Acute mesenteric vein thrombosis: factors associated with evolution to chronic mesenteric vein thrombosis

OBJECTIVE. Acute mesenteric venous thrombosis signs at MDCT are well described, but the literature lacks studies assessing their evolution. We aimed to describe the radiologic evolution of isolated acute mesenteric venous thrombosis and associated prognostic factors. MATERIALS AND METHODS. Patients with isolated acute mesenteric venous thrombosis with follow-up for a minimum of 1 month with MDCT were selected. Images at the acute phase and on follow-up were reviewed in consensus reading. For acute mesenteric venous thrombosis, we searched for low-attenuated intraluminal filling defect. For chronic mesenteric venous thrombosis, we searched for vessel stenosis or occlusion associated with collateral mesenteric veins. Treatment, thrombosis risk factor, symptoms, location, and length and diameter of mesenteric venous thrombosis were reported and correlated with evolution over time. RESULTS. Twenty patients (nine women and 11 men; mean age, 52 years) were selected. Four patients recovered without radiologic sequelae, and 16 developed chronic mesenteric venous thrombosis signs. Anticoagulation did not influence recovery (p = 1). Patients with recovery compared with patients with chronic mesenteric venous thrombosis showed more frequent central lesions (p = 0.03). At diagnosis, the thrombosed segment was shorter and larger in the complete radiologic recovery group compared with the chronic mesenteric venous thrombosis signs group: mean length (± SD) 6.25 ± 3.21 cm and 12.81 ± 5.96 cm, respectively (p = 0.01); mean transverse diameter 1.82 ± 0.42 cm and 1.12 ± 0.34 cm, respectively (p = 0.01). Mesenteric fat infiltration at diagnosis was more frequent in the chronic mesenteric venous thrombosis signs group than in the complete recovery group (p = 0.03). CONCLUSION. Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins. Location, length of mesenteric venous thrombosis, transverse diameter of the vein, and mesenteric fat infiltration at diagnosis are determinant factors for mesenteric venous thrombosis evolution.

Field Evaluation of Cold In-Place Recycling of Asphalt Concrete, HR-303, 1993

The average thickness of the existing asphalt cement concrete (ACC) along route E66 in Tama County was 156 mm (6.13 in.). The rehabilitation strategy called for widening the base using the top 75 mm (3 in.) of the existing ACC by a recycling process involving cold milling and mixing with additional emulsion/rejuvenator. The material was then placed into a widening trench and compacted to match the level of the milled surface. The project had the following results: (1) Cold recycled ACC pavement provided adequate pavement structure for a low volume road; (2) Premature cracking of the ACC in the widened pavement area was caused by compaction of the mix over a saturated subgrade; and (3) Considerably less transverse and longitudinal cracking was observed with 75 mm (3 in.) of cold recycled ACC and a 50 mm (2 in.) hot mix ACC overlay than with a conventional hot mix overlay with no cold recycling. More research should be done on efficient construction procedures and incorporating longer test sections for proper evaluation.

Pavement Wear and Studded Tire Use in Iowa, HR-148, 1979

This report presents the results of surveys to determine studded tire usage in Iowa. Also reported are the results of measurements of transverse pavement profiles at selected locations where the pavement is subjected to a high volume of traffic. The surveys were made in January of each of the years 1969 through 1978 and in each of 27 areas into which the state was divided. Estimates of studded tire usage were also made at various locations on Interstate highways in Iowa. The lowest percentage of studded tires was observed in the initial count during the winter of 1968-69. Two years later the percentage had increased to the maximum (22.6%) and then began a gradual decline. The latest count in January of 1978 indicated 8.5% of the cars had studded tires. The decline in the use of studded tires is attributed to the efforts of the Iowa DOT and others to obtain a ban on studded tires and a continual increase in the use of radial tires with claims of improved traction. The wear measurements were recorded by camera. It was found that studded tires have worn ruts in Iowa pavements as deep as 5/16 inch. The ruts lead to water on the pavement and this causes hydroplaning, as well as splash and spray. The conclusion of the study was that studded tires should be banned in Iowa.

