Abciximab for thrombolysis during intracranial aneurysm coiling

INTRODUCTION: Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. MATERIALS AND METHODS: All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, +/-12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. RESULTS: No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. CONCLUSIONS: Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke.

Comparison of outcome and recurrence-free survival after sentinel lymph node biopsy and lymphadenectomy in vulvar cancer

OBJECTIVES: Lymph node status is an important prognostic factor in patients with squamous cell carcinoma (SCC) of the vulva. Complete inguinofemoral lymph node dissection (ILND) is accompanied by a high morbidity. Sentinel lymph node biopsy (SLNB) was established for less invasive lymph node (LN) staging. The aim of this study was to evaluate safety of SLNB in terms of accuracy and outcome in a clinical routine setting. METHODS: We retrospectively reviewed the data of patients who underwent SLNB and/or ILND for vulvar SCC in the years 1990-2007. Clinical follow-up was evaluated for histological nodal-negative patients with tumor stage T1 or T2. The false negative rate of SLNB was determined in patients who underwent both SLNB and ILND. RESULTS: Preoperative sentinel lymph node (SLN) visualization by scintigraphy was successful in 95% of all patients. SLNB was false negative in 1/45 inguinae (2.2%). All SLN were detected intraoperatively. During the follow-up period (median 24 months for SLNB and 111 months for ILND), no groin recurrences in initially nodal negative patients occurred (n=34, 59 inguinae). Transient lymph edema occurred in 7/18 patients after ILND (39%) and 2/16 patients (13%) after SLNB. No persistent edemas were found after SLNB and ILND. CONCLUSION: According to our experience SLNB is feasible and accurately predicts LN status of vulvar SCC under clinical routine conditions. SLNB in vulvar cancer seems to be a safe alternative to ILND in order to reduce morbidity of surgical treatment.

Acute lower gastrointestinal hemorrhage: minimally invasive management with microcatheter embolization

PURPOSE: To evaluate the efficacy of superselective embolization therapy in the management of acute lower gastrointestinal (LGI) hemorrhage, including any bleeding distal to the ligament of Treitz. MATERIALS AND METHODS: Between June and August 2007, 20 patients with acute LGI bleeding underwent superselective transcatheter arterial embolization (TAE) at the authors' institution. The bleeding had different causes. All patients were treated with use of microcatheters. The following embolic agents were used: microcoils (n = 16), polyvinyl alcohol (PVA) particles (n = 2), and a combination of microcoils and PVA particles (n = 2). Outcome measures included technical success (complete cessation of bleeding as documented at completion angiography), clinical success (resolution of signs or symptoms of LGI bleeding within 30 days after TAE), and the rate of major and minor complications. RESULTS: The identified bleeding sources were as follows: jejunal branch, branch of middle colic artery, branch of ileocolic artery, ileal branch, branch of left colic artery, branch of sigmoid artery, branch of the superior rectal artery, and branch of the middle rectal artery. Technical success with effective control of active bleeding was achieved in all patients (100%). Clinical success attributed to TAE was documented in 18 of the 20 patients (90%). Major complications included death due to pulmonary embolism, heart infarction, and multiorgan failure in the 3rd week after TAE; a procedure-related colonic infarction occurred in one patient. A minor complication occurred in one patient who developed a groin hematoma. CONCLUSIONS: Superselective embolization may be used for effective, minimally invasive control of acute LGI bleeding.

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke: Analysis of the Solitaire FR Thrombectomy for Acute Revascularization Study.

