Drainage Port Research Articles

Evaluation of the i-gel® Plus supraglottic airway device in elective surgery: a prospective international multicentre study.

The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice. This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported. In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients. The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.

The Use of Next Generation Sequencing to Detect Early Implant Infections: The Future of Microbiology and Targeted Antibiotic Treatment

Abstract Goals/Purpose The presence of fluid around foreign bodies, particularly breast implants, is a well-established phenomenon; However scant data exists regarding the composition of this fluid. The difficulty in studying this fluid arises from the lack of safe access to aspirate fluid post-breast augmentation, and by the loss of sterility once fluid exits the body via a drain bulb as traditionally placed during breast reconstruction. Our innovative breast reconstruction approach utilizes a drainless technique with a dual chamber tissue expander (TE) in the pre-pectoral plane, offering a unique avenue to sterilely aspirate peri-implant fluid through a percutaneous drainage port. In this study, we employ Next Generation Sequencing (NGS), utilizing polymerase chain reaction technology, to discern the composition of microbial DNA within peri-prosthetic breast implant fluid. NGS, known for its precision and cost-effectiveness, circumvents the biases inherent in traditional culture methods. By integrating this cutting-edge technology with our breast reconstruction methodology, we sought to study peri-prosthetic breast implant fluid to better understand when implant infections arise and if peri-prosthetic fluid could detect infections before clinical symptoms arise. Methods/Technique This is a single surgeon, prospective study of patients undergoing mastectomy, followed by pre-pectoral, drainless, TE reconstruction. Peri-prosthetic fluid was collected through the TE drainage port in the OR immediately after closure, at 1 week post op, and 3 weeks post op. This fluid was sent for traditional culture and NGS. Patients were observed for signs of infection, antibiotics, return to OR, or implant loss. Results/Complications 33 breasts from 20 patients were included. Patients had a mean age of 50 years. The average length of drainage was 21 days post-operative, with a mean of 131 cc of fluid drained per breast per week. Eight breasts had concern for skin necrosis. In 25 breasts (76%), complete sterility was achieved at the end of the case with no NGS detection of microorganisms in the initial peri-implant fluid sample. However, NGS detected microorganisms in the initial sample in 8 breasts (24%). In 5 of these 8 breasts, microorganisms were cleared by the 1-week sample and another 2 cleared by 3 weeks. The remaining 1 breast continued to have positive NGS and developed clinical signs of infections by week 2, which were not picked up by traditional culture until week 3. One breast with skin necrosis developed a positive NGS at week 3 and clinical signs of infection at week 4. No other clinical infections were seen throughout the study. Conclusion We are one of the first groups to demonstrate the ability to achieve peri-implant sterility at the time of implant insertion in the operating room. This could have significant implications for understanding the necessity of peri-operative antibiotics following breast implant placement. Our investigation into the microbial composition of ostensibly "sterile" peri-prosthetic breast implant fluid provides insight into when microorganisms arise and when they become clinical infections. These promising preliminary results suggests that peri-prosthetic fluid monitoring through Next-Generation Sequencing (NGS) holds significant potential in preemptively detecting implant infections before the onset of clinical symptoms, thereby reducing infection rates. Furthermore, our findings open avenues for targeted antibiotic therapy, contributing to the imperative goal of antibiotic stewardship. Ongoing work is beginning to explore the impact of microorganisms within the fluid on breast capsule formation, as we strive to enhance our understanding of breast implants and infections.