Vibratory Effects in Reinforced Portland Cement Concrete Pavement, MLR-97-2, 1997

A double mat of reinforcement steel consisting of No. 5 bars was placed in the longitudinal and transverse directions in a 26' wide, 10" thick pavement. The bars were placed on 12" centers with 2" of cover from the top and bottom surfaces. The special reinforcement is to provide additional strength in the pavement over an area of old coal mine tunnels. Auxiliary and standard paver vibrators were used to consolidate the concrete. There was concern that over-vibration could be occurring in some areas and also that a lack of consolidation may be occurring under the steel bars in some areas. A core evaluation study of the pavement was developed. The results showed that the consolidation and the air contents were satisfactory. Additional paving with reinforcement in the same area should use the same or similar method and amount of vibration as was used in the area evaluated in this study.

Cracking and Seating to Retard Reflective Cracking - Fremont County, HR-279, 1993

The concept of cracking and seating a portland cement concrete (pcc) pavement prior to laying an asphalt cement concrete (acc) surface in order to reduce reflection cracking has been around since the 1950s. With the advent of improved cracking equipment, this method gained renewed interest in the 1970s and 1980s. This project incorporated six test sections of which four were cracked and seated prior to being overlaid. Fremont County decided to utilize only a 0.9 m (3 ft) cracking pattern based on a 30 m (100 ft) trial test section. Pavement cracking appeared to be effective in reducing primarily longitudinal reflectance cracking, but only marginally successful in the reduction of transverse reflective cracking.

Pavement Texturing by Milling, HR-283, 1987

Experience has shown that milling machines with carbide tipped teeth have the capability of profiling most asphalt concrete (ac) and portland cement concrete (pcc) pavements. Most standard milling operations today leave a very coarse, generally objectionable surface texture. This research utilized a Cedarapids Wirtgen 1900C mill modified by adding additional teeth. There were 411 teeth at a 5 millimeter transverse spacing (standard spacing is 15 mm) on a 6 ft. 4 in. long drum. The mill was used to profile and texture the surface of one ac and two pcc pavements. One year after the milling operation there is still some noticeable change in tire noise but the general appearance is good. The milling operation with the additional teeth provides an acceptable surface texture with improved Friction Numbers when compared to a nonmilled surface.

Non-Corrosive Tie Reinforcing and Dowel Bars for Highway Pavement Slabs, HR-343, 1993

The use of non-metallic load transfer and reinforcement devices for concrete highway pavements is a possible alternative to avoid corrosion problems related to the current practice of steel materials. Laboratory and field testing of highway pavement dowel bars, made of both steel and fiber composite materials, and fiber composite tie rods were carried out in this research investigation. Fatigue, static, and dynamic testing was performed on full-scale concrete pavement slabs which were supported by a simulated subgrade and which included a single transverse joint. The bahavior of the full-scale specimens with both steel and fiber composite dowels placed in the test joints was monitored during several million load cycles which simulated truck traffic at a transverse joint. Static bond tests were conducted on fiber composite tie rods to determine the required embedment length. These tests took the form of bending tests which included curvature and shear in the embedment zone and pullout tests which subjected the test specimen to axial tension only. Fiber composite dowel bars were placed at two transverse joints during construction of a new concrete highway pavement in order to evaluate their performance under actual field conditions. Fiber composite tie rods were also placed in the longitudinal joint between the two fiber composite doweled transverse joints.

Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies

The aim of this study was to provide an insight into normative values of the ascending aorta in regards to novel endovascular procedures using ECG-gated multi-detector CT angiography. Seventy-seven adult patients without ascending aortic abnormalities were evaluated. Measurements at relevant levels of the aortic root and ascending aorta were obtained. Diameter variations of the ascending aorta during cardiac cycle were also considered. Mean diameters (mm) were as follows: LV outflow tract 20.3 +/- 3.4, coronary sinus 34.2 +/- 4.1, sino-tubular junction 29.7 +/- 3.4 and mid ascending aorta 32.7 +/- 3.8 with coefficients of variation (CV) ranging from 12 to 17%. Mean distances (mm) were: from the plane passing through the proximal insertions of the aortic valve cusps to the right brachio-cephalic artery (BCA) 92.6 +/- 11.8, from the plane passing through the proximal insertions of the aortic valve cusps to the proximal coronary ostium 12.1 +/- 3.7, and between both coronary ostia 7.2 +/- 3.1, minimal arc of the ascending aorta from left coronary ostium to right BCA 52.9 +/- 9.5, and the fibrous continuity between the aortic valve and the anterior leaflet of the mitral valve 14.6 +/- 3.3, CV 13-43%. Mean aortic valve area was 582.0 +/- 131.9 mm(2). The variation of the antero-posterior and transverse diameters of the ascending aorta during the cardiac cycle were 8.4% and 7.3%, respectively. Results showed large inter-individual variations in diameters and distances but with limited intra-individual variations during the cardiac cycle. A personalized approach for planning endovascular devices must be considered.

Review of Cold In-Place Recycled Asphalt Concrete Projects, HR-392, 1998

Highway Research Project HR-392 was undertaken to evaluate cold in-place asphalt recycled (CIR) projects in the State of Iowa. The research involved assessment of performance levels, investigation of factors that most influence pavement performance and economy, and development of guidelines for CIR project selection. The performance was evaluated in two ways: Pavement Condition Indices (PCI, U.S. Corps of Engineers) were calculated and overall ratings were given on ride and appearance. A regression analysis was extrapolated to predict the future service life of CIR roads. The results were that CIR roads within the State of Iowa, with less than 2000 annual average daily traffic (AADT), have an average predicted service life of fifteen to twenty-six years. Subgrade stability problems can prevent a CIR project from being successfully constructed. A series of Dynamic Cone Penetrometer (DCP) tests were conducted on a CIR project that experienced varying levels of subgrade failure during construction. Based on this case study, and supporting data, it was determined that the DCP test can be used to evaluate subgrades that have insufficient stability for recycling. Overall, CIR roads in Iowa are performing well. It appears that the development of transverse cracking has been retarded and little rutting has occurred. Contracting agencies must pay special attention to the subgrade conditions during project selection. Because of its performance, CIR is a recommended method to be considered for rehabilitating aged low volume (<2000 AADT) asphalt concrete roads in Iowa.

Athletic injuries of the extensor carpi ulnaris subsheath: MRI findings and utility of gadolinium-enhanced fat-saturated T1-weighted sequences with wrist pronation and supination.

OBJECTIVE: To report the magnetic resonance imaging (MRI) findings in athletic injuries of the extensor carpi ulnaris (ECU) subsheath, assessing the utility of gadolinium-enhanced (Gd) fat-saturated (FS) T1-weighted sequences with wrist pronation and supination. METHODS: Sixteen patients (13 male, three female; mean age 30.3 years) with athletic injuries of the ECU subsheath sustained between January 2003 and June 2009 were included in this retrospective study. Initial and follow-up 1.5-T wrist MRIs were performed with transverse T1-weighted and STIR sequences in pronation, and Gd FS T1-weighted sequences with wrist pronation and supination. Two radiologists assessed the type of injury (A to C), ECU tendon stability, associated lesions and rated pulse sequences using a three-point scale: 1=poor, 2=good and 3=excellent. RESULTS: Gd-enhanced FS T1-weighted transverse sequences in supination (2.63) and pronation (2.56) were most valuable, compared with STIR (2.19) and T1-weighted (1.94). Nine type A, one type B and six type C injuries were found. There were trends towards diminution in size, signal intensity and enhancement of associated pouches on follow-up MRI and tendon stabilisation within the ulnar groove. CONCLUSION: Gd-enhanced FS T1-weighted sequences with wrist pronation and supination are most valuable in assessing and follow-up athletic injuries of the ECU subsheath on 1.5-T MRI.

Perforation colique néonatale focale spontanée en dehors de la grande prématurité : rare et potentiellement insidieuse [Focal spontaneous colic perforation in term or near-term neonates: rare and potentially insidious].