BACKGROUND AND PURPOSE We report on workflow and process-based performance measures and their effect on clinical outcome in Solitaire FR Thrombectomy for Acute Revascularization (STAR), a multicenter, prospective, single-arm study of Solitaire FR thrombectomy in large vessel anterior circulation stroke patients. METHODS Two hundred two patients were enrolled across 14 centers in Europe, Canada, and Australia. The following time intervals were measured: stroke onset to hospital arrival, hospital arrival to baseline imaging, baseline imaging to groin puncture, groin puncture to first stent deployment, and first stent deployment to reperfusion. Effects of time of day, general anesthesia use, and multimodal imaging on workflow were evaluated. Patient characteristics and workflow processes associated with prolonged interval times and good clinical outcome (90-day modified Rankin score, 0-2) were analyzed. RESULTS Median times were onset of stroke to hospital arrival, 123 minutes (interquartile range, 163 minutes); hospital arrival to thrombolysis in cerebral infarction (TICI) 2b/3 or final digital subtraction angiography, 133 minutes (interquartile range, 99 minutes); and baseline imaging to groin puncture, 86 minutes (interquartile range, 24 minutes). Time from baseline imaging to puncture was prolonged in patients receiving intravenous tissue-type plasminogen activator (32-minute mean delay) and when magnetic resonance-based imaging at baseline was used (18-minute mean delay). Extracranial carotid disease delayed puncture to first stent deployment time on average by 25 minutes. For each 1-hour increase in stroke onset to final digital subtraction angiography (or TICI 2b/3) time, odds of good clinical outcome decreased by 38%. CONCLUSIONS Interval times in the STAR study reflect current intra-arterial therapy for patients with acute ischemic stroke. Improving workflow metrics can further improve clinical outcome. CLINICAL TRIAL REGISTRATION: URL http://www.clinicaltrials.gov. Unique identifier: NCT01327989.

Operation bei asymptomatischer Inguinalhernie – unnötig?

Until recently, the repair of asymptomatic groin hernia has been advocated as a prophylaxis for incarceration. However, incarcerations of inguinal hernias are rare events and can be treated adequately if the patient presents himself early after onset of symptoms. Randomized controlled trials showed, that watchful waiting is not associated with increased incarcerations and can be offered as a save alternative. However, within seven years after randomization 50 % to 70 % of the patients in the watchful waiting groups required surgery, mainly because of new onset or increasing symptoms.

Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

Background Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. Methods We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]). Results The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12). Conclusions In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days.

Surgical Technique: Reverse Periacetabular Osteotomy

Acetabular retroversion is the result of an externally rotated hemipelvis rather than a focal overgrowth of the anterior wall and/or hypoplasia of the posterior wall. Acetabular retroversion is a cause of pincer impingement which, if left untreated, can lead to hip pain and osteoarthritis. The causal surgical treatment in hips with acetabular retroversion is acetabular reorientation with a reverse periacetabular osteotomy (PAO). Indication is based on a positive correlation among symptoms (typically groin pain), physical findings on examination (positive anterior impingement test and decreased flexion and internal rotation), and radiographic signs for acetabular retroversion. These include a positive crossover, posterior wall, and ischial spine sign. A reverse PAO is performed with four osteotomies and a controlled fracture. Unlike reorientation of the acetabular fragment in dysplastic hips, correction for acetabular retroversion is achieved by a combined extension and internal rotation of the acetabular fragment. Typically, a small supra-acetabular wedge resection is required to allow sufficient extension of the fragment. The quality of acetabular reorientation is evaluated by intraoperative AP pelvic radiographs. In addition, intraoperative testing of range of motion following acetabular reorientation is mandatory. An arthrotomy and offset correction of the femoral head-neck area is indicated in hips with decreased internal rotation following acetabular reorientation. In a 10-year follow-up study of reverse PAO, a favorable outcome with preservation of all native joints was found. Correct acetabular orientation and, if necessary, a concomitant offset correction were the keys of successful outcome.

Coastal shapes. Geentic clasification 1973 - 2010

An analysis of a stretch of coastline shows multiple alterations through environmental climate actions. The narrow, fragile line displays singularities due to three basic causes. The first is the discontinuity in feed or localised loss of solid coastal material. Called massics, their simplest examples are deltas and undersea canyons. The second is due to a brusque change in the alignment of the shoreline’s edge, headlands, groins, harbour and defence works. Given the name of geometric singularities, their simplest uses are artificial beaches in the shelter of a straight groin or spits. The third is due to littoral dynamics, emerged or submerged obstacles which diffract and refract wave action, causing a change in the sea level’s super-elevation in breaker areas. Called dynamics, the simplest examples are salients, tombolos and shells. Discussion of the causes giving rise to variations in the coastline and formation of singularities is the raison d’être of investigation, using actual cases to check the suitability of the classification proposed, the tangential or differential action of waves on the coastal landscape in addition to possible simple, compound and complex shapes detected in nature, both in erosion and deposit processes

