had been a discrepancy between our expectations; while I took it for granted that our relationship would end with the graduation, she expected to see me even after she graduated, and she actually came up to see me once in a while during the next year. A year later, we faced another occasion of separation, that was my resignation. Although I worried about her, all I have done for her was to hand a leaflet of a counseling office, where I work as a part time counselor. Again I could not refer to her feelings or show any concrete directions such as making a fixed arrangement. After an occasional correspondence for the next 10 months (about 2 years after her graduation), she contacted me at the counseling office asking for a constant counseling. Why could I not deal with both occasions? and how did that affect the client thereafter? There were two occasions of separation. At the time of the client's graduation, I seemed to be enmeshed in the way of separation that is peculiar to the school setting. In general in therapeutic relationship, mourning work between counselor and client is regarded as being quite important. At school, however, separation attendant on graduation is usually taken for granted and mourning work for any personal relationship tends to be neglected. Graduation ceremony is a big event but it is not about mourning over one's personal relationships but separation from school. That may be why I did not appreciate how the client counted on our relationship. At the time of my resignation I was too worried about working through a change from very loose structure which is peculiar to the school setting to a usual therapeutic structure (fees are charged, and time, place are fixed). That is why I did nothing but give her a leaflet. In this way, we never talked about her complex feelings such as sadness or loneliness, which she was supposed to experience on separation. Looking at the aforementioned process from the client's viewpoint, it can be easily imagined that she could not accept the fact of separation just because she graduated. and later, she was forced to be in double-bind situation, in which she was accepted superficially (handed a leaflet), while no concrete possibility was proposed concerning our relationship (she could never see me unless she tries to contact me.) As a result, she was left alone and at a loss whether she could count on me or not. The halfway situation or her suspense was reflected in her letter, in which she appeared to be just chatting at first sight, but between the lines there was something more implying her sufferings. Above discussion suggests that in some case, we should not neglect the mourning work even in a school setting. To whom or how it is done is the next theme we should explore and discuss in the future. For now, we should at least be conscious about the question of separation in school setting. Study of the process of psychotherapy with intervals for months M. TERASHIMA Bunkyo Gakuin University, Tokyo, Japan This is a report on the process of psychotherapy of an adolescent girl who showed manic and depressive state. At the time of a depressed state, she could not go to a college and withdrew into home, and the severe regressive situation was shown. Her therapy began at the age of 20 and she wanted to know what her problem was. The process of treatment went on for 4 years but she stopped coming to sessions for several months because of failure of the therapist. She repeated the same thing twice. After going through these intervals the client began to remember and started to talk about her childhood , suffering abusive force from her father, with vivid impressions. They once were hard for her to accept, but she began to establish the consistent figure of herself from past to present. In this case, it could be thought that the intervals of the sessions had a certain role, with which the client controlled the structure of treatment, instead of an attack against the therapist. Her object relation, which is going to control an object offensively, was reflected in these phenomena. That is, it can be said that the ambivalence about dependency , difficult to depend but desirous of the object , was expressed. Discontinuation of the sessions was the product of the compromise formation brought about the ambivalence of the client, and while continuing to receive this ambivalence in the treatment, the client started to realize discontinuance of her memories and then advanced integration of her self-image. For the young client with conflict to dependence such as her, an interval does not destroy the process of treatment but in some cases it could be considered as a therapeutic element. In the intervals the client could assimilate the matter by herself, that acquired by the sessions. Psychotherapy for a schizoid woman who presented eccentric speech and behaviour M. OGASAWARA Osaka University Graduate School of Medicine, Osaka, Japan Case presentation: A case of a 27-year-old woman at the beginning of therapy. Life history: She had been having a wish for death since she was in kindergarten and she had been feeling strong resistance to do the same as others after school attendance. She had a history of ablutomania from the age of 10,15, but the symptom disappeared naturally. and she said that she had been eliminated from groups that she tried to enter. After graduating a junior college, she changed jobs several times without getting a full-time position. Present history: Scolded by her boy friend for her coming home too late one day, she showed confusion such as excitement, self-injury or terror. She consulted a psychiatrist in a certain general hospital, but she presented there eccentric behaviours such as tense facial expression, stiffness of her whole body, or involuntary movement of limbs. and because she felt on bad terms with the psychiatrist and she had come to cause convulsion attacks in the examination room, she was introduced to our hospital. Every session of this psychotherapy was held once a week and for approximately 60 min at a time. Treatment process: She sometimes presented various eccentric attitudes, for example overturning to the floor with screaming (1), going down on her knees when entrance at the door (5), entering with a knife in her mouth and hitting the wall suddenly (7), stiffening herself just outside the door without entering the examination room (9), taking out a knife abruptly and putting it on her neck (40), exclaiming with convulsion responding to every talk from the therapist (41), or stiffening her face and biting herself in the right forearm suddenly (52). She also repeated self-injuries or convulsion attacks outside of the examination room in the early period of the therapy. Throughout the therapy she showed hypersensitivity for interpersonal relations, anxiety about dependence, terror for self-assertion, and avoidance for confrontation to her emotional problems. Two years and 6 months have passed since the beginning of this therapy. She ceased self-injury approximately 1 year and 6 months before and her sense of obscure terror has been gradually reduced to some extent. Discussion: Her non-verbal wariness and aggression to the therapist made the sessions full of tension and the therapist felt a sense of heaviness every time. In contrast, she could not express aggression verbally to the therapist, and when the therapist tried to identify her aggression she denied it. Her anxiety, that she will be thoroughly counterattacked to self-disintegration if she shows aggression to other persons, seems to be so immeasurably strong that she is compelled to deny her own aggression. Interpretations and confrontations by the therapist make her protective, and occasionally she shows stronger resistance in the shape of denial of her problems or conversion symptoms (astasia, aphonia, or involuntary movements) but she never expresses verbal aggression to the therapist. and the therapist feels much difficulty to share sympathy with her, and she expresses distrust against sympathetic approach of the therapist. However, her obvious disturbance that she expresses when she feels the therapist is not sympathetic shows her desire for sympathy. Thus, because she has both strong distrust and desire for sympathy, she is in a porcupine dilemma, which is characteristic of schizoid patients as to whether to lengthen or to shorten the distance between herself and the therapist. This attitude seems to have been derived from experience she might have had during her babyhood and childhood that she felt terror to be counterattacked and deserted when she showed irritation to her mother. In fact, existence of severe problems of the relationship between herself and her mother in her babyhood and childhood can be guessed from her statement. Although she has been repeating experiences to be excluded from other people, she shows no attitude to construct interpersonal relationship actively. On the contrary, by regarding herself to be a victim or devaluating other persons she externalizes responsibility that she herself should assume essentially. The reason must be that her disintegration anxiety is evoked if she recognizes that she herself has problems; that is, that negative things exist inside of her. Therefore, she seems to be inhibited to get depressive position and obliged to remain mainly in a paranoid,schizoid position. As for the pathological level, she seems to have borderline personality organization because of frequent use of mechanisms to externalize fantastically her inner responsibility. For her high ability to avoid confronting her emotional problems making the most of her verbal ability, every intervention of the therapist is invalidated. So, it seems very difficult for her to recognize her own problems through verbal interpretations or confrontation by the therapist, for the present. In general, it is