936 resultados para Straight Tenckhoff catheter
Resumo:
Venäjän lainsäädäntö mahdollistaa erilaisten rajoitusten asettamisen liikenteelle kelirikkoajan aikana ja alhaisten painorajoitusten asettaminen on tällöin yleistä. Kelirikon aikaisiin rajoituksiin liittyvä lainsäädäntö on pääosin tarkoituksenmukainen, mutta sitä sovelletaan tavalla, jolla vaikeutetaan huomattavasti yritysten toimintaa ja tarvittavien kuljetusten järjestämistä. Diplomityössä tutkitaan kelirikon vaikutuksia liiketoimintaan erityisesti caseyksikössä, joka on metsäteollisuusyhtiön Venäjällä sijaitseva tuotantoyksikkö. Venäläinen liiketoimintaympäristö eroaa huomattavasti suomalaisesta, ja kelirikon aikana korostuvat etenkin korruption ja henkilökohtaisten suhteiden merkitys. Suuri osa havaituista sallitun painon ylityksistä hoidetaan kelirikon aikana maksamalla epävirallisia maksuja suoraan tarkastajille. Myös virallisia kulkulupia myydään, mutta niiden hankinta on kallista ja aikaa vievää. Työn lähtökohta kiteytyy lainsäädännön, viranomaisten tulkinnan ja todellisen tilanteen välisten ristiriitojen avaamiseen ja selvittämiseen, ja tavoitteena on ollut mahdollisimman objektiivisen kokonaiskuvan luominen tilanteesta. Case-yksikössä on kehitetty vaihtoehtoisia toimintamalleja kelirikkoajan kuljetusten varmistamiseksi. Rautatiekuljetusten määrää on lisätty huomattavasti ja välivarastointiterminaalin rakentamista on suunniteltu. Vaihtoehtoiset toimintamallit aiheuttavat kuitenkin huomattavia lisäkustannuksia. Tutkimuksen tuottamien tietojen avulla case-yhtiössä voidaan jatkossa arvioida todellisia riskejä sekä vaihtoehtoisten toimintamallien tarpeellisuutta ja kustannustehokkuutta aikaisempaa tarkemmin.
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Tässä diplomityössä tarkastellaan tietomallintamista eng. BIM (Building Information Modeling) LVI-suunnittelun näkökulmasta sekä esitellään tietomallintamisen vaikutuksia ja hyötyjä suunnitteluprosessiin. Tietomallintaminen mahdollistaa esimerkiksi LVI-suunnittelijan tuottaman määräluettelon 3D-mallista, jonka seurauksena eri toimijoiden väliset rajapinnat tulevat luultavasti kokemaan muutoksia. Työssä vertaillaan käsin laskettuja ja 3D-mallista tuotettuja määräluetteloita toisiinsa. Työhön sisällytetään myös urakoitsijoiden haastatteluja, joissa pyritään selvittämään heidän näkemyksiään suunnittelijan tuottamiin määrätietoihin.
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Photosystem II (PSII) is susceptible to light-induced damage defined as photoinhibition. In natural conditions, plants are capable of repairing the photoinhibited PSII by on-going degradation and re-synthesis of the D1 reaction centre protein of PSII. Photoinhibition is induced by both visible and ultraviolet light and photoinhibition occurs under all light intensities with the same efficiency per photon. In my thesis work, I studied the reaction kinetics and mechanism of photoinhibition of PSII, as well as photoprotection in leaves of higher plants. Action spectroscopy was used to identify photoreceptors of photoinhibition. I found that the action spectrum of photoinhibition in vivo shows resemblance to the absorption spectra of manganese model compounds of the oxygen evolving complex (OEC) suggesting a role for manganese as a photoreceptor of photoinhibition under UV and visible light. In order to study the protective effect of non-photochemical quenching, the action spectrum was measured from leaves of wild type Arabidopsis thaliana and two mutants impaired in nonphotochemical quenching of chlorophyll a excitations. The findings of action spectroscopy and simulations of chlorophyll-based photoinhibition mechanisms suggested that quenching of antenna excitations protects less efficiently than would be expected if antenna chlorophylls were the only photoreceptors of photoinhibition. The reaction kinetics of prolonged photoinhibition was studied in leaves of Cucurbita maxima and Capsicum annuum. The results indicated that photoinhibitory decrease in both the oxygen evolution activity and ratio of variable to maximum fluorescence follows firstorder kinetics in vivo. The persistence of first-order kinetics suggests that already photoinhibited reaction centres do not protect against photoinhibition and that the mechanism of photoinhibition does not have a reversible intermediate. When Cucurbita maxima leaves were photoinhibited with saturating single-turnover flashes and continuous light, the light response curve of photoinhibition was found to be essentially a straight line with both types of illumination, suggesting that similar photoinhibition mechanisms might function during illumination with continuous light and during illumination with short flashes.
