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Maneuver
Kinds of Maneuver Selected AbstractsWARRANTED ASSERTABILITY MANEUVERS AND THE RULES OF ASSERTIONPACIFIC PHILOSOPHICAL QUARTERLY, Issue 4 2008LEO IACONO I argue that no invariantist WAM against Stewart Cohen's Airport Case can succeed. The problem is that such a WAM is inconsistent with the known ways of accounting for the evidence that motivates the knowledge account of assertion. [source] A Simple Maneuver on Sternal Saw Facilitates to Perform Curved Sternal Mini-incisions like J- and C-Shaped Partial SternotomiesJOURNAL OF CARDIAC SURGERY, Issue 4 2009Koray Ak M.D. To increase the cosmetic benefit and improve the surgical exposure, the length of underlying partial sternotomy is usually 3 to 5 cm longer than the length of skin incision in most of these approaches. Using a standard sternal saw or a rotary craniotome, it is quite difficult to make sternal incision under subcutaneous tissue at both ends of skin incision. Moreover, standard sternal saws do not allow doing fine manipulations on sternum that may cause inadvertent sternal cutting, especially at the curved parts of C- or J-type partial sternotomies. We removed the blade protector part of a standard sternal saw. This simple maneuver enables surgeons to perform several challenging mini-sternotomies easily for adult cardiac procedures. [source] Intraoperative Precise Localization of Paravalvular Mitral Leak by a Simple Surgical ManeuverJOURNAL OF CARDIAC SURGERY, Issue 5 2008F.R.C.S.C., Idris Ali M.D. The first and the most important step is to localize the leaking spot precisely. Echocardiogram is the standard technique that is used to localize the leak.2,3 The echocardiogram is accurate most of the time; however, in some occasions it does not easily provide the exact orientation of the leaking areas. A simple operative maneuver, which was used to allow the surgeon to localize the leak visually, and have accurate and solid repair, is described below. [source] A Novel Pacing Maneuver to Localize Focal Atrial TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2007F.R.A.C.P., UWAIS MOHAMED M.B.B.S. Background: Although focal atrial tachycardias cannot be entrained, we hypothesized that atrial overdrive pacing (AOP) can be an effective adjunct to localize the focus of these tachycardias at the site where the post-pacing interval (PPI) is closest to the tachycardia cycle length (TCL). Methods: Overdrive pacing was performed in nine patients during atrial tachycardia, and in a comparison group of 15 patients during sinus rhythm. Pacing at a rate slightly faster than atrial tachycardia in group 1 and sinus rhythm in group 2 was performed from five standardized sites in the right atrium and coronary sinus. The difference between the PPI and tachycardia or sinus cycle length (SCL) was recorded at each site. The tachycardia focus was then located and ablated in group 1, and the atrial site with earliest activation was mapped in group 2. Results: In both groups the PPI-TCL at the five pacing sites reflected the distance from the AT focus or sinus node. In group 1, PPI-TCL at the successful ablation site was 11 ± 8 msec. In group 2, PPI-SCL at the site of earliest atrial activation was 131 ± 37 msec (P < 0.001 for comparison). In groups 1 and 2, calculated values at the five pacing sites were proportional to the distance from the AT focus or sinus node, respectively. Conclusions: The PPI-TCL after-AOP of focal atrial tachycardia has a direct relationship to proximity of the pacing site to the focus, and may be clinically useful in finding a successful ablation site. [source] Contralateral Incipient Posterior Canal Benign Positional Paroxysmal Vertigo: Complication After Epley ManeuverTHE LARYNGOSCOPE, Issue 11 2008Annabelle C. Leong BSc MRCS Abstract Background: Particle repositioning procedures give consistent results for the treatment of benign positional paroxysmal vertigo (BPPV). However, little consideration has been given to the possibilities of bilateral disease. Objective/Hypothesis: To report contralateral symptoms and signs suggestive of revealed or incipient BPPV as a complication of Epley maneuver. Study Design: A prospective cohort of 198 cases over a period of 11 years. Results: Ten (5.0%) developed contralateral symptoms and signs suggestive of revealed or incipient posterior canal BPPV within 2 weeks of treatment. Conclusion: This novel observation has not been previously described and may influence the strategy for future management of patients with BPPV. Particle repositioning maneuvers for the previously asymptomatic contralateral ear may need to be considered in a subset of patients with posterior canal BPPV who suffer contralateral symptoms after undergoing treatment for the original ear. [source] Therapeutic Efficacy of the Epley Canalith Repositioning Maneuver,THE LARYNGOSCOPE, Issue 6 2001Michael J. Ruckenstein MD Abstract Objectives/Hypotheses The hypotheses of the current study are as follows: 1) That if the Epley canalith repositioning maneuver is an