impossible to confront self problems without containing negative emotions inside of the self, but her ability seemed to be insufficient. So, to point out her problems is considered to be very likely to result in her confusion caused by persecution anxiety. Although the therapy may attain the stage on which verbal interpretation and confrontation work better some day, the therapist is compelled to aim at promoting her ability to hold negative emotion inside of herself for the time being. For the purpose, the therapist is required to endure the situation in which she brings emotion that makes the therapist feel negative counter-transference and her process to experience that the therapeutic relation itself would not collapse by holding negative emotion. On supportive psychotherapy with a male adolescent Y. TERASHIMA Kitasato University Health Care Center, Kanagawa, Japan Adolescent cases sometimes show dramatic improvements as a consequence of psychotherapy. The author describes how psychotherapy can support an adolescent and how theraputic achievements can be made. Two and a half years of treatment sessions with a male adolescent patient are presented. The patient was a 19-year-old man, living with his family. He had 5 years of experience living abroad with his family and he was a preparatory school student when he came to a mental clinic for help. He was suffering from not being able to sleep well, from difficulties concerning keeping his attention on one thing, and from fear of going to distant places. He could barely leave his room, and imagined the consequence of overdosing or jumping out of a window. He claimed that his life was doomed because his family moved from a town that was familiar to him. At the first phase of psychotherapy that lasted for approximately 1 year, the patient seldom responded to the therapist. The patient was basically silent. He told the therapist that the town he lives in now feels cold or that he wants to become a writer. However, these comments were made without any kind of explanation and the therapist felt it very difficult to understand what the patient was trying to say. The sessions continued on a regular basis. However, the therapist felt very useless and fatigued. Problems with the patient and his family were also present at this phase of psychotherapy. He felt unpleasant at home and felt it was useless to expect anything from his parents. These feelings were naturally transferred to the therapist and were interpreted. However, interpretation seemed to make no changes in the forms of the patient's transference. The second phase of psychotherapy began suddenly. The patient kept saying that he did not know what to talk about. However, after a brief comment made by the therapist on the author of the book he was reading, the patient told the therapist that it was unexpected that the therapist knew anything of his favorite writer. After this almost first interaction between the patient and the therapist, the patient started to show dramatic changes. The patient started to bring his favorite rock CDs to sessions where they were played and the patient and the therapist both made comments on how they felt about the music. He also started asking questions concerning the therapist. It seemed that the patient finally started to want to know the therapist. He started communicating. The patient was sometimes silent but that did not last long. The therapist no longer felt so useless and emotional interaction, which never took place in the first phase, now became dominant. The third phase happened rapidly and lasted for approximately 10 months. Conversations on music, art, literature and movies were made possible and the therapist seldom felt difficulties on following the patient's line of thought. He started to go to schools and it was difficult at first but he started adjusting to the environment of his new part-time jobs. By the end of the school year, he was qualified for the entrance to a prestigious university. The patient's problems had vanished except for some sleeping difficulties, and he did not wish to continue the psychotherapy sessions. The therapist's departure from the clinic added to this and the therapy was terminated. The patient at first reminded the therapist of severe psychological disturbances but the patient showed remarkable progress. Three points can be considered to have played important roles in the therapy presented. The first and the most important is the interpretation by behavior. The patient showed strong parental transference to the therapist and this led the therapist to feel useless and to feel fatigue. Content analysis and here-and-now analysis seemed to have played only a small part in the therapy. However, the therapist tried to keep in contact with the patient, although not so elegant, but tried to show that the therapist may not be useless. This was done by maintaining the framework of the therapy and by consulting the parents when it was considered necessary. Second point is the role that the therapist intentionally took as a model or target of introjection. With the help of behavioral interpretation that showed the therapist and others that it may not be useless, the patient started to introject what seemed to be useful to his well being. It can be considered that this role took some part in the patient going out and to adjust to the new environment. Last, fortune of mach must be considered. The patient and the therapist had much in common. It was very fortunate that the therapist knew anything about the patient's favorite writer. The therapist had some experience abroad when he was young. Although it is a matter of luck that the two had things in common, it can be said that the congeniality between the patient and the therapist played an important role in the successful termination of the therapy. From the physical complaint to the verbal appeal of A's recovery process to regain her self-confidence C. ITOKAWA and S. KAZUKAWA Toyama Mental Health Center, Toyama, Japan This is one of the cases at Toyama Mental Health Center about a client here, we will henceforth refer to her simply as ,A'. A was a second grade high school student. We worked with her until her high school graduation using our center's full functions; counseling, medical examination and the course for autogenic training (AT). She started her counseling by telling us that the reason for her frequent absences from school began because of stomach pains when she was under a lot of stress for 2 years of junior high school, from 2nd grade to 3rd grade. Due to a lack of self confidence and a constant fear of the people around her, she was unable to use the transportation. She would spend a large amount of time at the school infirmary because she suffered from self-diagnosed hypochondriac symptoms such as nausea, diarrhea and a palpitation. She continued that she might not be able to have the self-confidence to sit still to consult me on her feelings in one of our sessions. A therapist advised her to take the psychiatric examination and the use of AT and she actually saw the medical doctor. In counseling (sessions), she eventually started to talk about the abuse that started just after her entering of junior high school; she approached the school nurse but was unable to tell her own parents because she did not trust them. In doing so, she lost the rest of her confidence, affecting the way she looked at herself and thought of how others did. At school she behaved cheerfully and teachers often accused her of idleness as they regarded this girl's absences along with her brightly dyed hair and heavy make-up as her negligent laziness. I, as her therapist, contacted some of the school's staff and let them know of her situation in detail. As the scolding from the teachers decreased, we recognized the improvement of her situation. In order to recover from the missed academic exposure due to her long absence, she started to study by herself. In a couple of months her physical condition improved gradually, saying ,These days I have been doing well by myself, haven't I?' and one year later, her improved mental condition enabled her to go up to Tokyo for a concert and furthermore even to enjoy a short part-time job. She continued the session and the medical examination dually (in tangent) including the consultation about disbelief to the teachers, grade promotion, relationships between friends and physical conditions. Her story concentrated on the fact that she had not grown up with sufficiently warm and compassionate treatment and she could not gain any mental refuge in neither her family nor her school, or even her friends. Her prospects for the future had changed from the short-ranged one with no difficulty to the ambitious challenge: she aimed to try for her favorite major and hoped to go out of her prefecture. But she almost had to give up her own plan because the school forced her to change her course as they recommended. (because of the school's opposition with her own choice). So without the trust of the teachers combined with her low self-esteem she almost gave up her hopes and with them her forward momentum. In this situation as the therapist, I showed her great compassion and discussed the anger towards the school authorities, while encouraging this girl by persuading her that she should have enough self-confidence by herself. Through such sessions, she was sure that if she continued studying to improve her own academic ability by herself she could recognize the true meaning of striving forward. and eventually, she received her parents' support who had seemed to be indifferent to her. At last she could pass the university's entrance exams for the school that she had yearned to attend. That girl ,A' visited our center 1 month later to show us her vivid face. I saw a bright smile on her face. It was shining so brightly. [source]