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The condition of Baltic Sea has weakened considerably because of eutrophication which has caused massive increase of devalued fish. The condition of Baltic Sea can be helped by fishing these fish. This study handles three different ways to approach those fish utilizations and counts carbon footprint for those three chains. Environmental point of views are also examined. There are three different fish processing chains. Every processing chain begins with fishing the fish in Baltic Sea. After that the fishes are prepared by crushing and some formic acid is added to ensure preservation. In the first processing chain the fishes are processed as biodiesel. The waste from the biodiesel process is taken to the anaerobic digestion and the forming methane is used as energy. In the second chain the fishes are taken straight to the anaerobic digestion after preparing. In the third chain, the fish will be first prepared and then taken to fur farms as forage. The carbon footprint has been calculated for 1000 kg fish. The carbon footprint in the first chain is 164-178 kg CO2e, in the second chain 313 – 333 kg CO2e and in the third chain 363 kg CO2e. In the processing chains the bioenergy is produced from the biodiesel, anaerobic digestion and from the glycerol, which is by-product of the biodiesel. The energy produced from the biodiesel is so-called emission neutral, which is not taken into account when calculating emissions. The energy is used to compensate the emissions caused by fossil fuels. The PAS 2050 was used to calculate the carbon footprint. Only carbon dioxide and methane were used when calculating the carbon footprint.
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The objective of the work is to study fluid flow behavior through a pinch valve and to estimate the flow coefficient (KV ) at different opening positions of the valve. The flow inside a compressed valve is more complex than in a straight pipe, and it is one of main topics of interest for engineers in process industry. In the present work, we have numerically simulated compressed valve flow at different opening positions. In order to simulate the flow through pinch valve, several models of the elastomeric valve tube (pinch valve tube) at different opening positions were constructed in 2D-axisymmetric and 3D geometries. The numerical simulations were performed with the CFD packages; ANSYS FLUENT and ANSYS CFX by using parallel computing. The distributions of static pressure, velocity and turbulent kinetic energy have been studied at different opening positions of the valve in both 2D-axisymmetric and 3D experiments. The flow coefficient (KV ) values have been measured at different valve openings and are compared between 2D-axisymmetric and 3D simulation results.
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Colloid chemical behavior of indole dihydropyrimidines in non-aqueous solvent mixture benzene-methanol of varying composition has been investigated by viscometric measurements at 303K± 0.1. The viscosity of the system increases with the increase in concentration. The Trend Change Point (TCP) values have been determined by intersection of two straight lines, which are found to be dependent on the composition of solvent mixtures. The study confirms that the nature of synthesized compounds agglomerate formed below and above 50% benzene concentration is quite different. The viscometric data have been analyzed in terms of Einstein, Vand, Moulik and Jones-Dole equations. These well known equations have been successfully applied to explain the results of viscosity measurements and the viscometric parameters show that the behavior of compound changes in the proximity of 50% benzene concentration.
