Metabolic and hemodynamic changes during recovery and tracheal extubation in neurosurgical patients: immediate versus delayed recovery.

Delayed recovery has been advocated to limit the postoperative stress linked to awakening from anesthesia, but data on this subject are lacking. In this study, we measured oxygen consumption (V(O2)) and plasma catecholamine concentrations as markers of postoperative stress. We tested the hypothesis that delayed recovery and extubation would attenuate metabolic changes after intracranial surgery. Thirty patients were included in a prospective, open study and were randomized into two groups. In Group I, the patients were tracheally extubated as soon as possible after surgery. In Group II, the patients were sedated with propofol for 2 h after surgery. V(O2), catecholamine concentration, mean arterial pressure (MAP), and heart rate (HR) were measured during anesthesia, at extubation, and 30 min after extubation. V(O2) and noradrenaline on extubation and mean V(O2) during recovery were significantly higher in Group II than in Group I (V(O2) for Group I: preextubation 215 +/- 46 mL/min, recovery 198 +/- 38 mL/min; for Group II: preextubation 320 +/- 75 mL/min, recovery 268 +/- 49 mL/min; noradrenaline on extubation for Group I: 207 +/- 76 pg/mL, for Group II: 374 +/- 236 pg/ mL). Extubation induced a significant increase in MAP. MAP, HR, and adrenaline values were not statistically different between groups. In conclusion, delayed recovery after neurosurgery cannot be recommended as a mechanism of limiting the metabolic and hemodynamic consequences from emergence from general anesthesia. IMPLICATIONS: In this study, we tested the hypothesis that delayed recovery after neurosurgery would attenuate the consequences of recovery from general anesthesia. As markers of stress, oxygen consumption and noradrenaline blood levels were higher after delayed versus early recovery. Thus, delayed recovery cannot be recommended as a mechanism of limiting the metabolic and hemodynamic consequences from emergence after neurosurgery.

A statistical procedure for testing social reciprocity at group, dyadic and individual levels

This paper examines statistical analysis of social reciprocity, that is, the balance between addressing and receiving behaviour in social interactions. Specifically, it focuses on the measurement of social reciprocity by means of directionality and skew-symmetry statistics at different levels. Two statistics have been used as overall measures of social reciprocity at group level: the directional consistency and the skew-symmetry statistics. Furthermore, the skew-symmetry statistic allows social researchers to obtain complementary information at dyadic and individual levels. However, having computed these measures, social researchers may be interested in testing statistical hypotheses regarding social reciprocity. For this reason, it has been developed a statistical procedure, based on Monte Carlo sampling, in order to allow social researchers to describe groups and make statistical decisions.

Evaluation of clinician-operated sonography and fine-needle aspiration in the assessment of salivary gland tumours.

OBJECTIVES: To evaluate the combination of ultrasound (US) + fine-needle aspiration (FNA) in the assessment of salivary gland tumours in the hands of the otolaryngologist. DESIGN: A retrospective review of case notes was performed. SETTING: Two university teaching hospitals in Switzerland. PARTICIPANTS: One hundred and three patients with a total of 106 focal masses of the salivary glands were included. Clinician-operated US + FNA were the first line of investigation for these lesions. All patients underwent surgical excision of the lesion, which allowed for confirmation of diagnosis by histopathology in 104 lesions and by laboratory testing in two lesions. MAIN OUTCOME MEASURES: Primary--diagnostic accuracy in identifying true salivary gland neoplasms and detecting malignancy. Secondary--predicting an approximate and specific diagnosis in these tumours. RESULTS: The combination of US + FNA achieved a diagnostic accuracy of 99% in identifying and differentiating true salivary gland neoplasms from tumour-like lesions. In detecting malignancy, this combination permitted an accuracy of 98%. An approximate diagnosis was possible in 89%, and a specific diagnosis in 69% of our patients. CONCLUSIONS: Due to economic factors and a high diagnostic accuracy, the combination of US + FNA represents the investigation method of choice for most salivary gland tumours. We suggest that the otolaryngologist be employed in carrying out these procedures, as is already the rule in other medical specialties, while computed tomography and magnetic resonance imaging should be reserved to those few lesions, which cannot be delineated completely by sonography.