    Preparation Techniques for the Injection of Human Autologous Cartilage: An Ex Vivo Feasibility Study,

    THE LARYNGOSCOPE, Issue 1 2008
    J Pieter Noordzij MD
    Abstract Objectives: To determine the optimum donor site and preparation technique for injecting human autologous cartilage as a potentially permanent implant material for vocal fold medialization. Study Design: Prospective ex vivo experimental model. Methods: Human nasal septal and auricular cartilage was obtained from eight surgical cases after institutional review board approval. The auricle and nasal septum were chosen as potential donor sites because of ease of accessibility, volume of cartilage potentially available, and minimal subsequent cosmetic deformity after the tissue harvesting procedure. Various preparation techniques readily available in most operating rooms were tested for their efficacy in generating an injectable cartilage slurry. The various cartilage slurries were injected through sequentially smaller needles and examined cytologically. Results: The best injection properties for both nasal septal and auricular cartilage were obtained by drilling the cartilage down with a 5 mm otologic cutting bur, which allowed free passage through an 18 gauge needle. Cytologic examination of drilled septal cartilage showed good uniformity of cartilage pieces with a mean largest dimension of 0.44 0.33 mm, and 33% of lacunae contained viable-appearing chondrocytes. Cytologic examination of drilled auricular cartilage was similar, exceptonly 10% of lacunae were occupied by chondrocytes. Other techniques tested (knife, morselizer, and cartilage crusher) did not yield injectable cartilage slurries. Conclusions: Both nasal septal and auricular cartilage can be prepared for injection via an 18 gauge needle using a cutting otologic bur. Further testing of in vivo viability and long-term volume retention is needed. [source]