Intra Cervical Foley’s Versus Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion As Cervical Ripening Agent For Induction Of Labor

Objective: To compare IntraCervical Foleys (ICF) and intracervical Foleys along with Extra Amniotic Saline Infusion (EASI) as a cervical ripening agent for Induction Of Labour(IOL). Methods: It was carried out at the Department of Obstetrics and Gynecology Holy Family Hospital, Rawalpindi. In this comparative study, we included 100 patients with singleton cephalic presentation, intact membranes and a BISHOP score ≤ 6. These were further subdivided into two groups, Group A (ICF) and Group B (ICF with EASI),50 in each group. In Group A, Foley’s catheter was placed cervically while in Group B extraamniotic saline infusion was also administered in the urine drainage port at midnight. PGE2/ Augmentation with syntocinon was considered according to the bishop score at 6 am. Improvement in BISHOP score, induction to delivery interval, and feto-maternal outcomes were noted in both groups. Results: Data analysis showed that the mean improvement in the BISHOP score of the patients in Group A was 3.78 ± 1.75 while that of Group B was 3.56 ± 1.79(pvalue = 0.508). The induction to delivery interval in group A patients was 14.6 ± 4.75 hours while that of group B was 13.22 ± 4.54 hours (p =0.103). Only 14/100 patients had failed IOL and underwent C- C-sections and 8/100 neonates had NICU admissions and were discharged later on. Conclusion: Both Intra Cervical Foley’s and a Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion are equally effective as cervical ripening agents for induction Of labour with high chances of successful vaginal delivery and good feto-maternal outcome. Keywords: Induction of labour, Intracervical folleys, Extra-amniotic saline infusion, BISHOP score.

MP76-09 SCHELIN CATHETER TM FOR TRANS URETHRAL INTRAPROSTATIC ANESTHESIA BEFORE REZŪM WATER VAPOR TREATMENT: A NEW TOOL TO ENHANCE THE MINIMAL INVASIVENESS

You have accessJournal of UrologyCME1 Apr 2023MP76-09 SCHELIN CATHETERTM FOR TRANS URETHRAL INTRAPROSTATIC ANESTHESIA BEFORE REZŪM WATER VAPOR TREATMENT: A NEW TOOL TO ENHANCE THE MINIMAL INVASIVENESS Giampaolo Siena, Francesco Sessa, Paolo Polverino, Lorenzo Viola, Anna Rivetti, Pietro Spatafora, Riccardo Campi, and Luca Cindolo Giampaolo SienaGiampaolo Siena More articles by this author , Francesco SessaFrancesco Sessa More articles by this author , Paolo PolverinoPaolo Polverino More articles by this author , Lorenzo ViolaLorenzo Viola More articles by this author , Anna RivettiAnna Rivetti More articles by this author , Pietro SpataforaPietro Spatafora More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , and Luca CindoloLuca Cindolo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Among minimally invasive surgical techniques (MISTs) for moderate lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), RezūmTM water vapor treatment (Boston Scientific Corporation, Marlborough, USA) (RT) has been accepted as one of the most effective and versatile, with a very good sexual safety profile. To further enhance the minimal invasiveness of RT, we sought to evaluate potential advantages and feasibility of pure local transurethral intraprostatic anesthesia (TUIA) via the Schelin CatheterTM (ProstaLund AB, Lund, Sweden) (SC), a 3 ways device designed with an operational channel equipped with a retractile needle and the standard drainage and ballon ports (Figure 1). METHODS: After Ethical Commitee approval, included and collected data from 20 patients with moderate LUTS due to BPO, undergone RT procedure using TUIA by SC, from 2 centers. To rate their pain, patients were asked to use a numeric rating scale (NSR; numbered 0–10; 0 “No pain”/10 “Worst pain”) at 9-time points: 1-Preoperatively; 2-Schelin catheter insertion; 3-anestethic infiltration; 4-Rezum probe insertion; 5-Water Vapor Treatment (WVT); 6-Catheter insertion; 7-Day 1; 8-Day 7 catheter removal; 9-Day 30 follow-up visit. RESULTS: All 20 patients safely received TUIA prior RT. None required further anesthesiologic treatment. Median prostate size, Qmax, IPSS and QoL were 7 5ml, 9 mL/sec, 23 and 4, respectively. Median TUIA time was 3 minutes. Median catheterization time was 7 days. No need of re-catheterization or urinary tract infections at 30 days post-operatively were reported. Median NRS reported was 1.5 at each time point except at point 1, 2, 3 and 5. At preoperative stage NRS of pain was 0 in all cases. During catheter insertion (point 2) median NRS of pain was 2; during LA infiltration (point 3) was 2.5, and during WVT was 2 (point 5). One out of 10 patients reported a NRS of 6 during WVT (point 5). No perioperative anesthesiologic and procedure-related complications were recorded. CONCLUSIONS: Our data report for the first time in literature the feasibility and safeness of TUIA during RT using SC that showed full operative and post-operative pain control and reduced operative time and patient discomfort. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1094 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giampaolo Siena More articles by this author Francesco Sessa More articles by this author Paolo Polverino More articles by this author Lorenzo Viola More articles by this author Anna Rivetti More articles by this author Pietro Spatafora More articles by this author Riccardo Campi More articles by this author Luca Cindolo More articles by this author Expand All Advertisement PDF downloadLoading ...

