Complications biliaires après tranplantation hépatique

RESUME Après transplantation hépatique (TH), il persiste une morbidité et une mortalité liées aux complications immunologiques, infectieuses, rénales, vasculaires et, en particulier, aux complications biliaires - le "talon d'Achille" de la TH. Dans ce travail de thèse, nous avons analysé la fréquence et les caractéristiques des complications biliaires après TH dans l'expérience du CHUV à Lausanne entre 1988 et 2003. Au total 185 transplantations orthotopiques ont été réalisées chez 168 patients de décembre 1988 à mars 2003 (103 patients transplantés étaient de sexe masculin et 65 de sexe féminin). L'âge moyen pour les hommes était de 51 ans, celui de femmes étant de 49. Pendant la TH, une anastomose cholédoco-cholédocienne a été réalisée à 168 reprises et une anastomose cholédoco-jejunale à 17 reprises. Trente cas de complications biliaires ont été recensés, soit 16% des cas, avec un taux de mortalité de 0% durant le traitement de ces complications. Il s'agissait d'obstructions biliaires, fuites biliaires, lithiase biliaire isolée et sténoses biliaires. Les complications biliaires après TH restent donc relativement fréquentes et sont parfois graves. Elles nécessitent un diagnostic précoce et doivent être suspectées lors de fièvre, d'ictère, de douleurs abdominales ou de cholestase. En conclusion, l'incidence et le type de complications retrouvés dans la série lausannoise sont représentatifs des résultats observés dans d'autres centres de TH. Le traitement adéquat de ces complications, souvent graves, est de la plus haute importance et aura un impact important sur le pronostic.

Electromagnetic Design of a Solid Steel Rotor Motor for Demanding Operation Environments

The solid-rotor induction motor provides a mechanically and thermally reliable solution for demanding environments where other rotor solutions are prohibited or questionable. Solid rotors, which are manufactured of single pieces of ferromagnetic material, are commonly used in motors in which the rotationspeeds exceed substantially the conventional speeds of laminated rotors with squirrel-cage. During the operation of a solid-rotor electrical machine, the rotor core forms a conductor for both the magnetic flux and the electrical current. This causes an increase in the rotor resistance and rotor leakage inductance, which essentially decreases the power factor and the efficiency of the machine. The electromagnetic problems related to the solid-rotor induction motor are mostly associated with the low performance of the rotor. Therefore, the main emphasis in this thesis is put on the solid steel rotor designs. The rotor designs studied in thisthesis are based on the fact that the rotor construction should be extremely robust and reliable to withstand the high mechanical stresses caused by the rotational velocity of the rotor. In addition, the demanding operation environment sets requirements for the applied materials because of the high temperatures and oxidizing acids, which may be present in the cooling fluid. Therefore, the solid rotors analyzed in this thesis are made of a single piece of ferromagnetic material without any additional parts, such as copper end-rings or a squirrel-cage. A pure solid rotor construction is rigid and able to keep its balance over a large speed range. It also may tolerate other environmental stresses such as corroding substances or abrasive particles. In this thesis, the main target is to improve the performance of an induction motor equipped with a solid steel rotor by traditional methods: by axial slitting of the rotor, by selecting a proper rotor core material and by coating the rotor with a high-resistive stainless ferromagnetic material. In the solid steel rotor calculation, the rotor end-effects have a significant effect on the rotor characteristics. Thus, the emphasis is also put on the comparison of different rotor endfactors. In addition, a corrective slip-dependent end-factor is proposed. The rotor designs covered in this thesis are the smooth solid rotor, the axially slitted solid rotor and the slitted rotor having a uniform ferromagnetic coating cylinder. The thesis aims at design rules for multi-megawatt machines. Typically, mega-watt-size solidrotor machines find their applications mainly in the field of electric-motor-gas-compression systems, in steam-turbine applications, and in various types of largepower pump applications, where high operational speeds are required. In this thesis, a 120 kW, 10 000 rpm solid-rotor induction motor is usedas a small-scale model for such megawatt-range solid-rotor machines. The performance of the 120 kW solid-rotor induction motors is determined by experimental measurements and finite element calculations.

Permanent magnet synchronous motor for industrial inverter applications - analysis and design

During the latest few years the need for new motor types has grown, since both high efficiency and an accurate dynamic performance are demanded in industrial applications. For this reason, new effective control systems such as direct torque control (DTC) have been developed. Permanent magnet synchronous motors (PMSM) are well suitable for new adjustable speed AC inverter drives, because their efficiency and power factor are not depending on the pole pair number and speed to the same extent as it is the case in induction motors. Therefore, an induction motor (IM) with a mechanical gearbox can often be replaced with a direct PM motor drive. Space as well as costs will be saved, because the efficiency increases and the cost of maintenance decreases as well. This thesis deals with design criterion, analytical calculation and analysis of the permanent magnet synchronous motor for both sinusoidal air-gap flux density and rectangular air-gapflux density. It is examined how the air-gap flux, flux densities, inductances and torque can be estimated analytically for salient pole and non-salient pole motors. It has been sought by means of analytical calculations for the ultimate construction for machines rotating at relative low 300 rpm to 600 rpm speeds, which are suitable speeds e.g. in Pulp&Paper industry. The calculations are verified by using Finite Element calculations and by measuring of prototype motor. The prototype motor is a 45 kW, 600 rpm PMSM with buried V-magnets, which is a very appropriate construction for high torque motors with a high performance. With the purposebuilt prototype machine it is possible not only to verify the analytical calculations but also to show whether the 600 rpm PMSM can replace the 1500 rpm IM with a gear. It can also be tested if the outer dimensions of the PMSM may be the same as for the IM and if the PMSM in this case can produce a 2.5 fold torque, in consequence of which it may be possible to achieve the same power. The thesis also considers the question how to design a permanent magnet synchronous motor for relatively low speed applications that require a high motor torqueand efficiency as well as bearable costs of permanent magnet materials. It is shown how a selection of different parameters affects the motor properties. Key words: Permanent magnet synchronous motor, PMSM, surface magnets, buried magnets