effective treatment for benign positional vertigo (BPV), relief from the vertigo should occur virtually immediately after the performance of the maneuver; 2) that the Epley canalith repositioning maneuver does provide almost immediate relief in BPV and should be the established treatment of choice for this disorder in both primary and tertiary care settings; and 3) that residual symptoms of lightheadedness and imbalance do persist after the resolution of the vertigo. The distinction of these symptoms from the vertigo is required for the accurate evaluation of the efficacy of positional maneuvers. Study Design Prospective cohort study in a tertiary care balance center. Methods Eighty-six patients (95 cases) with a history and physical examination consistent with active BPV were entered in the study. Patients were treated with a modified Epley canalith repositioning maneuver. A modified 360° roll was used to treat those patients with horizontal canal BPV. Patients were provided with a preprinted diary in which they were to circle the answer most relevant to their symptoms for 14 days after the maneuver. Patients were then re-evaluated in the office at 2 weeks after the maneuver. Results The mean duration of the BPV before treatment was 9 weeks. Seventy-four percent of cases that were treated with one or two canalith repositioning maneuvers had a resolution of vertigo as a direct result of the maneuver. A resolution attributable to the first intervention was obtained in 70% of cases within 48 hours of the maneuver. An additional 14% of cases that were treated had a resolution of vertigo; however, it is not possible to say that these patients definitely benefited from the canalith repositioning maneuver. Only 4% of cases (three patients) manifested BPV that persisted after four treatments. Residual symptoms of lightheadedness or imbalance, or both, were frequent (47% of cases) but rarely required formal intervention with vestibular rehabilitation physical therapy. Conclusions The Epley canalith repositioning maneuver results in a resolution of vertigo in the majority of patients (70% of cases) immediately after one treatment. It is safe and requires no special equipment or investigations. It should be established as the treatment of choice for BPV in both primary and tertiary care settings. [source] Effectiveness of the Particle Repositioning Maneuver in Subtypes of Benign Paroxysmal Positional VertigoTHE LARYNGOSCOPE, Issue 8 2000Robert C. O'Reilly MD Objectives To assess the efficacy of the particle repositioning maneuver (PRM) in patients presenting with idiopathic benign paroxysmal positional vertigo (BPPV) compared with those with evidence of additional peripheral vestibulopathies. Methods Retrospective administration of the Dizziness Handicap Inventory (DHI) to 41 patients with primary BPPV and 31 patients with secondary BPPV to subjectively evaluate their symptoms before and after the PRM. Results Both groups indicated a marked improvement in symptoms after the PRM. Only two patients reported an increase in their symptoms after the PRM and both had secondary BPPV. Conclusions The PRM was found to be highly effective in all forms of BPPV, but careful history and judicious testing may identify patients requiring additional intervention to relieve their symptoms. [source] Lung Function Tests in Neonates and Infants with Chronic Lung Disease: Forced Expiratory ManeuversPEDIATRIC PULMONOLOGY, Issue 3 2006Sooky Lum PhD Abstract This fourth paper in a review series on the role of lung function testing in infants and young children with acute neonatal disorders and chronic lung disease of infancy (CLDI) addresses measurements of forced expiration using rapid thoraco-abdominal compression (RTC) techniques and the forced deflation technique. Following orientation of the reader to the subject area, we focus our comments on the areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. All studies on infants and young children with CLDI using forced expiratory or deflation maneuvers demonstrated that forced flows at low lung volume remain persistently low through the first 3 years of life. Measurement of maximal flow at functional residual capacity (V,maxFRC) is the most commonly used method for assessing airway function in infants, but is highly dependent on lung volume and airway tone. Recent studies suggested that the raised volume RTC technique, which assesses lung function over an extended volume range as in older children, may be a more sensitive means of discriminating changes in airway function in infants with respiratory disease. The forced deflation technique allows investigation of pulmonary function during the early development of CLDI in intubated subjects, but its invasive nature precludes its use in the routine setting. For all techniques, there is an urgent need to establish suitable reference data and evaluate within- and between-occasion repeatability, prior to establishing the clinical usefulness of these techniques in assessing baseline airway function and/or response to interventions in subjects with CLDI. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source] Heart Rate Variability in Patients with Essential Hyperhidrosis: Dynamic Influence of Sympathetic and Parasympathetic ManeuversANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2005Dayimi Kaya M.D. Background: Essential hyperhidrosis has been associated with an increased activity of the sympathetic system. In this study, we investigated cardiac autonomic function in patients with essential hyperhidrosis and healthy controls by time and frequency domain analysis of heart rate variability (HRV). Method: In this study, 12 subjects with essential hyperhidrosis and 20 healthy subjects were included. Time and frequency domain parameters of HRV were obtained from all of the participants after a 15-minute resting period in supine position, during controlled respiration (CR) and handgrip exercise (HGE) in sitting position over 5-minute periods in each stage. Results: Baseline values of HRV parameters including RR interval, SDNN and root mean square of successive R-R interval differences, low frequency (LF), high frequency (HF), normalized unit of high frequency (HFnu), normalized unit of low frequency (LFnu), and LF/HF ratio were identical in two groups. During CR, no difference was detected between the two groups with respect to HRV parameters. However, the expected increase in mean heart rate (mean R-R interval) did not occur in hyperhidrotic group, whereas it did occur in the control group (Friedman's P = 0.000). Handgrip exercise induced significant decrease in mean R-R interval in both groups and no difference was detected between the two groups with respect to the other HRV parameters. When repeated measurements were compared with two-way ANOVA, there was statistically significant difference only regarding mean heart rate in two groups (F = 6.5; P = 0.01). Conclusion: Our overall findings suggest that essential hyperhidrosis is a complex autonomic dysfunction rather than sympathetic overactivity, and parasympathetic system seems to be involved in pathogenesis of this disorder. [source] STANDARDIZATION OF ENDOSCOPIC ULTRASONOGRAPHY PROCEDURES FOR THE PANCREAS USING RADIAL and CONVEX methodsDIGESTIVE ENDOSCOPY, Issue 2002Yoshiki Hirooka We describe the standard endoscopic ultrasonography (EUS) procedure of the pancreas used in our institute. Both radial scanning and convex (or linear) scanning methods have valid uses, so these two methods will coexist in the future. Physicians learning EUS need to master both types. It is important to standardize both types of EUS procedure. Generally, physicians persist in the method mastered first and don't make use of the other method. In order to plan the standardization of EUS procedures, it may be reasonable to standardize the procedures of both type EUS simultaneously, comparing radial scan mode and linear (convex) scan mode. Here we demonstrate our standard procedures for both EUS modes, mainly emphasizing the visualization maneuver of the pancreas. [source] The Effect of Hemodialysis on Left Ventricular Outflow Tract GradientECHOCARDIOGRAPHY, Issue 6 2010Pawel Petkow Dimitrow M.D. Background: The aim of the study was to assess the effect of hemodialysis (HD) on left ventricular outflow tract gradient (LVOTG) measured both in supine and upright position (provocative maneuver to unload LV cavity by rapid preload reduction). Supine/standing echocardiography was performed immediately before and immediately after HD. For additional verification of the hypothesis about preload-dependence of LVOTG, the echocardiograms after long (2-day delay HD due to weekend) versus short (usual 1-day) pause between HDs were compared. Methods: Forty-one patients on chronic HD (mean age 44 ± 11 years) were examined using a portable hand-carried echocardiograph. In accordance with the prestudy assumption the ultrafiltration volume was significantly greater during HD after a long pause in comparison to HD after a short pause (3707 ± 2826 mL vs. 2665 ± 1152 mL P < 0.05). Results: After a long pause, the mean value of LVOTG at the pre-HD was mildly increased in the supine position and remained at a similar level in the upright position (13.1 ± 6.1 vs. 13.6 ± 9.1 mmHg). Mean LVOTG at the post-HD in the supine position was similar to pre-HD, however the orthostatic stress test induced a significant increase of LVOTG (13.9 ± 15.2 vs. 18.2 ± 19.9 mmHg P < 0.05). After a short pause at the pre-HD the LVOTG in the supine position and after the orthostatic provocation was very similar to measurements after long pause (13.3 ± 9.1 vs. 13.3 ± 10.8 mmHg). At the post-HD the mean value of LVOTG increased during upright posture but the differences were of borderline significance (13.2 ± 6.6 vs. 17.9 ± 18.6 mmHg P = 0.052). Conclusions: HD predisposed to standing-provoked LVOTG especially when a long pause (2 days) between HDs induced a greater weight gain and subsequently a larger volume of ultrafiltration was needed to reduce hypervolemia. (Echocardiography 2010;27:603-607) [source] Patent Foramen Ovale: Comparison among Diagnostic Strategies in Cryptogenic Stroke and MigraineECHOCARDIOGRAPHY, Issue 5 2009Concetta Zito M.D. Objective: The aim of this study was to compare transthoracic echocardiography (TTE) and transcranial Doppler ultrasonography (TCD) with transesophageal echocardiography (TEE) in order to define the best clinical approach to patent foramen ovale (PFO) detection. Methods: In total, 72 consecutive patients (33 men) with a mean age of 49 ± 13 years were prospectively enrolled. The TEE indication was cryptogenic stroke (36 patients) or migraine (36 patients, 22 with aura). All patients underwent standard TTE, TCD, and TEE examination. For any study, a contrast test was carried on using an agitated saline solution mixed with urea-linked gelatine (Haemaccel), injected as a rapid bolus via a right antecubital vein. A prolonged Valsalva maneuver was performed to improve test sensitivity. Results: TEE identified a PFO in 65% of the whole population: 56.5% in the migraine cohort and 43.5% in the cryptogenic stroke cohort. TTE was able to detect a PFO in 55% of patients positive at TEE (54% negative predictive value, 100% positive predictive value, 55% sensitivity, and 100% specificity). TCD was able to identify a PFO in 97% of patients positive at TEE (89% negative predictive value, 98% positive predictive value, 94% sensitivity, and 96% specificity). Conclusions: In patients with cryptogenic stroke and migraine, there is a fair concordance (k = 0.89) between TCD and TEE in PFO recognition. Accordingly, TCD should be recommended as a simple, noninvasive, and reliable technique, whereas TEE indication should be restricted to selected patients. TTE is a very specific technique, whose major advantage is the ability to detect a large right-to-left shunt, particularly if associated with an atrial septal aneurysm. [source] A clinical maneuver to increase tremor differentiation between Parkinson disease and essential tremorEUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2010R. Mazzocchio No abstract is available for this article. [source] Trigeminal Neuralgia as the Sole Manifestation of an Arnold-Chiari Type I Malformation: Case ReportHEADACHE, Issue 4 2008Giovanni Caranci MD Arnold-Chiari type I malformations usually manifest clinically with short-lasting headaches typically involving the occipital-nuchal region and precipitated by the Valsalva maneuver, coughing, sudden postural change, or physical exertion. We describe the case of an adult patient who presented with symptomatic trigeminal neuralgia caused by an Arnold-Chiari type I malformation. Unlike previous cases, the malformation involved the trigeminal ophthalmic division alone. [source] Revisiting Autonomic Dysfunction in End-Stage Renal Disease PatientsHEMODIALYSIS INTERNATIONAL, Issue 3 2003Jocemir R. Lugon Background:,Autonomic dysfunction is frequent in end-stage renal disease (ESRD) patients, but both the relative involvement of the parasympathetic and sympathetic branches and the role of antihypertensive drugs in this setting are still controversial. The present study addressed these issues employing a battery of standard noninvasive cardiovascular autonomic tests. Methods:,Sympathetic (S) function was evaluated by responses of both systolic blood pressure (BP) to passive tilting and diastolic BP to handgrip; parasympathetic (P) function, through the respiratory sinus arrhythmia test and the heart rate response to the 4-s unloaded exercise test. Additional tests influenced by both branches of the autonomic system (P + S) were accomplished by the assessment of heart rate response to the Valsalva maneuver, handgrip, and tilting. Results:,Studied subjects belonged to one of the three groups: ESRD patients not requiring BP medications (n = 11; 8 men, 3 women); ESRD patients receiving antihypertensive therapy (n = 36; 21 men, 15 women); and apparently healthy controls (n = 15; 10 men, 5 women). When the variables grouped according to the branch of the autonomic nervous system predominantly probed were analyzed, only the frequency of impaired sympathetic autonomic responses was higher in ESRD patients not receiving BP drugs compared to controls (55 vs. 23%, P = 0.040). In contrast, when ESRD patients receiving BP drugs were compared to controls, the differences became significant in S, P, and P + S tests (46 vs. 23%, P = 0.045; 22 vs. 3%, P = 0.020; and 34 vs. 13%, P = 0.010, respectively). With the criterion of more than one positive finding in any of the variables examined for diagnosing autonomic dysfunction, the prevalence of autonomic dysfunction was 20% in controls, 64% in ESRD patients not receiving BP drugs (P = 0.005 vs. controls), and 67% in ESRD patients receiving BP drugs (P = 0.043 vs. controls). Conclusions:,ESRD continues to be associated with a high prevalence of autonomic dysfunction. ESRD patients receiving BP drugs were found to have detectable impairment in the entire autonomic system in contrast to those not receiving BP drugs in whom inadequate responses were restricted to the sympathetic branch. [source] Use