Numerical simulation study on the structure optimization of liquid separation device in supersonic separator

ABSTRACT The effect of the supersonic separator on the condensation characteristics and fluid separation efficiency is not clear, and the structure of the liquid separation device still has room for optimization. Therefore, based on the rear-swirl type supersonic separator, three kinds of drainage ports and three kinds of liquid collection tank structures were proposed. The supersonic flow and separation process was studied numerically under nine different combination structures. The influence of the drainage port’s length and width and the inclination of the liquid collection tank on the liquefaction and separation process were analyzed. The separation trajectory of condensation droplets and the influence of particle size on the separation efficiency were clarified. The results show that the liquid separation device structure of the Em-Attached wall type can take condensation and separation efficiency into account, and its separation effect is the best. The optimal size of the key components was obtained: the length of the drainage port is 150 mm, the width of the drainage port is 3 mm, and the inclination of the liquid collection tank is 14 °. The particle size of the condensation droplets is in the range of 2 μm to 6 μm.

Characteristics and effects of a new Atom uterine hemostatic balloon for postpartum hemorrhage: First experience of 17 cases

Uterine balloon tamponade is the first-line treatment for postpartum hemorrhage (PPH). However, as cases accumulate, the disadvantages of conventional balloons, such as difficulties with insertion, displacement, dislodgement, slipping outside, and occlusion of the drainage tube with blood clots, have become evident. The newly developed Atom uterine hemostatic balloon has a stylet designed as an insertion guide for smooth insertion. The end of the insufflation portion can be housed in the handle tip of the stylet inserted into the other drainage tube to facilitate retrograde insertion of the balloon and prevent damage to the cervical canal during cesarean section. This balloon was designed in the shape of an apple to prevent it from slipping off. A drainage port without projections was used to improve adhesion to the uterine luminal wall.

A novel strategy for comprehensive optimization of structural and operational parameters in a supersonic separator using computational fluid dynamics modeling

In this study, the effects of several structural and operational parameters affecting the separation efficiency of supersonic separators were investigated by numerical methods. Different turbulence models were used and their accuracies were evaluated. Based on the error analysis, the V2-f turbulence model was more accurate for describing the high swirling turbulent flow than other investigated turbulence models. Therefore, the V2-f turbulence model and particle tracing model were selected to optimize the structure of the convergence part, the diffuser, the drainage port, and the swirler. The cooling performance of three line-type in the convergent section were calculated. The simulation results demonstrated that the convergent section designed by the Witoszynski curve had higher cooling depth compared to the Bi-cubic and Quintic curves. Furthermore, the expansion angle of 2° resulted in the highest stability of fluid flow and therefore was selected in the design of the diffuser. The effect of incorporating the swirler and its structure on the separation performance of supersonic separator was also studied. Three different swirler types, including axial, wall-mounted, and helical, were investigated. It was observed that installing the swirler significantly improved the separation efficiency of the supersonic separator. In addition, the simulation results demonstrated that the separation efficiency was higher for the axial swirler compared to the wall-mounted and helical swirlers. Therefore, for the improved nozzle, the swirling flow was generated by the axial swirler. The optimized axial swirler was constructed from 12 arced vanes each of which had a swirl angle of 40°. For the optimized structure, the effects of operating parameters such as inlet temperature, pressure recovery ratio, density, and droplet size was also investigated. It was concluded that increasing the droplet size and density significantly improved the separation efficiency of the supersonic separator. For hydrocarbon droplets, the separation efficiency improved from 4.6 to 76.7% upon increasing the droplet size from 0.1 to 2 µm.