Two cases of neonatal focal spontaneous colic perforations are reported. The 1st infant, born at 36 3/7 weeks gestational age, presented on day 3 with crying, abdominal distension, and liquid stools. Clinical examination showed a slightly irritable hypothermic (35.7 °C) infant with a distended abdomen and few bowel sounds. Blood tests were normal apart from an elevated C-reactive protein level (59 mg/l). The abdomen x-ray was erroneously considered normal. The infant's condition remained stable for nearly 3 days. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was started on antibiotics and operated. Macroscopically, the entire gut was normal apart from a focal sigmoid perforation, which was stitched. A transmural colic biopsy revealed focal vascular dilation but was negative for necrotising enterocolitis or Hirschsprung disease. The infant recovered quickly. She is now a healthy, normal 3-year-old. The 2nd infant, born at 38 5/7 weeks gestational age, presented between day 1 and 2 with clinical signs of infection associated with slowly progressive ileus. The chest and abdomen x-ray was mistakenly considered normal. Frank septicemia developed. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was operated. Macroscopically, the small intestine was normal, the ascending and transverse colons were dilated, and the descending and sigmoid colons were narrow. Three cecal perforations were discovered and stitched. An ileostomy and multiple colic biopsies were also performed. The postoperative course was complicated by persistent septic ileus due to descending and sigmoid colon leaks, which led to colic resections with end-to-end anastomosis. Rectal aspiration biopsies were also performed. At 1 month of age, the infant was discharged from the hospital. The ileostomy was closed in two steps at 2 and 5 months of age. A normal sweat test excluded cystic fibrosis. All colic and rectal biopsies revealed nonspecific inflammatory signs and excluded necrotizing enterocolitis and Hirschsprung disease. Nonspecific irregular thinning of muscularis mucosae and muscularis propria were observed in the two resected colic segments. The boy is now a healthy 7-year-old. The incidence of neonatal focal spontaneous colic perforations at term or close to term is unknown but probably very rare. Our department is the neonatal referral center for approximately 14,000 annual births. In the last 10 years (2000-2009), out of 5115 neonatal admissions in our unit, only ten cases have presented a neonatal spontaneous intestinal perforation, seven of ten in very-low-birth-weight infants and three of ten in term or near-term neonates (one with Hirschsprung disease and the two cases reported herein). In the same period, 108 infants suffered from necrotizing enterocolitis, seven of 108 were term infants and 6 out of 7 had a congenital heart disease. The medical literature is poor on the subject of focal spontaneous colic perforations at term; no risk factor is described. The most specific clinical sign seems to be the abdominal distension. The presence of pneumoperitoneum on an abdominal x-ray is the most sensitive paraclinical sign. In case of an intestinal perforation, surgery must be performed quickly. The vital prognosis seems to be good. The objective of this study was to draw pediatricians' attention to focal spontaneous colic perforations in term or close to term newborns. In the cases reported, the diagnostic delays could have been prevented if the entity - with its radiological manifestation - had been well known.

High Molecular Weight Methacrylate Sealing of a Bridge Deck, HR-2031, 1988

The Iowa Department of Transportation used a high molecular weight methacrylate (HMWM) resin to seal a 3,340 ft. x 64 ft. bridge deck in October 1986. The sealing was necessary to prevent deicing salt brine from entering a substantial number of transverse cracks that coincided with the epoxy coated top steel and unprotected bottom steel. HMWM resin is a three component product composed of a monomer, a cumene hydroperoxide initiator and a cobalt naphthenate promoter. The HMWM was applied with a dual spray bar system and flat-fan nozzles. Initiated monomer delivered through one spray bar was mixed in the air with promoted monomer from the other spray bar. The application rate averaged 0.956 gallons per 100 square feet for the tined textured driving lanes. Dry sand was broadcast on the surface at an average coverage of 0.58 lbs. per square yard to maintain friction. Coring showed that the HMWM resin penetrated the cracks more than two inches deep. Testing of the treated deck yielded Friction Numbers averaging 33 with a treaded tire compared to 36 prior to treatment. An inspection soon after treatment found five leaky cracks in one of the 15 spans. One inspection during a steady rain showed no leakage, but leakage from numerous cracks occurred during a subsequent rain. A second HMWM application was made on two spans. Leakage through the double application occurred during a rain. Neither the single or double application were successful in preventing leakage through the cracks.