of dissecting sealer may affect the early outcome in patients submitted to hepatic resectionHPB, Issue 4 2008I. DI CARLO Abstract Background. Many technological devices have been used to avoid intraoperative bleeding during hepatic parenchymal transection and to avoid morbidity and mortality, but until now none is complete. The aim of this work is to prospectively analyze hepatic resection patients treated with a water-cooled high frequency monopolar device in order to evaluate its effectiveness. Patients and methods. All consecutive patients who underwent liver resection by use of this device, between January 2003 until December 2007, were analyzed prospectively. The following variables were considered: age, sex, kind of disease, kind of liver resection, number of major/minor resections, total operative time and transection time, number and time of clamping, blood loss, time of hospitalization, morbidity, and mortality. Results. Between January 2003 and December 2007, 26 patients were analyzed prospectively (69% women, 31% men). Ages ranged from 18 to 84 years. Sixty-five percent of patients had a malignant disease; 35%, a benign disease. The procedures performed were two major hepatectomies (7.6%) and 24 minor hepatectomies (92.4%). Hepatic transection was performed in 35 to 150 min. Total operative time range was 120,480 min. The average blood loss was 325 ml (range 50,600 ml). The mean postoperative stays were nine days for all the patient and six days for non-cirrhotic patients. Conclusion. The water-cooled high frequency monopolar device is useful for reducing ischemia,reperfusion damage due to the Pringle maneuver and for reducing the risk of morbidity. However, the Kelly forceps remains the only inexpensive instrument really essential for liver surgery. [source] Current techniques of liver transectionHPB, Issue 3 2007RONNIE T.P. POON The operative mortality rate of liver resection has decreased from 10% to 20% before the 1980s to <5% in most specialized hepatobiliary centers nowadays. The most important factor for better outcome is reduced blood loss due to improvement in surgical techniques. Liver transection is the most challenging part of liver resection, associated with a risk of massive hemorrhage. Understanding the segmental anatomy of the liver and delineation of the proper transection plane using intraoperative ultrasound are prerequisites to safe liver transection. Clamp crushing and ultrasonic dissection are the two most widely used transection techniques. In recent years, new instruments using different types of energy for coagulation or sealing of vessels have been developed for liver transection. These include radiofrequency devices, Harmonic Scalpel, Ligasure and TissueLink dissecting sealer. Whether these new instruments, used alone or in combination with clamp crushing or ultrasonic dissection, improve the safety of liver transection has not been clearly demonstrated. The use of the vascular stapler for transection of major intrahepatic vascular trunks is also gaining popularity. These new instruments are particularly useful in liver transection during laparoscopic liver resection. Adjunctive measures such as intermittent Pringle maneuver and low central venous pressure anesthesia are also useful measures to reduce the risk of hemorrhage. This article reviews the safety and efficacy of different techniques of liver transection, with particular attention to evidence from randomized controlled trials available in the literature. [source] Longitudinal auto-landing controller design via adaptive backsteppingINTERNATIONAL JOURNAL OF ADAPTIVE CONTROL AND SIGNAL PROCESSING, Issue 7 2009Hann-Shing Ju Abstract This paper presents an auto-landing controller for glide-slope tracking and the flare maneuver via adaptive backstepping design and describes a flight path command generator for indirect altitude control in order to provide precise altitude trajectories for auto-landing of unmanned aerial vehicles (UAVs). Using the adaptive backstepping procedure to synthesize a glide-slope tracking and flare maneuver control law is being used differently from designing the guidance and control loops separately in autopilot. An adaptive controller is proposed to control aircraft from glide-slope to flare by following the flight path angle command for indirect altitude control via elevator and maintaining the constant airspeed control via throttle. Simulation results demonstrate that the adaptive auto-landing controller is capable of effectively guiding the UAV along the flight path angle command under the presence of the wind turbulence. Copyright © 2008 John Wiley & Sons, Ltd. [source] Caudal analgesia for prostate biopsyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010M. CESUR Background: Although various local anesthesia techniques have been suggested to decrease pain and discomfort during a transrectal ultrasound (TRUS)-guided prostate biopsy, the best method has not yet been defined. The present prospective, double-blind, randomized study aims to investigate the