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The aim of this study was to simulate blood flow in thoracic human aorta and understand the role of flow dynamics in the initialization and localization of atherosclerotic plaque in human thoracic aorta. The blood flow dynamics in idealized and realistic models of human thoracic aorta were numerically simulated in three idealized and two realistic thoracic aorta models. The idealized models of thoracic aorta were reconstructed with measurements available from literature, and the realistic models of thoracic aorta were constructed by image processing Computed Tomographic (CT) images. The CT images were made available by South Karelia Central Hospital in Lappeenranta. The reconstruction of thoracic aorta consisted of operations, such as contrast adjustment, image segmentations, and 3D surface rendering. Additional design operations were performed to make the aorta model compatible for the numerical method based computer code. The image processing and design operations were performed with specialized medical image processing software. Pulsatile pressure and velocity boundary conditions were deployed as inlet boundary conditions. The blood flow was assumed homogeneous and incompressible. The blood was assumed to be a Newtonian fluid. The simulations with idealized models of thoracic aorta were carried out with Finite Element Method based computer code, while the simulations with realistic models of thoracic aorta were carried out with Finite Volume Method based computer code. Simulations were carried out for four cardiac cycles. The distribution of flow, pressure and Wall Shear Stress (WSS) observed during the fourth cardiac cycle were extensively analyzed. The aim of carrying out the simulations with idealized model was to get an estimate of flow dynamics in a realistic aorta model. The motive behind the choice of three aorta models with distinct features was to understand the dependence of flow dynamics on aorta anatomy. Highly disturbed and nonuniform distribution of velocity and WSS was observed in aortic arch, near brachiocephalic, left common artery, and left subclavian artery. On the other hand, the WSS profiles at the roots of branches show significant differences with geometry variation of aorta and branches. The comparison of instantaneous WSS profiles revealed that the model with straight branching arteries had relatively lower WSS compared to that in the aorta model with curved branches. In addition to this, significant differences were observed in the spatial and temporal profiles of WSS, flow, and pressure. The study with idealized model was extended to study blood flow in thoracic aorta under the effects of hypertension and hypotension. One of the idealized aorta models was modified along with the boundary conditions to mimic the thoracic aorta under the effects of hypertension and hypotension. The results of simulations with realistic models extracted from CT scans demonstrated more realistic flow dynamics than that in the idealized models. During systole, the velocity in ascending aorta was skewed towards the outer wall of aortic arch. The flow develops secondary flow patterns as it moves downstream towards aortic arch. Unlike idealized models, the distribution of flow was nonplanar and heavily guided by the artery anatomy. Flow cavitation was observed in the aorta model which was imaged giving longer branches. This could not be properly observed in the model with imaging containing a shorter length for aortic branches. The flow circulation was also observed in the inner wall of the aortic arch. However, during the diastole, the flow profiles were almost flat and regular due the acceleration of flow at the inlet. The flow profiles were weakly turbulent during the flow reversal. The complex flow patterns caused a non-uniform distribution of WSS. High WSS was distributed at the junction of branches and aortic arch. Low WSS was distributed at the proximal part of the junction, while intermedium WSS was distributed in the distal part of the junction. The pulsatile nature of the inflow caused oscillating WSS at the branch entry region and inner curvature of aortic arch. Based on the WSS distribution in the realistic model, one of the aorta models was altered to induce artificial atherosclerotic plaque at the branch entry region and inner curvature of aortic arch. Atherosclerotic plaque causing 50% blockage of lumen was introduced in brachiocephalic artery, common carotid artery, left subclavian artery, and aortic arch. The aim of this part of the study was first to study the effect of stenosis on flow and WSS distribution, understand the effect of shape of atherosclerotic plaque on flow and WSS distribution, and finally to investigate the effect of lumen blockage severity on flow and WSS distributions. The results revealed that the distribution of WSS is significantly affected by plaque with mere 50% stenosis. The asymmetric shape of stenosis causes higher WSS in branching arteries than in the cases with symmetric plaque. The flow dynamics within thoracic aorta models has been extensively studied and reported here. The effects of pressure and arterial anatomy on the flow dynamic were investigated. The distribution of complex flow and WSS is correlated with the localization of atherosclerosis. With the available results we can conclude that the thoracic aorta, with complex anatomy is the most vulnerable artery for the localization and development of atherosclerosis. The flow dynamics and arterial anatomy play a role in the localization of atherosclerosis. The patient specific image based models can be used to diagnose the locations in the aorta vulnerable to the development of arterial diseases such as atherosclerosis.
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Kirjallisuusarvostelu
Resumo:
Os autores apresentaram sua experiência com o posicionamento do catéter de diálise peritoneal ambulatorial utilizando a laparoscopia como via de acesso. Este trabalho tem por finalidade demonstrar os resultados obtidos com o procedimento, enfatizando a técnica cirúrgica e as vantagens em relação à abordagem convencional. Foram operados 51 paciente portadores de insuficiência renal crônica (IRC), que necessitavam de terapia dialítica. A faixa etária oscilou de 12 a 82 anos, sendo 19 pacientes do sexo masculino (37,3%) e trinta do sexo feminino (62,7%). O procedimento cirúrgico constou de implante do catéter em 44 pacientes, reimplante em três e retirada com reimplante em outros quatro. A avaliação pós-operatória demonstrou funcionamento satisfatório do catéter em 92,2% dos pacientes, sendo evidenciadas complicações relacionadas ao procedimento em três casos (5,9%). Nenhum paciente evoluiu para óbito em nossa casuística.