    ANZ JOURNAL OF SURGERY, Issue 4 2008
    Vu Kwan
    Background: Pancreas divisum (PD) is the commonest congenital pancreatic abnormality and is implicated as a cause of acute recurrent pancreatitis (ARP). We report our experience in minor papilla sphincterotomy (MPS) for this condition. Studies published at present have not examined MPS as the primary treatment method in a homogenous (i.e. only those with ARP) patient group. Methods: Patients with PD and ARP were identified from an endoscopic database. Treatment protocol consisted of minor papilla guidewire cannulation and sphincterotomy with either sphincterotome over the wire or needle knife over pancreatic stent. A 5-Fr stent was placed for 1 week. Adjunctive therapy was carried out as required. Follow-up data was collected by interview with the patient and referring doctors and review of the medical record. Results: Twenty-one patients underwent MPS for PD and ARP (median age = 33 years, range 9,77 years, men = 14). Median number of procedures to achieve cannulation and MPS was 1 (range 1,3). Complications encountered were pancreatitis (n = 2) and pain (n = 3). MPS restenosis occurred in 2. Adjuvant therapy was required in 14: stricture dilatation (n = 9), stone extraction (n = 7) and extracorporeal shock-wave lithotripsy (n = 6). Complete stone clearance was achieved in 7/7. Median follow up was 38 months (range 4,67 months). Median total number of pancreatitis episodes and hospitalizations pre-MPS were 4 and 2, respectively (range 1,20 and 0,5, respectively). Post-MPS these were reduced to 0 and 0, respectively (range 0,8 and 0,4; P = 0.0007 and P = 0.0003), with complete abolition of episodes in 13 patients. Conclusion: MPS in association with other endoscopic therapies imparts a significant clinical benefit to patients with ARP and PD. Complete clinical resolution occurs in the majority. Treatment is safe, and the response is durable. [source]