Airway stenting with the LT-Mold? for severe glotto-subglottic stenosis or intractable aspiration: experience in 65 cases.

The purpose of this study was to assess the safety and efficacy of stenting in upper airway reconstructions for benign laryngotracheal stenosis (LTS) with a newly designed prosthesis, the LT-Mold?. The LT-Mold and its proper use during open surgery and endoscopy are described, and the experience gathered from a prospectively collected database on 65 patients treated for complex LTS or severe aspiration is reported. This series is compared to the results of other stenting methods. All patients were available for evaluation. In all but one case, the prosthesis was removed at the end of the study. The new prosthesis did not induce any stent-related trauma to the supraglottis, glottis and subglottis. Before adding a distal round-shaped silicone cap to the LT-Mold, granulation tissue was usually seen at the stent-mucosal interface at the tracheostoma level. In 14 cases, there has been a spontaneous extrusion of the prosthesis through the mouth; this problem was solved by fixing the prosthesis through the reinforced portion of the prosthesis at the cap level and by adding one fixation stitch in the supraglottis. We have to document the loss of the silicone cap in three cases. This problem was resolved by designing a new prototype with an integrated cap, glued with a slow hardening silicone glue. Fifty-four (83 %) of 65 patients were decannulated after a mean duration of stenting of 3 months (range 1-12 months). The mean follow-up after decannulation was 23 months (range 1 month to 10 years). The experience gathered with the LT-Mold shows that long-term stenting for complex LTS is safely achieved when the prosthesis is used with its distal integrated silicone cap. The softness and smoothness of the prosthesis with a round-shaped configuration of both extremities help avoid ulceration and granulation tissue formation in the reconstructed airway. Adequate fixation is mandatory to avoid extrusion.

Rehabilitation of orbital cavity after total orbital exenteration using oculofacial prostheses anchored by osseointegrated dental implants posed as a one-step surgical procedure

BACKGROUND: Total orbital exenteration is a radical surgical procedure, which typically involves the removal of the entire contents of the orbit including the periorbita, leaving the patient with a deep orbital deformity and results in devastating cosmetic, functional, and psychological consequences requiring difficult and challenging procedures for oculoplastic surgeons. Oculofacial prostheses retained by endosseous dental implants present an attractive and viable alternative when aesthetic and functional demands are beyond the capacity of local reconstructive efforts. PATIENTS AND METHODS: A 72-year-old woman presenting a malignant melanoma of the right eyelids and a 77-year-old man presenting a sebaceous carcinoma of the left upper eyelid underwent a total exenteration followed by positioning of endosseous implants (Straumann system Dental implants) as an integrated one-step combined surgical procedure. The oculofacial prosthesis was placed after epithelialization of the orbital cavity. RESULTS: The implants were perfectly osseointegrated without any complications, providing sufficient retention of the prostheses. A satisfactory aesthetic outcome has been achieved for both patients. CONCLUSIONS: Oculofacial prostheses anchored by osseointegrated dental implants placed as one-step surgical procedure ensure an adequate aesthetic result as well as a considerably decreased rehabilitation time and present a satisfactory solution when reconstruction is not a suitable option.

EEG signal analysis via a cleaning procedure based on multivariate empirical mode decomposition

Artifacts are present in most of the electroencephalography (EEG) recordings, making it difficult to interpret or analyze the data. In this paper a cleaning procedure based on a multivariate extension of empirical mode decomposition is used to improve the quality of the data. This is achieved by applying the cleaning method to raw EEG data. Then, a synchrony measure is applied on the raw and the clean data in order to compare the improvement of the classification rate. Two classifiers are used, linear discriminant analysis and neural networks. For both cases, the classification rate is improved about 20%.