La deformación del tipo Construcción de bóvedas no-canónicas en España (siglos XVI-XVIII)

Una bóveda no canónica es una bóveda que se adapta a una forma distinta de aquella para la que ha sido inicialmente concebida. Bóvedas raras, anormales, no convencionales, habitualmente consideradas excepciones o casos particulares, resultan ser más frecuentes de lo inicialmente esperado. El interés por este tipo de bóvedas surge a raíz de una investigación inicial sobre las bóvedas empleadas para cubrir espacios de planta anular, como en el caso de las girolas de las iglesias. Sin embargo, el problema de la bóveda anular no puede ser abordado directamente, sino como parte de una investigación más general sobre bóvedas que se deforman para adaptarse a una situación anómala. El análisis de las posibilidades que un determinado tipo de bóveda brinda para resolver el abovedamiento de espacios de planta irregular, trascendiendo el problema de la planta anular, es lo que da origen a esta investigación. La cuestión de las bóvedas deformadas forma parte de un contexto mayor, el de la deformación en arquitectura abovedada. Ante una contradicción, la deformación de la bóveda es sólo una de las posibles opciones que esta arquitectura ofrece para resolver un problema de deformación. La tesis se estructura en dos partes: en la primera parte se analizan los conceptos de forma y deformación en el contexto de la arquitectura abovedada con objeto de sentar las bases para una teoría de las bóvedas no canónicas. El objetivo es establecer un punto de partida para la investigación en un campo que todavía no había sido abordado. En la segunda parte se analizan tres tipos de bóveda desde la perspectiva de las bóvedas no canónicas, a partir de un estudio de casos de bóvedas en España entre los siglos XVI y XVIII. El estudio de la deformación en arquitectura abovedada se centra en el problema de la girola, por tratarse de un caso generalizado de deformación, directamente relacionado con el problema de las bóvedas irregulares y cuyo estudio, llamativamente, no había sido llevado a cabo hasta la fecha. Se propone una primera aproximación al problema de la girola, desde un punto de vista puramente morfológico, al margen de consideraciones históricas. En el caso de las bóvedas deformadas, el análisis se centra en tres tipos de bóveda: la bóveda de crucería, la bóveda de arista y la bóveda baída. Estos tres tipos de bóveda, aunque basadas en criterios formales distintos, están íntimamente relacionados entre sí. Por un lado permiten resolver el mismo problema –planta cuadrada delimitada por arcos–, por otro lado es posible establecer una relación formal entre la bóveda de arista y la bóveda baída a través de la bóveda de crucería. El estudio de casos recogido en la segunda parte de la tesis se fundamenta en dos líneas de investigación, la primera sobre soluciones teóricas de bóvedas no convencionales propuestas en los manuscritos y tratados de cantería, y la segunda sobre bóvedas efectivamente construidas, tratado de establecer una comparación entre teoría y práctica, confrontando el grado de relación entre ambas. Sin embargo este doble análisis sólo se ha podido llevar a cabo en contadas ocasiones. Constatamos que las bóvedas no canónicas reflejadas en los tratados son pocas y apenas se han llevado a la práctica, mientras que las soluciones construidas no responden a modelos teóricos propuestos, manifestando un divorcio entre teoría y práctica. El estudio de estas bóvedas permite poner en cuestión la definición tradicional que relaciona los conceptos de ‘bóveda’ y ‘superficie’. Al iniciar el trabajo nos encontramos con un modelo teórico extremadamente rígido que deja fuera un gran número de bóvedas, obligando a agruparlas bajo el término «no canónicas». El trabajo realizado pone en evidencia lo limitado del modelo. El problema no está en la presencia de bóvedas anómalas, que no se adaptan al modelo tradicionalmente propuesto, sino en la extrema rigidez del modelo. ABSTRACT A non canonical vault is a vault adapted to a different form from that for which was originally conceived. These rare, abnormal, unconventional vaults are usually considered as exceptions or special cases. However they prove to be more frequent than it was initially expected. Interest in this type of vaults arises from an initial research on the vaults used to roof annular spaces, such as ambulatories. Nevertheless, the annular vault question cannot be addressed directly, but as a part of a broader research on distorted vaults; a research on vaults deformed to conform an anomalous layout. The analysis of the possibilities that a particular type of vault provides to solve the vaulting of an irregular layout, beyond the problem of the annular plan is the origin of this research. The argument of deformed vaults is part of a greater context, the context of deformation in vaulted architecture. Facing a contradiction, deforming a vault is just one of the options that vaulted architecture offers to solve a problem of deformation. This dissertation is organised in two parts: in the first part we analyse the concepts of form and deformation in the context of vaulted architecture in order to lay the foundations for a non canonical vaults theory. The objective is to establish a starting point for future research in a field that has not been addressed yet. In the second part, we analyse three types of vault from the perspective of non canonical vaults, based on a case study of Spanish vaults between the 16th and 18th Centuries. The analysis of deformation in vaulted architecture focuses on the question of the ambulatory, because it is a generalized example of deformation, directly related to the problem of irregular vaults. Remarkably, the analysis of these spaces had not been conducted to date. We propose a first approach to the question of the ambulatory, from a purely morphological point of view, setting aside historical considerations. The analysis of deformed vaults focuses on three types of vault: the groin vault, the ribbed vault and the sail vault. These three types of vault, although based on different formal criteria, are closely related between them. On the one hand, they allow to solve the same problem –a square perimeter limited by arcs-; on the other hand, it is possible to establish a formal relationship between the groin vault and the sail vault through the ribbed vault. The case study presented in the second part of this dissertation is based on two research lines: theoretical non conventional vaults solutions proposed on stonecutting treatises; and currently built vaults. The aim of this double analysis was to establish a comparison between theory and practice, comparing the degree of relationship between them. Nevertheless, this double analysis has only been carried out on rare occasions. It is noted that non canonical vaults reflected in treaties are few and hardly been employed, while the built solutions do not meet proposed theoretical models, expressing a divorce between theory and practice. The analysis of these vaults allows us to question the traditional definition that connects the concepts of 'vault' and 'surface'. When we began this research, we found an extremely rigid theoretical model that leaved out many vaults, forcing to group them under the term of «non canonical vaults». This research evidences the limitations of the model. The problem is not the presence of abnormal vaults, which cannot adapt to the traditional model, but in the very high stiffness of the model.