clinical efficacy of ,walking' caudal block compared with an intrarectal lidocaine gel for this procedure. Methods: One hundred patients were randomly assigned to two groups. In the lidocaine gel group, 10 ml of gel containing 2% lidocaine was given intrarectally. In the caudal group, 20 ml 0.1% bupivacaine with 75 ,g fentanyl was injected. Pain scores, anal sphincter tone and patient satisfaction were evaluated. Results: The pain scores were significantly lower in the caudal group at all stages. Verbal rating scores (scale 1,4) during probe insertion, probe maneuver and biopsies were 1 (0,2), 1 (0,2) and 1 (0,2) vs. 3 (0,5), 2 (1,3) and 4 (2,6), respectively (P value <0.0001 at all stages). The anal sphincter was more relaxed in the caudal group than in the gel group (P value <0.0001 in all categories). Highly satisfied patients were more frequently encountered in the caudal group, 34 (68%) vs. 8 (16%), P<0.0001, and unsatisfied patients were more frequently found in the gel group 1 (2%) vs. 12 (24%); P<0.001. All patients were able to walk without any assistance immediately after the procedures. Conclusion: ,Walking' caudal analgesia is an efficacious method for relieving the pain during TRUS-guided prostate biopsies in ambulatory practice. [source] Lane change algorithm for autonomous vehicles via virtual curvature methodJOURNAL OF ADVANCED TRANSPORTATION, Issue 1 2009M. L. Ho This paper addresses the lane changing problem of autonomous vehicles when there is no road infrastructure support. The autonomous vehicle should drive from the current lane to the adjacent lane in the absence of a reference path to guide the vehicle to the new lane. We suggest an algorithm that incorporates a virtual road curvature with bicycle model for lane change guidance. As the name suggests, the virtual road curvature does not physically exist. It is a user assigned radius of a curved path which connects the current lane to the adjacent lane. Since the lateral sensor readings during lane changing maneuver are erroneous, the steering angle along with the virtual curvature is fed into a bicycle model to estimate the lateral position during the transition to the next lane. Details of the algorithm and the virtual road curvature determination are presented in the paper. In contrast to other lane changing methods, controller switching is not required and the same controller is for both lane keeping and lane changing. The algorithm is verified experimentally and the results are comparable with lane changing with physical transition lane. [source] Observing freeway ramp merging phenomena in congested trafficJOURNAL OF ADVANCED TRANSPORTATION, Issue 2 2007Majid Sarvi This work conducts a comprehensive investigation of traffic behavior and characteristics during freeway ramp merging under congested traffic conditions. On the Tokyo Metropolitan Expressway, traffic congestion frequently occurs at merging bottleneck sections, especially during heavy traffic demand. The Tokyo Metropolitan Expressway public corporation, generally applies different empirical strategies to increase the flow rate and decrease the accident rate at the merging sections. However, these strategies do not rely either on any behavioral characteristics of the merging traffic or on the geometric design of the merging segments. There have been only a few research publications concerned with traffic behavior and characteristics in these situations. Therefore, a three-year study is undertaken to investigate traffic behavior and characteristics during the merging process under congested situations. Extensive traffic data capturing a wide range of traffic and geometric information were collected using detectors, videotaping, and surveys at eight interchanges in Tokyo Metropolitan Expressway. Maximum discharged flow rate from the head of the queue at merging sections in conjunction with traffic and geometric characteristics were analyzed. In addition, lane changing maneuver with respect to the freeway and ramp traffic behaviors were examined. It is believed that this study provides a thorough understanding of the freeway ramp merging dynamics. In addition, it forms a comprehensive database for the development and implementation of congestion management techniques at merging sections utilizing Intelligent Transportation System. [source] Measurements of functional residual capacity during intensive care treatment: the technical aspects and its possible clinical applicationsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009H. HEINZE Direct measurement of lung volume, i.e. functional residual capacity (FRC) has been recommended for monitoring during mechanical ventilation. Mostly due to technical reasons, FRC measurements have not become a routine monitoring tool, but promising techniques have been presented. We performed a literature search of studies with the key words ,functional residual capacity' or ,end expiratory lung volume' and summarize the physiology and patho-physiology of FRC measurements in ventilated patients, describe the existing techniques