Numerical procedure for estimating temperature in solarized soils

The objective of this work was to develop a simplified numerical procedure for the estimation of accumulated monthly hours of solarized soil temperatures. The proposed model requires monthly means of daily solar radiation and maximum air temperature as input data, and a daily pattern of temperature variation assumed to be sine-shaped. The procedure was verified using observations made during the years 1992 and 1993 in Jaguariúna, SP. The proposed procedure can predict monthly temperature hours at 10 cm depth in the solarized soil, with acceptable accuracy, in the region for which it was developed.

Manual of Laboratory Mix Design Procedure for Cold In-Place Recycling using Foamed Asphalt (CIR-foam), TR-474, 2007

The objective is to determine the optimum percentage of water needed to produce the best foam properties for a given asphalt binder. The optimum water content is determined by achieving the maximum expansion ratio and half-life of the foamed asphalt. Expansion ratio is defined as the maximum volume over its original volume and half-life is defined as the time in seconds for foam to become a half of its maximum volume.

Repair of tracheal aspergillosis perforation causing tension pneumothorax.

Tracheobronchial aspergillosis is a rare entity mainly observed in immune-compromised patients or those who have undergone transplantation. It may cause airway ulcerations or bleeding. We report the case of a 17-year-old patient receiving chemotherapy for acute lymphoblastic leukemia who presented with right-sided tension pneumothorax. Chest tube drainage revealed a massive air leak without reexpansion of the lung, and bronchoscopy showed a 15- × 15-mm defect of the distal trachea related to aspergillosis infection. The defect was closed by an intrathoracic transposition of a pedicled latissimus dorsi muscle flap, which was sutured into the debrided defect followed by temporary endotracheal stenting and antifungal medication.

Biological Sampling and Physical Habitat Assessment Standard Operating Procedure for Iowa Wadeable Streams and Rivers, July 24, 2015

The Iowa Department of Natural Resources uses benthic macroinvertebrate and fish sampling data to assess stream biological condition and the support status of designated aquatic life uses (Wilton 2004; IDNR 2013). Stream physical habitat data assist with the interpretation of biological sampling results by quantifying important physical characteristics that influence a stream’s ability to support a healthy aquatic community (Heitke et al., 2006; Rowe et al. 2009; Sindt et al., 2012). This document describes aquatic community sampling and physical habitat assessment procedures currently followed in the Iowa stream biological assessment program. Standardized biological sampling and physical habitat assessment procedures were first established following a pilot sampling study in 1994 (IDNR 1994a, 1994b). The procedure documents were last updated in 2001 (IDNR 2001a; 2001b). The biological sampling and physical habitat assessment procedures described below are evaluated on a continual basis. Revision of this working document will occur periodically to reflect additional changes.

Outcome of a Modified Broström-Gould Procedure for Lateral Ankle Instability

Introduction: Ankle sprains affect 200'000 persons/year in Switzerland. Most incidences are successfully treated by conservative measures but 20% require reconstruction for symptomatic chronic lateral ankle instability. This study evaluates the functional outcome after a modified Broström-Gould technique as measured by different clinical scores and compares the functional outcome of this technique with other surgical treatments of ankle instability. Methods: This retrospective cohort study evaluates 47 patients who underwent a modified Broström-Gould procedure using suture anchors to refix the lateral ankle capsuloligamentary structures at our institution from 2005 to 2009 with a minimum follow-up of one year (13-72 Mo). All patients were operated by one single surgeon and evaluated by an independent examiner. The function was assessed using 4 scores including: the AOFAS (American Orthopaedic Foot and Ankle Society's Score) hindfoot score; the FAAM (Foot and Ankle Ability Measurement); the CAIT (Cumberland Ankle Instability Tool); the CAIS (Chronic Ankle Instability Scale). Results: Six patients were excluded leaving 41 patients for examination. 34 patients (83%) thought that their ankle was more stable after the surgery, 7 (17%) did not feel any difference. 27 patients were very satisfied, 11 satisfied and 3 not satisfied. Reasons for non satisfaction included persistent instability and pain. Ankle mobility returned to normal in 93% of patients. Five patients had transcient hypoesthesy in the area of the superficial peroneal nerve. One patient suffered from a superficial infection treated successfully by local measures. 80% had the perception of a normal ankle, 20% thought to be below normal. At follow-up the AOFAS was 89/100 (37-100), the FAAM 85/100% (35-100%), the CAIT 20/30 (5-30), and the CAIS 74/100% (27-100%). Conclusions: The modified Broström-Gould procedure, which belongs to the anatomic ankle stabilizations is relatively simple and offers good outcome that satisfied 93% of the patients in the present study. No active stabilisator is sacrificed. Preservation of the ankle mobility is better and the complication rate is lower than after non-anatomical procedures described in the literature. The CAIT appeared as the most severe score compared to the other scales used in our study.