Induction motor versus permanent magnet synchronous motor in motion control applications: a comparative study

High dynamic performance of an electric motor is a fundamental prerequisite in motion control applications, also known as servo drives. Recent developments in the field of microprocessors and power electronics have enabled faster and faster movements with an electric motor. In such a dynamically demanding application, the dimensioning of the motor differs substantially from the industrial motor design, where feasible characteristics of the motor are for example high efficiency, a high power factor, and a low price. In motion control instead, such characteristics as high overloading capability, high-speed operation, high torque density and low inertia are required. The thesis investigates how the dimensioning of a high-performance servomotor differs from the dimensioning of industrial motors. The two most common servomotor types are examined; an induction motor and apermanent magnet synchronous motor. The suitability of these two motor types indynamically demanding servo applications is assessed, and the design aspects that optimize the servo characteristics of the motors are analyzed. Operating characteristics of a high performance motor are studied, and some methods for improvements are suggested. The main focus is on the induction machine, which is frequently compared to the permanent magnet synchronous motor. A 4 kW prototype induction motor was designed and manufactured for the verification of the simulation results in the laboratory conditions. Also a dynamic simulation model for estimating the thermal behaviour of the induction motor in servo applications was constructed. The accuracy of the model was improved by coupling it with the electromagnetic motor model in order to take into account the variations in the motor electromagnetic characteristics due to the temperature rise.

Dyrk1A is dynamically expressed on subsets of motor neurons and in the neuromuscular junction: possible role in Down syndrome

Individuals with Down syndrome (DS) present important motor deficits that derive from altered motor development of infants and young children. DYRK1A, a candidate gene for DS abnormalities has been implicated in motor function due to its expression in motor nuclei in the adult brain, and its overexpression in DS mouse models leads to hyperactivity and altered motor learning. However, its precise role in the adult motor system, or its possible involvement in postnatal locomotor development has not yet been clarified. During the postnatal period we observed time-specific expression of Dyrk1A in discrete subsets of brainstem nuclei and spinal cord motor neurons. Interestingly, we describe for the first time the presence of Dyrk1A in the presynaptic terminal of the neuromuscular junctions and its axonal transport from the facial nucleus, suggesting a function for Dyrk1A in these structures. Relevant to DS, Dyrk1A overexpression in transgenic mice (TgDyrk1A) produces motor developmental alterations possibly contributing to DS motor phenotypes and modifies the numbers of motor cholinergic neurons, suggesting that the kinase may have a role in the development of the brainstem and spinal cord motor system.

Complications of systemic juvenile idiopathic arthritis: risk factors and management recommendations.

Systemic juvenile idiopathic arthritis (SJIA) is an inflammatory condition characterized by fever, lymphadenopathy, arthritis, rash and serositis. Systemic inflammation has been associated with dysregulation of the innate immune system, suggesting that SJIA is an autoinflammatory disorder. IL-1 and IL-6 play a major role in the pathogenesis of SJIA, and treatment with IL-1 and IL-6 inhibitors has shown to be highly effective. However, complications of SJIA, including macrophage activation syndrome, limitations in functional outcome by arthritis and long-term damage from chronic inflammation, continue to be a major issue in SJIA patients' care. Translational research leading to a profound understanding of the cytokine crosstalk in SJIA and the identification of risk factors for SJIA complications will help to improve long-term outcome.

Lower limb lymphedema and neurological complications after lymphadenectomy for gynecological cancer.

OBJECTIVE: Lymphadenectomy is a frequent procedure for surgical staging of gynecological malignancies. Nevertheless, minor complications, such as lower limb lymphedema (LLL) and neurological complications (NCs), after pelvic and aorto-caval lymphadenectomy still remain underinvestigated. The present study considers short-term and long-term incidence and risk factors for LLL and NC in patients with gynecological cancer who underwent lymphadenectomy. MATERIALS AND METHODS: In 2 different institutions, University of Turin and University of Lausanne, a total of 152 patients who received lymphadenectomy for endometrial, cervical, or ovarian cancer were retrospectively identified. During the follow-up, data about LLL and NC were collected by means of a questionnaire. Short-term and long-term incidence of LLL and NC was evaluated, and risk factors, such as age, body mass index, type of cancer, surgical approach, number and extension of the removed lymph nodes, presence of lymph node metastasis, and adjuvant treatments, were analyzed. RESULTS: Short-term incidence of LLL and NC after lymphadenectomy was high (36%) and predictive of long-term persistence. Between the analyzed risk factors, number of removed lymph nodes and adjuvant radiotherapy were significantly associated with an increased incidence of minor complications (P < 0.05). CONCLUSIONS: Lower limb lymphedema and NC are more frequent than expected. They are related to the radicality of lymphadenectomy and adjuvant radiotherapy. They affect the quality of life of the patients treated for gynecological cancer and their perceptions of healing. Minor complications are commonly persistent and need a prompt diagnosis and a specialized management to improve their prognosis.