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Laparoscopic techniques have provided a new dimension to correct functional disorders of the esophagus, which has stimulated some investigators to recently report the use of laparoscopic cardiomyotomy in the treatment of esophageal achalasia. Now, a new instrument has been added to the current laparoscopic technique to offer a safer and easier method to proceed complete myotomy. After the dissection of the esophagogastric junction, a special catheter is introduced reaching the stomach. lt has an illuminated 10 cm extremity connected to a light source. lts withdrawal allows to visualize every muscle circular fiber by transillumination withan improved view provide by the laparoscopic optic system lens. This condition modifies the operative surgeon s attitude offering a better controlled situation over the procedure. The use of transillumination o fthe esophagogastric junction provides a good identification of the mucosa e submucosa avoiding the risk of esophageal perforation. It also helps to perform a complete myotomy preventing the ocurrence of persistent disphagia in the postoperative period. Cardiomyotomy with parcial fundoplication is possible by videolaparoscopic approach, now made easier with transillumination. This technique is safe and the functional results are similar to those observed in the literature for conventional open procedures, with the obvious advantages of the minimally invasive approach.
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The success of peritoneal dialysis in the treatment of patients with chronic renal failure depends on a proper performance of peritoneal catheter. This study shows the experience from the Service of Surgery from Departament of Medicine of State University of Maringá and the Service of Nephrology from Maria Auxiliadora Hospital, Maringá, in the laparoscopic approach of catheters with obstruction.
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Our objective is to report a case of a patient with a descending thoracic aortic aneurysm and chronic aortic dissection, who was submitted to an endovascular treatment. A 68-year-old male with coronary artery disease and hypertension, with no history of trauma, diabetes or smoking. He had myocardial infarction ten years ago. Under general anesthesia, the left femoral artery was surgically exposed and the left braquial artery was catheterized with a "pigtail" catheter, under Seldinger technique. The proximal 46mm/Æ and distal 34mm/Æ stent-graft was placed just distal to the origen of the left subclavian artery. Control arteriography showed that the lesion was completely excluded. The patient was discharged seven days after the surgery, when a computed tomographic control, was performed showing a sustained aneurysm exclusion and a satisfactory endovascular position.
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In these paper we are presenting a technical alternative to laparoscopic adjustable gastric banding. From January 1999 to April 2000, 60 patients with mean body mass index (BMI) of 40,7 kg/m2 underwent laparoscopic adjustable gastric banding. The new technique is performed in two steps. In the first step, an isolation instrument (laparoscopic finger) is inserted through the lesser sac, next to the junction of diaphragmatic crura, including the lesser omentum in order to pull the band catheter. The second step separates the lesser omentum from the right side of the stomach.There was no mortality and the morbidity was 11,6% (1 slippage of the band and 6 trocar port seroma). The new technique was performed in all patients with no conversion to open procedure. We didn't have respiratory complications. This technical alternative is safe and easily performed, helping to prevent transoperative perforations.
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Barogenic rupture of the stomach is a rare complication following cardiopulmonary resuscitation, administration of nasal oxygen by catheter and diving accidents. We report a case of gastric barotrauma following oroesophageal intubation. In most cases, the tears occur along the lesser curvature, what have been already attributed to Laplace's formula and, more recently, to morphological features of the stomach.
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The pectus excavatum treatment has two different approaches: non-surgical techniques (modified dynamic thoracic compressor, exercises and the vacuum bell) or surgical techniques (silastic or solid silicone implant, open surgical repair like sternochondroplasty and minimally invasive repair). The introduction of Nuss procedure improved the pectus excavatum treatment, but its low acceptance was due to the high complication rate (e.g. cardiac perfuration). The thoracoscopy use for bar mediastinal passage reduced the complication rate. In comparison with sternochondroplasty, the Nuss procedure has smaller incision, less blood loss and less operative time. However, it has more reoperations, complications, longer hospital stay and more readmission rates, more time of thoracic epidural catheter for postoperative analgesia and more need for analgesic after being discharged. Although Nuss procedure has been used in children, patients under ten years must be only observed. The Nuss procedure is applicable to moderate or light symmetrical pectus excavatum, without costal protrusion, in young and adolescents patients. Furthermore, the sternochondroplasty is applicable to severe or asymmetric pectus excavatum, with or without inferior costal protrusion. Therefore, Nuss procedure and sternocondroplasty are not antagonistic procedures, and they must be used in accordance with a treatment organogram and the technique choice must be by functional and aesthetic outcome.