Ponctions et infiltrations articulaires [Arthrocentesis and joint infiltration]

Cet article se veut être un condensé des bases nécessaires à la pratique d'une ponction et, ou infiltration articulaire, des indications principales aux complications potentielles en passant par la description de la procédure et de ses contre-indications. La ponction du genou fait l'objet d'une description plus détaillée. Les données permettant de justifier une façon particulière de procéder ont spécifiquement été recherchées dans la littérature (Cochrane et Medline, termes de recherche : arthrocentesis ; joint aspiration). Le détail de ces données, comme par exemple le résultat d'études, ne trouve pas sa place dans ce résumé mais fait l'objet d'une publication à part. What should be known in order to practice safely a joint aspiration and/or infiltration is summarized in the following article. This summary includes various aspects, such as the indications and contraindications, the procedure itself, and the possible complications. The arthrocentesis of the knee is described in more details. Data in support of a specific modus operandi have been searched for in Cochrane and Pubmed (key words: arthrocentesis, joint aspiration). Only the conclusions of this research are exposed in this summary. A more comprehensive article will be published

An Adaptive Remeshing Procedure for Proximity Maneuvering Spacecraft Formations

We consider a methodology to optimally obtain reconfigurations of spacecraft formations. It is based on the discretization of the time interval in subintervals (called the mesh) and the obtainment of local solutions on them as a result of a variational method. Applied to a libration point orbit scenario, in this work we focus on how to find optimal meshes using an adaptive remeshing procedure and on the determination of the parameter that governs it

A Multi-Project Scheduling Procedure for Transportation Projects, Final Report, HR-339, 1993

This report proposes, that for certain types of highway construction projects undertaken by the Iowa Department of Transportation, a scheduling technique commonly referred to as linear scheduling may be more effective than the Critical Path Method scheduling technique that is currently being used. The types of projects that appear to be good candidates for the technique are those projects that have a strong linear orientation. Like a bar chart, this technique shows when an activity is scheduled to occur and like a CPM schedule it shows the sequence in which activities are expected to occur. During the 1992 construction season, the authors worked with an inlay project on Interstate 29 to demonstrate the linear scheduling technique to the Construction Office. The as-planned schedule was developed from the CPM schedule that the contractor had developed for the project. Therefore, this schedule represents what a linear representation of a CPM schedule would look like, and not necessarily what a true linear schedule would look like if it had been the only scheduling technique applied to the project. There is a need to expand the current repertoire of scheduling techniques to address those projects for which the bar chart and CPM may not be appropriate either because of the lack of control information or due to overly complex process for the actual project characteristics. The scheduling approaches used today on transportation projects have many shortcomings for properly modeling the real world constraints and conditions which are encountered. Linear project's predilection for activities with variable production rates, a concept very difficult to handle with the CPM, is easily handled and visualized with the linear technique. It is recommended that work proceed with the refinement of the method of linear scheduling described above and the development of a microcomputer based system for use by the Iowa Department of Transportation and contractors for its implementation. The system will be designed to provide the information needed to adjust schedules in a rational understandable method for monitoring progress on the projects and alerting Iowa Department of Transportation personnel when the contractor is deviating from the plan.