A Closed-Circuit Ex Vivo Perfusion System for Pediatric Solid Organ Transplantation

<h3>Purpose</h3> Donation after cardiac death and ex-vivo organ perfusion are increasingly used strategies to mitigate donor organ shortage in cardiac transplantation. These concepts have mainly been established in adults, while neglecting the specific needs for application in children. To address this gap, we have developed an adjustable closed-circuit ex-vivo perfusion system that reduces priming volume, accommodates a wide range of organ sizes, and allows longer support times. <h3>Methods</h3> Silicone-infused thermoplastic polyurethane was used to construct a flexible biocompatible structure to closely envelop the heart. The cone-shaped bottom of the envelope serves as a drainage port to recirculate coronary sinus blood to a pump and oxygenator. Additional ports allow for aortic perfusion, left ventricular venting, deairing, pacing, ECG, and other monitoring. T-slot aluminum extrusion frames were constructed to suspend the device. A microprocessor with custom-built software was incorporated into the design to monitor and store key parameters, such as ECG, temperature, pressure in various compartments, and flow. <h3>Results</h3> Feasibility of ex-vivo perfusion was tested in a mock-loop setup. The design allowed use of commercially available and clinically approved oxygenators (Quadrox-i, Getinge, Sweden) and pumps (Rotaflow, Getinge, Sweden). Envelope design eliminated blood-air contact, while maintaining flow rates up to and above expected resting coronary blood flow values in adult hearts of 300ml/min. Flow consistency could be shown for extended runs of >3h. Perfusion of an isolated pig heart was performed to prove technical validity of the model. <h3>Conclusion</h3> We have developed an initial prototype for a novel ex-vivo organ perfusion capable of accommodating hearts of variable sizes from neonates to adults, ideally suited for the pediatric population. The system further aims at a reduction of blood trauma and foreign surface contact to increase support times without increasing inflammatory response and organ damage.