Bóvedas sexpartitas : los orígenes del gótico

Uno de los capítulos más interesantes del gótico europeo lo constituyen las bóvedas sexpartitas, sin lugar a dudas una de las bóvedas más singulares jamás creadas dentro de este estilo. Las primeras bóvedas góticas, en cruce de ojivas y de planta cuadrada, limitaban su uso a espacios relativamente pequeños, pero ante la necesidad de cubrir espacios de considerables dimensiones, apareció una nueva bóveda de características muy peculiares; la sexpartita. Esta bóveda en cruce de ojivas está reforzada por el centro con un arco paralelo a los arcos fajones que la divide por la mitad y que fragmenta el arco formero en dos, creando una pareja de ventanales en cada lado. La sencilla superficie en bóveda de arista, en el origen de las bóvedas de crucería, se complica extraordinariamente creando una volumetría de gran complejidad con seis cuarteles de plementería y con seis apoyos de distinto tamaño, cuatros esquineros y dos centrales más pequeños. Las dificultades que implica la construcción de este tipo de bóvedas explican quizás su abandono prematuro y la vuelta a la bóveda de crucería simple, ahora de tramos rectangulares. No obstante, a pesar de su corta existencia, la bóveda sexpartita fue la gran protagonista de los inicios del gótico y con ella se llevaron a cabo importantes abovedamientos, desde Inglaterra hasta Rumanía. La disciplina de la Historia de la Construcción se vio extraordinariamente favorecida por los estudios realizados en el siglo XIX, sin embargo su investigación se abandona durante el siglo XX para ser recuperada recientemente. Viollet-le-Duc, a finales del s. XIX, hace una sucinta explicación de este tipo de bóvedas. También Auguste Choisy, más tarde, dedica unas páginas a la bóveda sexpartita francesa; desde entonces, este tema, ha merecido escasísimas referencias en los estudios posteriores. Esta investigación se enmarca en este contexto y pretende poner de manifiesto los conocimientos geométricos y constructivos que hicieron posible la realización de las bóvedas sexpartitas europeas. Para ello se ha llevado a cabo la investigación de las principales bóvedas en Europa occidental; Francia, España, Inglaterra, Alemania, Suiza e Italia. Su estudio comparativo nos ha permitido poner de manifiesto sus características constructivas comunes y aquellos aspectos propios de cada país, así como algunos de los canales de comunicación que permitieron la expansión de esta arquitectura. Las nuevas tecnologías de medición, el escáner láser, la estación total, la fotogrametría, etc., han supuesto una revolución para la documentación y restauración del Patrimonio y un salto cualitativo formidable para el análisis de las bóvedas góticas, permitiendo estudios de la arquitectura histórica hasta ahora inabordables. Para realizar el análisis de las bóvedas sexpartitas europeas se ha llevado a cabo un levantamiento exhaustivo de las mismas, lo que ha permitido definir su despiece, obteniendo la forma de la talla de cada uno de los elementos constructivos que la componen; jarjas, dovelas, claves y plementería. La obtención de estos datos nos ha permitido abordar un profundo estudio de su estereotomía y construcción, aportando datos inéditos hasta el momento. Por otro lado se ha llevado a cabo la detección y catalogación de las principales bóvedas sexpartitas que aún se conservan en Europa. Los estudios realizados nos permiten afirmar que la bóveda sexpartita surge en Francia en la segunda mitad del siglo XII, utilizándose en las principales catedrales francesas, como Notre Dame de Paris, Bourges o Laon. A comienzos del siglo XIII cae en desuso en Francia y comienza su expansión por el resto de Europa, donde se abandona medio siglo después, desapareciendo definitivamente del gótico europeo. Mientras que los ejemplos que datan del siglo XII muestran soluciones escasamente desarrolladas y propias del románico, las bóvedas construidas en el siglo XIII muestran soluciones enormemente complejas, con grandes jarjamentos e inteligentes estrategias constructivas y geométricas que permiten la simplificación de sus estructuras auxiliares y una mayor libertad en su diseño. Estas bóvedas son el