    Design and Test of a Vascular Access Device

    ARTIFICIAL ORGANS, Issue 5 2000
    Gijsbertus Jacob Verkerke
    Abstract: Transarterial left ventricular assist devices (LVADs), such as the Hemopump, IABP, and PUCA-pump, are meant to be introduced into the body via the femoral or axillary artery without major surgery. For certain applications, introduction is performed directly into the aorta via an open thorax procedure. A prototype of a vascular access device has been realized that allows direct access into the aorta as an alternative for the common surgical graft anastomosis suturing technique. The device consists of a metal tube acting as a circular knife to cut a hole in the aortic wall, a screw to store the removed part of the aortic wall, and a plastic tube that is introduced through the hole and tightly connected to the aortic wall. The device could be placed without aortic clamping. The device has been tested on a slaughterhouse porcine aorta. A low-pressurized aorta appeared to be the worst case; thus, two animal experiments in the low-pressurized pulmonary artery were performed. No leakage occurred for pressures between 40 and 300 mm Hg. [source]

    For perimortem caesarean section, the surgical knife is the most important instrument

    Q Warraich
    No abstract is available for this article. [source]

    Corrosion behaviour of tool steels in tannic acids

    H. Winkelmann
    Abstract It is well known that cutting knifes in the wood industry often suffer from corrosion. Investigations showed that the corrosiveness of different wood types is responsible for a major part of the damage, and that different woods have a different corrosive impact. It is revealed that tannin, a water-soluble acid, which can be found in all woods in different concentrations, is the most aggressive acid contained in the wood, and so it is responsible for the main part of the corrosive attack. In view of the above, the ability of different cold-work steels to resist corrosion caused by tannic acid has been investigated. Often corrosion is measured by the mass loss of the sample divided by the surface of the sample under certain conditions during a fixed period of time. One problem with this method is that there is also a weight gain caused by oxidation or by other side reactions at the samples surface. So in some cases the weight of the sample even increases during the testing time, which makes the quantification of the corrosion impossible with this method. Due to the reasons already mentioned, another method was used to quantify the test results. This method is based on inductive coupled plasma,optical emission spectral analyses (ICP-OES), where the released Fe is quantified. The results of the corrosion resistant tests get correlated to the microstructure and the elemental composition of the analysed cold-work steels. The present investigations improve the understanding of important material parameters to enhance the corrosion resistance against tannin. It is revealed that the higher the primary carbide concentration is the more Cr or other passivating elements are necessary in the matrix to show a good protection against corrosion by tannin. Three materials with different elemental compositions have been investigated, and for one of those materials the influence of different heat treatments was also analysed. The investigations could show that annealing parameters and freeze-cycle processing (FCP) have less impact on the corrosion resistance to tannin than elemental composition and austenitising temperature. [source]