Creation of a novel inflatable vaginal stent for McIndoe vaginoplasty

To describe how to create an inflatable vaginal stent for use in McIndoe vaginoplasty that can be constructed using standard operating room supplies. Step-by-step video instructions that demonstrate how to construct and use an inflatable vaginal stent. (This video article was exempt from institutional review board approval.) SETTING: Academic hospital. A woman presenting with vaginal agenesis requiring a McIndoe vaginoplasty for the creation of a neovagina. A novel inflatable vaginal stent compliant with operating room procedures that is radio-opaque, functional, and can be used for patients with or without a functional uterus. The device is modeled after the effective inflatable vaginal stent that was previously commercially available but is no longer produced. Although a vaginal stent may be created in the operating room by placing surgical sponges inside a sterilized condom, many operating rooms have restrictions on equipment that can be brought into the operating room and special criteria for how to sterilize this equipment, and there are also restrictions against leaving non-radio-opaque objects "inside" the patient. The novel inflatable vaginal stent we have developed has multiple advantages compared with a rigid dilator: it is deflatable, so it does not cause trauma or interrupt the delicate tissue graft during insertion, removal, or repositioning; it is firm enough to conform and circumferentially press the tissue graft against the dissected vaginal space but is soft enough to decrease the risk of pressure necrosis or damage to the urethra; and it has a drainage port to prevent the buildup of a fluid pocket that could interfere with graft adherence. Our stent incorporates all these unique properties and can be easily constructed using sterile operating room supplies. The construction of this device requires a silicone Foley catheter, sterile foam sponges from a vaginal prep kit, a sterile radio-opaque sponge, a sterile vaginal ultrasound probe cover, a long Kelly, a 60-cc catheter tip syringe, a ruler, scissors, 0-vicryl suture, and sterile gloves. Effectiveness of a self-made inflatable vaginal stent using standard operating room supplies that meets operating room protocol standards. A standard dose of prophylactic antibiotics should be administered preoperatively to prevent surgical site infection. After placement of the tissue graft in the dissected neovagina cavity, the vaginal stent is placed and slowly inflated to circumferentially apply the tissue graft against the dissected vaginal space. The stent remains in place for 7 days and then should be removed in the operating room to allow for an examination under anesthesia, which provides the ideal setting to best evaluate the initial graft adherence. After careful inspection of the neovagina and tissue graft, a standard silicone vaginal mold is placed to maintain vaginal patency and prevent stricture of the tissue graft. The silicone mold should remain in place continuously until complete graft adherence occurs (approximately 4 to 6 weeks), and then it can be worn nightly until the patient is regularly sexually active. If at any point the patient discontinues nightly use of the silicone mold before regular sexual activity, vaginal stricture and a decrease in vaginal caliber will occur. Our novel inflatable vaginal stent is useful to surgeons performing a McIndoe vaginoplasty for vaginal agenesis with or without a uterus. It is compliant with operating room protocols and restrictions, as it is constructed from operating room supplies and is radio-opaque. Moreover, it is adjustable in size and effective in applying circumferential pressure for graft adherence. When used for segmental vaginal agenesis, the Foley catheter may be advanced through the cervix, then the balloon can be inflated, to stabilize the position of the stent during the first week postoperatively. The main limitation of this device is that it must be constructed by the surgeon, but the advantage of self-constructing the stent is that the size and shape can be tailored to conform to each individual patient. We prefer this inflatable vaginal stent to a rigid vaginal dilator in the first week of tissue healing to allow for easy insertion and removal of the stent without disrupting the tissue graft, to help prevent tissue necrosis, and to provide a fluid drainage port during graft adherence. We recommend this device as an ideal option for surgeons to consider when performing a McIndoe vaginoplasty.

Numerical Modeling of a Laboratory-Scale Waste Rock Pile Featuring an Engineered Cover System

Improved design to reduce contaminant mass loadings from waste rock piles is an increasingly important consideration. In certain cases, an engineered cover system containing a flow control layer (FCL) may be used to mitigate the release of metals out of a pile using capillary barrier effects (CBEs), diverting water away from reactive materials below. In this study, a reactive transport model was calibrated to observational data from a laboratory experiment designed to evaluate a cover system. The results show that the numerical model is capable of capturing flow rates out of multiple drainage ports and matching key effluent concentrations by including the spatial distribution of hydraulic parameters and mineral weathering rates. Simulations were also useful for characterizing the internal flow pathways within the laboratory experiment, showing the effectiveness of the cover in diverting the flow away from the reactive waste rock and identifying secondary CBEs between different rock types. The numerical model proved beneficial in building an improved understanding of the processes controlling the metal release and conceptualizing the system. The model was expanded to investigate the robustness of the cover system as a function of the applied infiltration rate, supporting that water diversion will occur with infiltration rates representative of field conditions.

Study on the influence of wall-mounted cyclone on the purification and separation performance of supersonic separator

To avoid the secondary nozzle caused by the large area occupied by the cyclone, in this paper, a new type of wall-mounted cyclone was proposed for the structural design of supersonic separator, which significantly reduces the space occupied by the cyclone and thus delays the generation of shock waves. The natural airflow field and droplets movement trajectory in supersonic separator were numerically calculated by RNG k-ε turbulence model and DPM model of Fluent software. The influence of different cyclone structures and different drain sizes on the separation performance of the device was studied systematically. The results show that the structure of the cyclone seriously affects the separation performance of the device. When the length of the cyclone is 0.02 m, the number of blades is 3, the thickness of the blades is 0.25 mm, the rotation angle of the blades is 60°, and the clearance of the drainage port is 2.5 mm, the separation efficiency of the liquid droplets with diameter of 2.5 μm reaches over 89 %, and the effect is good.