reflejo del desarrollo de la estereotomía gótica en sus comienzos por lo que su estudio nos ha permitido conocer el desarrollo y la evolución del gótico primitivo en Europa. ABSTRACT One of the most interesting chapters of European Gothic is the sexpartite vault, without doubt one of the most remarkable vaults ever created within this style. The first Gothic vaults, with crossed ribs on a square base, were restricted to relatively small areas, but a new vault, with very particular characteristics emerged to address the need to cover spaces of considerable size; the sexpartite vault. This cross-ribbed vault is reinforced in the centre by an arch that runs parallel to the transverse arches, divides the vault in half and splits the wall arch in two, creating a pair of windows, one on each side. The simple groin vault surface, the source of ribbed vaults, was greatly complicated creating a highly complex volume with six sections of severies and with six supports of different sizes, four on the corners and two smaller central ones. The construction difficulties involved in building this type of vault may explain its premature abandonment and a return to the simple cross-ribbed vault, now in rectangular sections. However, despite its brief existence, the sexpartite vault was the great protagonist of the beginnings of Gothic architecture and important vaulting was built using this system from England to Romania. Studies undertaken in the 19th century helped the History of Construction as a discipline tremendously. Research was abandoned during the twentieth century however, and has only recently been taken up again. Towards the end of the 19th century, Viollet-le-Duc gave a brief description of this type of vault. Later, Auguste de Choisy also devoted some pages to the French sexpartite vault; since then, later studies have made very few references to it. Against this background, this research now attempts to bring to light the knowledge of geometry and construction that made the construction of the European sexpartite vault possible. To this end, the main vaults in Western Europe - France, Spain, England, Germany, Switzerland and Italy, have been studied. By making a comparative study we have been able to reveal the common construction features and those that are specific to each country, as well as some of the channels of communication that enabled this architecture to spread. New measuring technologies, the laser scanner, total station, photogrammetry, etc., have given rise to a revolution in heritage documentation and restoration, as well as facilitating a huge qualitative leap for the analysis of Gothic vaults, enabling studies of historical architecture that until now were inaccessible. A comprehensive survey was carried out to be able to analyse European sexpartite vaults. We could thus create an exploded view, which enabled us to obtain the form of each of the elements; tas-de-charges, voussoirs, keystones and severies. The data gathered provided previously unknown facts that enabled us to make an in-depth study of stereotomy and construction. Furthermore, the main sexpartite vaults still preserved in Europe have been identified and categorised. The studies undertaken allowed us to affirm that the sexpartite vault appeared in France in the second half of the twelfth century, being used in the main French cathedrals, such as Notre Dame de Paris, Bourges or Laon. At the beginning of the thirteenth century it fell into disuse in France and began to expand throughout the rest of Europe, where it was abandoned half a century later, disappearing from European Gothic for good. While the examples dating back to the 12th century display poorly developed solutions more characteristic of the Romanesque, the vaults built in the 13th century reveal enormously complex solutions, with large tas-de-charges and intelligent construction and geometric strategies that allowed auxiliary support structures to be simplified, and gave more freedom to design. These vaults reflect the beginnings of Gothic stereotomy and by studying them we have been able to learn more about the development and evolution of Early Gothic architecture in Europe.

