Investigations of a thermosensitive gel to temporarily occlude crural arteries in femoro-distal bypass surgery.

OBJECTIVES: Long occlusions in calcified crural arteries are a major cause of endovascular technical failure in patients with critical limb ischaemia. Therefore, distal bypasses are mainly performed in patients with heavily calcified arteries and with consequently delicate clamping. A new reverse thermosensitive polymer (RTP) is an alternative option to occlude target vessels. The aim of the study is to report our technical experience with RTP and to assess its safety and efficiency to temporarily occlude small calcified arteries during anastomosis time. METHODS: Between July 2010 and December 2011, we used RTP to occlude crural arteries in 20 consecutive patients with 20 venous distal bypasses. We recorded several operative parameters, such as volume of injected RTP, duration of occlusion and anastomotic time. Quality of occlusion was subjectively evaluated. Routine on-table angiography was performed to search for plug emboli. Primary patency, limb salvage and survival rates were reported at 6 months. RESULTS: In all patients, crural artery occlusion was achieved with the RTP without the use of an adjunct occlusion device. Mean volume of RTP used was 0.3 ml proximally and 0.25 ml distally. Mean duration of occlusion was 14.4 ± 4.5 min, while completion of the distal anastomosis lasted 13.4 ± 4.3 min. Quality of occlusion was judged as excellent in eight cases and good in 12 cases. Residual plugs were observed in two patients and removed with an embolectomy catheter, before we amended the technique for dissolution of RTP. At 6 months, primary patency rate was 75% but limb salvage rate was 87.5%. The 30-day mortality rate was 10%. CONCLUSIONS: This study shows that RTP is safe when properly dissolved and effective to occlude small calcified arteries for completion of distal anastomosis.

Hypertension and intra-operative incidents: a multicentre study of 125000 surgical procedures in Swiss hospitals

Background: It is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. Methods: We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetia since 1996. The focus was on cardiovascular incidents, though other anaesthesia-related incidents were also evaluated. Results: Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% [95% CI 5.9-6.2%]). The average adjusted odds ratio of cardiovascular risk in patients with chronic hypertension was 1.38 (95% CI 1.27-1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Conclusions: Hypertensive patients are still at risk of intra-operative cardiovascular incidents. The heterogeneity of the risk to develop cardiovascular incidents varied across hospitals, despite taking into account casemix and hospital characteristics. These variations suggest that anaesthetic practices differ across anesthesia services

Spray coating technique asa surface treatment for woodcontaining paper grades

The objective of this work was to introduce the emerging non-contacting spray coating process and compare it to the existing coating techniques. Particular emphasis was given to the details of the spraying process of paper coating colour and the base paper requirements set by the new coating method. Spraying technology itself is nothing new, but the atomisation process of paper coating colour is quite unknown to the paper industry. The differences between the rheology of painting and coating colours make it very difficult to utilise the existing information from spray painting research. Based on the trials, some basic conclusion can be made:The results of this study suggest that the Brookfield viscosity of spray coating colour should be as low as possible, presently a 50 mPas level is regarded as an optimum. For the paper quality and coater runnability, the solids level should be as high as possible. However, the graininess of coated paper surface and the nozzle wear limits the maximum solids level to 60 % at the moment. Most likelydue to the low solids and low viscosity of the coating colour the low shear Brookfield viscosity correlates very well with the paper and spray fan qualities. High shear viscosity is also important, but yet less significant than the low shear viscosity. Droplet size should be minimized and besides keeping the brrokfield viscosity low that can be helped by using a surfactant or dispersing agent in the coating colour formula. Increasing the spraying pressure in the nozzle can also reduce the droplet size. The small droplet size also improves the coating coverage, since there is hardly any levelling taking place after the impact with the base paper. Because of the lack of shear forces after the application, the pigment particles do not orientate along the paper surface. Therefore the study indicates that based on the present know-how, no quality improvements can be obtained by the use of platy type of pigments. The other disadvantage of them is the rapid deterioration of the nozzle lifetime. Further research in both coating colour rheology and nozzle design may change this in the future, but so far only round shape pigments, like typically calcium carbonate is, can be used with spray coating. The low water retention characteristics of spray coating, enhanced by the low solids and low viscosity, challenge the base paper absorption properties.Filler level has to be low not to increase the number of small pores, which have a great influence on the absorption properties of the base paper. Hydrophobic sizing reduces this absorption and prevents binder migration efficiently. High surface roughness and especially poor formation of the base paper deteriorate thespray coated paper properties. However, pre-calendering of the base paper does not contribute anything to the finished paper quality, at least at the coating colour solids level below 60 %. When targeting a standard offset LWC grade, spraycoating produces similar quality to film coating, but yet blade coating being on a slightly better level. However, because of the savings in both investment and production costs, spray coating may have an excellent future ahead. The porousnature of the spray coated surface offers an optimum substrate for the coldset printing industry to utilise the potential of high quality papers in their business.

Análisis comparativo de la eficiencia de las cooperativas fruteras de la provincia de Lleida

En este trabajo se describen algunas actuaciones llevadas a cabo en el sector frutero leridano de cara a la concentración de oferta y la creación de las cooperativas de segundo grado. A continuación se analizan las acciones adoptadas por una entidad de segundo grado, de la provincia, que es la que ha conseguido integrar a un mayor número de entidades. Seguidamente se analiza comparativamente el grado de eficiencia técnica y económica que presentan las cooperativas asociadas a la entidad de segundo grado en contraposición a las que no han ejercido la opción de asociarse. En el periodo analizado no aparecen grandes diferencias entre los niveles de eficiencia obtenidos por ambos grupos de entidades.

Transanal minimal invasive surgery for rectal lesions: should the defect be closed?

AIM: Transanal minimal invasive surgery (TAMIS) of rectal lesions is increasingly being used, but the technique is not yet standardized. The aims of this study were to evaluate peri-operative complications and long-term functional outcome of the technique and to analyse whether or not the rectal defect needs to be closed. METHOD: Consecutive patients undergoing TAMIS using the SILS port (Covidien) and standard laparoscopic instruments were studied. RESULTS: Seventy-five patients (68% male) of mean age 67 (± 15) years underwent single-port transanal surgery at three different centres for 37 benign lesions and 38 low-risk cancers located at a mean of 6.4 ± 2.3 cm from the anal verge. The median operating time was 77 (25-245) min including a median time for resection of 36 (15-75) min and for closure of the rectal defect of 38 (9-105) min. The defect was closed in 53% using interrupted (75%) or a running suture (25%). Intra-operative complications occurred in six (8%) patients and postoperative morbidity was 19% with only one patient requiring reoperation for Grade IIIb local infection. There was no difference in the incidence of complications whether the rectal defect was closed or left open. Patients were discharged after 3.4 (1-21) days. At a median follow-up of 12.8 (2-29) months, the continence was normal (Vaizey score of 1.5; 0-16). CONCLUSION: Transanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1 year continence is not compromised.