Semiquantification of Systemic Venous Admixture During Venovenous Extracorporeal Oxygenation Via Bicaval Double-Lumen Cannula in Critically Ill Patients.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in acute reversible cases of severe respiratory failure and as a bridge to lung transplantation. Venovenous extracorporeal membrane oxygenation using a bicaval double-lumen cannula (BCDLC) has several advantages over the traditional ECMO configuration; however, it also presents with several unique challenges. The assessment and quantification of venous admixture is difficult due to the specific position of BCDLC within the circulatory system. We describe the nature of the double-lumen bicaval venovenous ECMO cannula and relevant specific issues associated with monitoring complex details of oxygenation within different parts of circulation, including existing barriers for quantification of recirculation and venous admix. New conceptual approach to the quantification of venous admix is described. Right side echocardiographic contrast, when sequentially injected in separate superior vena cava (SVC) and inferior vena cava (IVC) venous basins, bypasses drainage ports of the catheter in double-lumen bicaval VV-ECMO configuration together with deoxygenated returning from the periphery venous blood. It was easily detectable entering right heart chambers by two- and three-dimensional echocardiography. Amount of bubbles from the agitated fluid contrast within right atrium indicates relative amount of venous admixture in relation to the returning from the oxygenator blood which is bubble free.

Same sized three-way indwelling urinary catheters from various manufacturers present different irrigation and drainage properties

Background:The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Although there seems to be a logical relationship between catheter size and efficacy of irrigation and drainage, we often observe relevant variations in these parameters between different brands of catheters available on the market. The aim of this study was to compare the mechanical properties of different models of latex and silicone three-way catheters in an in vitro setting that resembles clinical use.Methods:Three different three-way catheters were evaluated: Gold Silicone-Coated Rusch® (Model A), 100% Silicone Rusch® (Model B) and X-Flow Coloplast® (Model C). Irrigation channel, drainage channel, and overall cross-sectional areas were all digitally measured. Irrigation and drainage channel flow rates were measured and correlated with their corresponding catheter cross-sectional area values.Results:Different catheter models of the same caliber have different internal irrigation port diameters, internal drainage port diameters and internal cuff port diameters. The Model C IUC internal irrigation port diameter is significantly larger than models A and B. When flows were evaluated, we found that in the same model, the increase in caliber of the IUC was related to an increased drainage flow, but not to an increased irrigation flow.Conclusion:Precise measurements of the internal architecture of the three-way catheter, rather than relying on the caliber itself, could assist surgeons in choosing the best product for each specific patient, while minimizing complications.

Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak

CONTEXTRadical prostatectomy (RP) is a major oncologic urological surgery that can have high morbidity if complications arise. Bladder-urethral urine anastomotic leaks (AL) are one of the most common complications and can greatly increase morbidity. To date, there are few resources to manage AL. One management technique is using a Foley catheter with an additional auxiliary drainage port, also known as a fenestrated catheter. This type of auxiliary drainage port allows a low-pressure drainage source that is located near the anastomosis to increase urine drainage from catheter rather than from the AL site. The optimal size and location of this additional drainage port is currently unknown. This experiment evaluated the optimal auxiliary drainage port size and an inexpensive technique to easily construct such a catheter.METHODSUtilizing different size punch biopsies, auxiliary drainage ports were placed in different size Foley catheters and drainage rates and the structural integrity of the catheter was assessed.RESULTSA 3.0 mm punch biopsy located 1.0 cm proximal to the Foley balloon in an 18 French (Fr) catheter was determined to be the optimal size. A 2.0 mm punch biopsy provided significantly less drainage. The 4.0 mm punch biopsy compromised the structural integrity of the catheter.CONCLUSIONSBased on these experimental results, we recommend using a 3.0 mm punch biopsy in an 18 Fr catheter 1.0 cm. proximal to the balloon for an auxiliary drain site in Foley catheter when the anastomosis is not watertight or the surgeon has reason to believe the patient is at higher risk for an AL Factors such as history of pelvic radiation, abnormal anatomy, large prostate, post-surgical hematoma formation, obesity, previous prostatic surgery, difficult anastomosis, blood loss and postoperative urinary tract infection may make use of this type of device more attractive.