Une étude cadavérique pour réduire les risques des approches chirurgicales et percutanées de l’artère fémorale

En chirurgie vasculaire, l’accès à l’artère fémorale, qu’il soit par une incision chirurgicale ou par une approche percutanée, est très fréquemment utilisé pour une multitude d’interventions vasculaires ou endovasculaires; pour des pontages divers, le traitement d’occlusions artérielles, la réparation d’anévrismes et la pose d’endoprothèses. L’objectif général de ce projet de recherche est de faciliter et réduire les risques des approches de l’artère fémorale par une meilleure compréhension anatomique du triangle fémoral. La méthodologie a été réalisée grâce à l’utilisation de cadavres spécialement embaumés par la méthode développée par Walter Thiel. Les résultats présentés dans ce mémoire ont permis de proposer des solutions en réponse à des problèmes cliniques en chirurgie vasculaire. Dans un premier temps, l’étude de la vascularisation cutanée du triangle fémoral a mené à proposer de nouvelles incisions chirurgicales afin de limiter la dévascularisation cutanée des plaies et ainsi réduire les problèmes de cicatrisation observés. Ensuite, nous avons validé l’identification radiographique et échographique de l’artère fémorale à son croisement avec le ligament inguinal afin de faciliter l’identification d’un site de ponction artérielle adéquat. Enfin, nous avons développé une méthode échographique simple qui facilite l’approche percutanée de l’artère fémorale, même chez les patients obèses. Les retombées de ce projet de recherche sont multiples pour les cliniciens, l’étude fournit une meilleure compréhension anatomique tridimensionnelle du triangle fémoral et les techniques proposées dans ce mémoire pourront apporter une amélioration de la pratique chirurgicale et faciliter le travail des médecins. Toutefois, ces propositions devront maintenant être validées en clinique.