for bedside measurement, and provide an overview of the clinical questions that can be addressed using an FRC assessment. The wash-in or wash-out of a tracer gas in a multiple breath maneuver seems to be best applicable at bedside, and promising techniques for nitrogen or oxygen wash-in/wash-out with reasonable accuracy and repeatability have been presented. Studies in ventilated patients demonstrate that FRC can easily be measured at bedside during various clinical settings, including positive end-expiratory pressure optimization, endotracheal suctioning, prone position, and the weaning from mechanical ventilation. Alveolar derecruitment can easily be monitored and improvements of FRC without changes of the ventilatory setting could indicate alveolar recruitment. FRC seems to be insensitive to over-inflation of already inflated alveoli. Growing evidence suggests that FRC measurements, in combination with other parameters such as arterial oxygenation and respiratory compliance, could provide important information on the pulmonary situation in critically ill patients. Further studies are needed to define the exact role of FRC in monitoring and perhaps guiding mechanical ventilation. [source] External Security Stitch for Retrograde Cardioplegia CannulaJOURNAL OF CARDIAC SURGERY, Issue 4 2009Davide Gabbieri M.D. However, this maneuver is time consuming, often implies the loss of surgical exposure, and exposes again the coronary sinus to the risk of iatrogenic injuries. We describe the use of an external security stitch through the muscular right atrial wall to avoid the displacement of a retrograde cardioplegia catheter and analyze the anatomic conditions which predispose to this complication. [source] A Simple Maneuver on Sternal Saw Facilitates to Perform Curved Sternal Mini-incisions like J- and C-Shaped Partial SternotomiesJOURNAL OF CARDIAC SURGERY, Issue 4 2009Koray Ak M.D. To increase the cosmetic benefit and improve the surgical exposure, the length of underlying partial sternotomy is usually 3 to 5 cm longer than the length of skin incision in most of these approaches. Using a standard sternal saw or a rotary craniotome, it is quite difficult to make sternal incision under subcutaneous tissue at both ends of skin incision. Moreover, standard sternal saws do not allow doing fine manipulations on sternum that may cause inadvertent sternal cutting, especially at the curved parts of C- or J-type partial sternotomies. We removed the blade protector part of a standard sternal saw. This simple maneuver enables surgeons to perform several challenging mini-sternotomies easily for adult cardiac procedures. [source] Intraoperative Precise Localization of Paravalvular Mitral Leak by a Simple Surgical ManeuverJOURNAL OF CARDIAC SURGERY, Issue 5 2008F.R.C.S.C., Idris Ali M.D. The first and the most important step is to localize the leaking spot precisely. Echocardiogram is the standard technique that is used to localize the leak.2,3 The echocardiogram is accurate most of the time; however, in some occasions it does not easily provide the exact orientation of the leaking areas. A simple operative maneuver, which was used to allow the surgeon to localize the leak visually, and have accurate and solid repair, is described below. [source] The Results of Probe Technique for Transatrial Repair of Tetralogy of FallotJOURNAL OF CARDIAC SURGERY, Issue 6 2002Ahmet Turan Yilmaz M.D. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to a right ventricular approach. However, it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. Methods: Nineteen patients were reviewed who had repair of isolated TOF by this technique from 1993 to 2001. The mean age of patients was 5 ± 2 years . Transatrial-transpulmonary approach was performed for all patients. To make the infundibular muscle-bundle resection easier and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. Tricuspid valve detachment in order to improve the exposure was done in 11 patients. All patients were followed up in our clinic at regular six-month intervals by echocardiography. Results: There was no early or late mortality nor reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. Conclusions: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases gives excellent early and mid-term results.(J Card Surg 2002;17:490-494) [source] Bilateral round ligament varicosities mimicking an inguinal hernia in pregnancy: Case reportJOURNAL OF CLINICAL ULTRASOUND, Issue 9 2010Guven Kahriman Abstract A 22-year-old pregnant woman presented with a painful swelling in the right groin. Sonography was performed to confirm a presumptive diagnosis of inguinal hernia based on physical examination. Gray-scale sonography examination revealed bilateral inguinal cystic lesion expanding with the Valsalva maneuver. Color Doppler imaging demonstrated multiple prominent vessels with retrograde venous flow during Valsalva maneuver. Bilateral round ligament varicosities were diagnosed and inguinal hernia was excluded by sonographic findings. Round ligament varicosities should be