Intrusion of Dacron suture knot 15\u2009years after scleral buckling

BackgroundWe present a case of intrusion of a suture knot 15 years after scleral buckling surgery.Case presentationA 62-year-old woman with high myopia had undergone scleral buckling surgery in her left eye 15 years previously for rhegmatogenous retinal detachment. She recently displayed highly elevated intraocular pressure, with hyphema and vitreous hemorrhage. After the blood was cleared, a ring-shaped protrusion was noted around the equator of the eyeball, with a blue suture knot standing out on its surface and extending into the vitreous cavity at 5 o’clock. The suture knot was removed successfully. Mass spectrometry revealed that the material of the suture was polyethylene terephthalate, or Dacron. One week later, at the place where the suture knot had been located, the choroidal and retinal tissue disappeared and the silicone buckle remained an uncovered intrusion, whereas the rest of the retina was still attached.ConclusionsThe suture knot was possibly the one used to close the drainage port for subretinal fluid, which was covered by the encircling band. During the buckling procedure, covering a nonabsorbable suture, which is usually placed where the sclera is compromised by trauma or the surgical incision, with an encircling band may lead to the intrusion of the suture. Therefore, a soft absorbable suture may be preferable, if possible.

Patient-Specific Atrial Hemodynamics of a Double Lumen Neonatal Cannula in Correct Caval Position.

Clinical success of pediatric veno‐venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with the double lumen cannula cardiovascular device design as well as its anatomic orientation in the atrium. The positions of cannula ports with respect to the vena cavae and the tricuspid valve are believed to play a significant role on device hemodynamics. Despite various improvements in ECMO catheters, especially for the neonatal and congenital heart patients, it is still challenging to select a catalogue size that would fit to most patients optimally. In effect, the local unfavorable blood flow characteristics of the cannula would translate to an overall loss of efficiency of the ECMO circuit. In this study, the complex flow regime of a neonatal double lumen cannula, positioned in a patient‐specific right atrium, is presented for the first time in literature. A pulsatile computational fluid dynamics (CFD) solver that is validated for cardiovascular device flow regimes was used to perform the detailed flow, oxygenated blood transport, and site‐specific blood damage analysis using an integrated cannula and right atrium model. A standard 13Fr double lumen cannula was scanned using micro‐CT, reconstructed and simulated under physiologic flow conditions. User defined scalar transport equations allowed the quantification of the mixing and convection of oxygenated and deoxygenated blood as well as blood residence times and hemolysis build‐up. Site‐specific CFD analysis provided key insight into the hemodynamic challenges encountered in cannula design and the associated intra‐atrial flow patterns. Due to neonatal flow conditions, an ultra high velocity infusion jet emanated from the infusion port and created a zone of major recirculation in the atrium. This flow regime influenced the delivery of the oxygenated blood to the tricuspid valve. Elevated velocities and complex gradients resulted in higher wall shear stresses (WSS) particularly at the infusion port having the highest value followed by the aspiration hole closest to the drainage port. Our results show that, in a cannula that is perfectly oriented in the atrium, almost 38% of the oxygenated blood is lost to the atrial circulation while only half of the blood from inferior vena cava (IVC) can reach to the tricuspid valve. As such, approximately 6% of venous blood from superior vena cava (SVC) can be delivered to tricuspid. High values of hemolysis index were observed with blood damage encountered around infusion hole (0.025%). These results warrant further improvements in the cannula design to achieve optimal performance of ECMO and better patient outcomes.