Beach changes at Long Beach Island, New Jersey, 1962-73 /

Beach profile line data collected from 32 profile sites along Long Beach Island, New Jersey. A total of 2,158 profile line surveys were examined, using empirical eigenfunction analysis and other measures of beach variability. Most profile lines have shown an accretionary trend since 1962 with rates between 2.3 and 0.24 meter per year in spite of erosion estimates due to sea level rise on the order of 0.68 meter per year. A great deal of variability in profile line change takes place along the beach, increasing from north to south, due to the location of profile lines relative to structures and offshore linear shoals. Detailed closely spaced profile lines taken over a year in a groin field near the north end of the island indicate littoral transport directions shift from north to south. Evidence of a littoral transport node near the north end of the groin field has been found. Net transport of the node is toward the south, but the rate could not be established due to lack of adequate wave data. Profile line variability within groin cells shows that single profile lines are not sufficient to determine the net change within a cell. The design of future beach monitoring studies should consider coastal structures, offshore bathymetry, the method of analysis, and the scales of processes under study. A coastal storm in November 1968 moved the MSL back as much as 22 meters; however, the beach recovered without artificial measures. The offshore bathymetry shows a series of shoreface-connected linear shoals at several locations along the island. Limited data show that these have remained stable and that most beach variability takes place in water shallower than 3 meters.

A numerical model for predicting shoreline changes /

A mathematical model for long-term, three-dimensional shoreline evolution is developed. The combined effects of variations of sea level; wave refraction and diffraction; loss of sand by density currents during storms, by rip currents, and by wind; bluff erosion and berm accretion; effects of manmade structures such as long groin or navigational structures; and beach nourishment are all taken into account. A computer program is developed with various subroutines which permit modification as the state-of-the-art progresses. The program is applied to a test case at Holland Harbor, Michigan. (Author).

Investigation of in vitro transdermal absorption of fentanyl from patches placed on skin samples obtained from various anatomic regions of dogs

Objective-To investigate in vitro transdermal absorption of fentanyl from patches through skin samples obtained from various anatomic regions of dogs. Sample Population-Skin samples from 5 Greyhounds. Procedure-Skin samples from the dogs' thoracic, neck, and groin regions were collected postmortem and frozen. After samples were thawed, circular sections were cut and placed in Franz-type diffusion cells in a water bath (32degreesC). A commercial fentanyl patch, attached to an acetate strip with a circular hole, was applied to each skin sample. Cellulose strips were used as control membranes. Samples of receptor fluid in the diffusion cells were collected at intervals for 48 hours, and fentanyl concentrations were analyzed by use of high-performance liquid chromatography. Results-Mean +/- SD release rate of fentanyl from the patch, defined by its absorption rate through the non-rate-limiting cellulose membrane, was linear during the first 8 hours (2.01 +/- 0.05 pg/cm(2) of cellulose membrane/h) and then decreased. Fentanyl passed through skin from the groin region at a faster rate and with a significantly shorter lag time, compared with findings in neck or thoracic skin samples. Conclusions and Clinical Relevance-In vitro, fentanyl from a patch was absorbed more quickly and to a greater extent through skin collected from the groin region of dogs, compared with skin samples from the thoracic and neck regions. Placement of fentanyl patches in the groin region of dogs may decrease the lag time to achieve analgesia perioperatively; however, in vivo studies are necessary to confirm these findings.

The effect of region of application on absorption of ethanol and hexanol through canine skin

The effect of region of application on the percutaneous penetration of solutes with differing lipophilicity was investigated in canine skin. Skin from the thorax, neck, back, groin, and axilla regions was harvested from Greyhound dogs and placed in Franz-type diffusion cells. Radiolabelled (C-14) ethanol (Log P 0.19) or hexanol (Log P 1.94) was applied to each skin section for a total of 5 h. The permeability coefficient (k(P), cm h(-1)) and residue of alcohol remaining in the skin were significantly (P = 0.001) higher for hexanol compared to ethanol. In contrast, ethanol had a far greater maximum flux (J(max), mol (cm(2))(-1) h(-1)) than hexanol (P = 0.001). A comparison of regional differences shows the k(P) and Jmax for ethanol in the groin was significantly lower (P = 0.035) than the back. The k(P) and Jmax for hexanol were significantly higher (P = 0.001) in the axilla than the other four skin sites. An understanding of factors influencing percutaneous drug movement is important when formulating topical preparations for the dog. (C) 2003 Elsevier Ltd. All rights reserved.