considered in the differential diagnosis of groin swelling during pregnancy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:512,514, 2010 [source] New method for the detection of intraperitoneal free air by sonography: Scissors maneuverJOURNAL OF CLINICAL ULTRASOUND, Issue 8 2004Okkes Ibrahim Karahan MD Abstract Purpose This study was conducted to investigate the diagnostic value of a new sonographic technique for the detection of intraabdominal free air. Methods Seventy-two patients with a suspected gastrointestinal tract perforation were included in the study and prospectively evaluated by sonography and abdominal and chest radiography for the detection of intraperitoneal free air. A new sonographic technique (the scissors maneuver) was used to detect intraperitoneal free air superficial to the liver; the maneuver consists of applying and then releasing slight pressure onto the abdominal wall with the caudal part of a parasagittaly oriented linear-array probe. The results of the imaging studies were correlated with surgical findings when possible. Results Sixteen patients had a surgically proven gastrointestinal tract perforation causing pneumoperitoneum. Sonography and radiography each showed pneumoperitoneum in 15 patients, with 1 false-negative result for each modality. The sensitivity and specificity values of sonography and radiography were identical; sensitivity was 94% and specificity was 100% for both imaging modalities. The scissors maneuver was positive in all patients with sonographically detected pneumoperitoneum. Conclusions Sonography is an effective tool in the diagnosis of pneumoperitoneum, with sensitivity and specificity equal to those of radiography. The scissors maneuver may be a useful adjunct for improving the diagnostic yield of sonography. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:381,385, 2004 [source] Power Doppler sonography of the kidney: Effect of Valsalva's maneuverJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2001Ryuichi Takano MD Abstract Purpose It has been reported that an intra-abdominal pressure (IAP) above 15 mm Hg may cause oliguria and that an IAP above 25 mm Hg may cause anuria. Because Valsalva's maneuver yields an IAP exceeding 180 mm Hg, it is presumed to affect renal perfusion. We evaluated the ability of power Doppler sonography to depict the changes in renal blood flow during Valsalva's maneuver. Methods Seven healthy men aged 21,24 years and 1 50-year-old man with massive ascites participated in the study. With each healthy subject lying in a supine position, longitudinal power Doppler sonograms of the kidney were obtained and analyzed semiquantitatively during Valsalva's maneuver. Also, in the patient with massive ascites, power Doppler sonography was performed before and after paracentesis. Results Along with an increase in IAP, monitored as expiratory pressure during Valsalva's maneuver, power Doppler signals decreased as indicated by both visual impression and computer scores. In the patient with massive ascites, signal intensity increased after paracentesis. Conclusions Our results demonstrated that an increase in IAP within the physiologic range affects renal perfusion and that power Doppler sonography depicts semiquantitatively the change in renal blood flow. © 2001 John Wiley & Sons, Inc. J Clin Ultra- 29:384,388, 2001. [source] A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009C. GRIVANS Background: The aim was to describe current practices for drug administration through inhalation, endotracheal suctioning and lung recruitment maneuvers in mechanically ventilated patients in Scandinavian intensive care units (ICUs). Methods: We invited 161 ICUs to participate in a web-based survey regarding (1) their routine standards and (2) current treatment of ventilated patients during the past 24 h. In order to characterize the patients, the lowest PaO2 with the corresponding highest FiO2, and the highest PaO2 with the corresponding lowest FiO2 during the 24-h study period were recorded. Results: Eighty-seven ICUs answered and reported 186 patients. Positive end-expiratory pressure (PEEP) levels (cmH2O) were 5,9 in 65% and >10 in 31% of the patients. Forty percent of the patients had heated humidification and 50% received inhalation of drugs. Endotracheal suctioning was performed >7 times during the study period in 40% of the patients, of which 23% had closed suction systems. Twenty percent of the patients underwent recruitment maneuvers. The most common recruitment maneuver was to increase PEEP and gradually increase the inspiratory pressure. Twenty-six percent of the calculated PaO2/FiO2 ratios varied >13 kPa for the same patient. Conclusion: Frequent use of drug administration through inhalation and endotracheal suctioning predispose to derecruitment of the lungs, possibly resulting in the large variations in PaO2/FiO2 ratios observed during the 24-h study period. Recruitment maneuvers were performed only in one-fifth of the patients during the day of the survey. [source] | ||||||||||||||||||||||||||||||||||||||||