Experimental and numerical investigation on the blade angle of axial-flow swirling generator and drainage structure for supersonic separators with diversion cone

The effect of axial-flow swirling generator and drainage structure with diversion cone on separation performance is very important to supersonic separators. But there is in the absence of experimental studies on separation characteristics of above-mentioned structure. In this paper, both experimental and numerical methods are utilized to investigate the influences of swirling generator and drainage structure. Good agreements are achieved between experimental data and high-order numerical simulation. The results demonstrate that the rotation strength decreases as the outlet angle of the swirler increases. The rotational flow causes the inconsistency of the radial distribution of the fluid in the nozzle and the inconsistency is more noticeable with the increase of rotation intensity. So the blade angle of swirling generator should be determined to find the balance between the expansion characteristic and swirling flow. Comparing two types of drainage structures, the internal extension structure has seriously damaged the supersonic flow in the nozzle, while the flush type drainage port has less influence on fluid. And the smaller outlet angle of drainage port can reduce the effect of drainage port on supersonic flow. When the pressure ratio is 1.4 for the flush type drainage structure, the optimal structural parameter is that the outlet angle of swirler is 55° and the inclination of the drainage structure is 22°. Under the optimum conditions, the ethanol removal rate is 57.06%.

Clinical analysis for preset double J tube in percutaneous nephrolithotripsy

Objective: To evaluate the clinical application and effect of preseting Double-J ureteric stent in percutaneous nephrolithotripsy. Method: 74 cases of renal calculi treated with PCNL in our hospital during June 2014 to February 2017 were retrospectively analyzed. Of 74 cases, 54 was male, 20 was female. All cases were aged 27 to 78, the mean age was (49.5±12.3) years old. The diameter of the stone was 20 to 59 mm, and the mean diameter was of (29.4±4.3) mm.Our Surgical methods was first putingFr6 double J tube in abnormal ureteral in advance in lithotomy position, then indwellingthree-way Foley catheter and clipping drainage port, perfusingirrigation port with 3 000 ml saline from 60-80 cm height.Perfusingsaline through irrigation port in prone position, we produce artificial hydronephrosis, then indwelling channel Fr20 through B ultrasound guided percutaneous nephrostomy, and removing renal calculi using holmium laser lithotripsy. Results: All patients were successfully completed percutaneous nephrostomy and indwell Fr20 channel, mean channel set up time (8.0 ±2.0) min, mean operation time (79±46) min, mean decline of hemoglobin (17.0±4.0) g/L, mean serum creatinine increased(3.1±1.1) μmol/L, one-stage stone-free rates 81.1%, complication rate 8.1% (1 case injured pleura and suffered from pneumothorax, 1 case suffered from massive hemorrhage of renal arteriovenous fistula after operation, 4 cases suffered postoperative fever). Conclusion: Advance in percutaneous nephrolithotripsy indwelling double J tube is a safe and feasible method, which is advantageous to the percutaneous renal puncture and the establishment of channels, and can avoid the blindness of along the line of indwelling double J.

A Survey of Phage Contamination in Natto-producing Factories and Development of Phage-resistant &lt;i&gt;Bacillus subtilis&lt;/i&gt; (natto) Strains

Eight natto-producing factories were surveyed for the contamination of phages that infect Bacillus subtilis (natto). A total of 160 sampling points, including manufacturing pipelines, instruments, floors, drainage ports, containers, and building facilities were inspected by wiping the surfaces. Virulent phages were detected from 28 survey points in four of the factories. Phages were frequently found in factories that had experienced product spoilage by phage contamination within the past 3 years. Isolated phages were not clonal and variations in their genomes were observed, although some phages were very similar. We developed phage-resistant B. subtilis (natto) strains using isolated phages as indicators. They were resistant against all phages found in the survey and those isolated decades ago from spoiled natto. The yueB gene that codes the receptor for phage SPP1 was not essential for the phages tested in this study to infect B. subtilis (natto) strains.

Ultrasound‐guided treatment of intrauterine adhesions in the outpatient setting

Ultrasound‐guided treatment of intrauterine adhesions in the outpatient setting