Design Manual for Strengthening of Continuous-Span Composite Bridges, HR-333, 1993

The need for upgrading a large number of understrength bridges in the United States has been well documented in the literature. This manual presents two methods for strengthening continuous-span composite bridges: post-tensioning of the positive moment regions of the bridge stringers and the addition of superimposed trusses at the piers. The use of these two systems is an efficient method of reducing flexural overstresses in undercapacity bridges. Before strengthening a given bridge however, other deficiencies (inadequate shear connection, fatigue problems, extensive corrosion) should be addressed. Since continuous-span composite bridges are indeterminant structures, there is longitudinal and transverse distribution of the strengthening axial forces and moments. This manual basically provides the engineer with a procedure for determining the distribution of strengthening forces and moments throughout the bridge. As a result of the longitudinal and transverse force distribution, the design methodology presented in this manual for continuous-span composite bridges is extremely complex. To simplify the procedure, a spreadsheet has been developed for use by practicing engineers. This design aid greatly simplifies the design of a strengthening system for a given bridge in that it eliminates numerous tedious hand calculations, computes the required force and moment fractions, and performs the necessary iterations for determining the required strengthening forces. The force and moment distribution fraction formulas developed in this manual are primarily for the Iowa DOT V12 and V14 three-span four-stringer bridges. These formulas may be used on other bridges if they are within the limits stated in this manual. Use of the distribution fraction formulas for bridges not within the stated limits is not recommended.

Testing of Old Reinforced Concrete Bridges, HR-390, 1997

The objective of this research project was to service load test a representative sample of old reinforced concrete bridges (some of them historic and some of them scheduled for demolition) with the results being used to create a database so the performance of similar bridges could be predicted. The types of bridges tested included two reinforced concrete open spandrel arches, two reinforced concrete filled spandrel arches, one reinforced concrete slab bridge, and one two span reinforced concrete stringer bridge. The testing of each bridge consisted of applying a static load at various locations on the bridges and monitoring strains and deflections in critical members. The load was applied by means of a tandem axle dump truck with varying magnitudes of load. At each load increment, the truck was stopped at predetermined transverse and longitudinal locations and strain and deflection data were obtained. The strain data obtained were then evaluated in relation to the strain values predicted by traditional analytical procedures and a carrying capacity of the bridges was determined based on the experimental data. The response of a majority of the bridges tested was considerably lower than that predicted by analysis. Thus, the safe load carrying capacities of the bridges were greater than those predicted by the analytical models, and in a few cases, the load carrying capacities were found to be three or four times greater than calculated values. However, the test results of one bridge were lower than those predicted by analysis and thus resulted in the analytical rating being reduced. The results of the testing verified that traditional analytical methods, in most instances, are conservative and that the safe load carrying capacities of a majority of the reinforced concrete bridges are considerably greater than what one would determine on the basis of analytical analysis alone. In extrapolating the results obtained from diagnostic load tests to levels greater than those placed on the bridge during the load test, care must be taken to ensure safe bridge performance at the higher load levels. To extrapolate the load test results from the bridges tested in this investigation, the method developed by Lichtenstein in NCHRP Project 12-28(13)A was used.

Low Cost Fly Ash - Sand Stabilized Roadway Des Moines County, HR-259, 1991

The objectives of this research were to develop a low cost fly ash-sand stabilized roadway and to correlate field performance with pavement design assumptions on a county road heavily trafficked by trucks hauling grain. The road was constructed during the summer of 1984. Three test sections comprised of different base thicknesses were incorporated in the roadway and were tested for compressive stength, structural rating, and rut depth. Annual crack surveys showed no appreciable difference in transverse cracking between the test sections and little to no rutting. The sandbase drainage characteristics beneath the roadway may have contributed to the satisfactory performance of the test sections. This project indicates that in spite of the inflated cost of construction due to the research nature of the work, a fly ash-sand base can be a viable alternative for roadway stabilization.