High Degree Of Obstruction Research Articles

Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment.

To identify computed tomographic (CT) findings that are associated with the effectiveness of nonsurgical treatment in patients with adhesive small-bowel obstruction ( SBO small-bowel obstruction ) that was initially treated medically. The local institutional review board approved this retrospective study; the informed consent requirement was waived. Multi-detector row CT studies in 159 patients (64 women, 95 men; median age, 69 years) with adhesive SBO small-bowel obstruction that was initially treated medically were reviewed retrospectively and independently by two emergency radiologists to identify numerous CT findings that could be associated with the effectiveness of nonsurgical treatment. Results were compared according to the success or failure of nonsurgical treatment. Univariate statistical analyses were performed for qualitative and quantitative data, as appropriate, and each significant parameter was entered in a multivariate logistic regression analysis. The κ statistic and correlation coefficients were used to assess interobserver agreement, as appropriate. Nonsurgical treatment succeeded in 113 patients (71%) and failed in 46 patients (29%). At univariate analysis, an anterior parietal adhesion, a feces sign, and the lack of a beak sign were associated with successful nonsurgical treatment, whereas two beak signs or more, a whirl sign, a C- or U-shaped appearance of the bowel loop, and a high degree of obstruction were associated with nonsurgical treatment failure. At multivariate analysis, fewer than two beak signs and the presence of an anterior parietal adhesion were independent predictors of the effectiveness of nonsurgical treatment, with odds ratios of 0.27 and 0.11, respectively. The number of beak signs and the location of the transition zone in relation to the anterior peritoneal layer are independent signs associated with the success or failure of nonsurgical treatment.

Correlation between changes in ultrasound measurements and clinical curative effect of tension-free vaginal tape-SECUR* procedure

The hypotheses of this study were that the TVT-SECUR procedure restricts urethral mobility, which leads to a greater likelihood of curative effect, and that the restriction might change over time. Analyses of the position of the urethra and the tape of 85 patients who underwent the TVT-S procedure were performed using perineal ultrasonography. The efficacy of the TVT-S procedure was evaluated by cough test and by the questionnaire ICIQ-UI SF. Objectively, 53/85 (62%) of patients had a negative cough test, and in 32/85 (38%) of patients leakage of urine persisted. The TVT-S procedure restricts urethral mobility, and a higher degree of obstruction is associated with a higher likelihood of cure. The restriction weakens within the first 3 months after surgery. The objective cure rate of TVT-S procedure is low irrespective of placement technique. This may be due to insufficient restriction of urethral mobility.

Optimizing Wireless LAN for Longwall Coal Mine Automation

A significant development in underground longwall coal mining automation has been achieved with the successful implementation of wireless LAN (WLAN) technology for communication on a longwall shearer. WIreless-FIdelity (Wi-Fi) was selected to meet the bandwidth requirements of the underground data network, and several configurations were installed on operating longwalls to evaluate their performance. Although these efforts demonstrated the feasibility of using WLAN technology in longwall operation, it was clear that new research and development was required in order to establish optimal full-face coverage. By undertaking an accurate characterization of the target environment, it has been possible to achieve great improvements in WLAN performance over a nominal Wi-Fi installation. This paper discusses the impact of Fresnel zone obstructions and multipath effects on radio frequency propagation and reports an optimal antenna and system configuration. Many of the lessons learned in the longwall case are immediately applicable to other underground mining operations, particularly wherever there is a high degree of obstruction from mining equipment

Significant pulmonary valve incompetence following oversize balloon pulmonary valveplasty in small infants: A long-term follow-up study.

Oversized dilatation balloons are recommended for relief of valvar pulmonic stenosis in infants and children during cardiac catheterization. Little information exists about the long-term outcome of this practice. Six of 107 consecutive patients undergoing balloon pulmonary valveplasty developed increasing pulmonary valve incompetence during follow-up periods of 0.5-10 years (mean, 7.2 years). Secondary right ventricular dilatation prompted insertion of a bioprosthetic pulmonary valve in one patient 6.8 years after intervention; valve replacement is pending in two additional patients, 4.3 and 10 years after intervention, respectively; and the three remaining subjects are thought likely to require valve replacement during childhood. The six reported subjects differ from the pulmonary valveplasty group as a whole in that they are younger (median age, 3 days vs. 11 months), had a higher degree of obstruction (right/left ventricular systolic pressure ratio prior to valveplasty 1.28 vs. 0.92), and underwent dilatation with relatively oversized balloons (balloon diameter to pulmonary valve annulus ratio 1.44 vs. 1.08). The balloon diameter to valve annulus ratio did not exceed 1.5 in any subject. Caution is advised in the use of oversized dilatation balloons in neonates or young infants with severe or critical pulmonic stenosis. Long-term consequences of substantial pulmonary valve incompetence outweigh, in our opinion, the limited gradient relief achieved with smaller balloons, sometimes requiring a second dilatation of the valve at an older age and larger size. Cathet. Cardiovasc. Intervent. 48:61-65, 1999.

Surgical Treatment of Anterior Septal Deviations

Anterior septal deviations are very difficult to handle because their location causes valvular obstruction, and any small residual deviation can cause a high degree of obstruction. The commonly performed submucous resection is not a suitable technique to handle this deformity. The maxilla-premaxilla technique offers a better approach. The surgical technique for anterior septal deviation differs from the standard septoplasty in several steps. A modified technique to treat this particular pathology is described in detail. This technique is highly reliable, and simplifies the access to a difficult-to-handle deformity.

Unenhanced helical CT of ureterolithiasis: value of the tissue rim sign.

The tissue rim sign-a rim or halo of soft-tissue attenuation seen around the circumference of an intraureteral calculus on unenhanced axial CT-has been described as useful in differentiating ureteral calculi from extraurinary abdominal or pelvic calcifications. The purpose of this study was to determine the prevalence of the tissue rim sign in patients with ureterolithiasis and extraurinary calcifications and to determine the relationship between the tissue rim sign, the size of a calculus, and the degree of urinary obstruction. Unenhanced helical CT studies followed by excretory urography were obtained in 59 patients with suspected acute ureterolithiasis. Each calcification along the expected course of the ureter seen on axial CT scans was categorized as a ureteral calculus or as an extraurinary calcification. Each categorization was based on CT, urographic, and clinical findings and the presence or absence of a tissue rim sign. When the outer wall of the ureter could not be seen because there was no clear fat plane at the level of the calcification on CT, the sign was categorized as "indeterminate." The size of the calculus was measured on CT, and the degree of urinary obstruction was estimated on the basis of the urograms. Thirty-two patients each had a single ureteral calculus. Of these patients, CT revealed a positive tissue rim sign in 16 patients (50%), was negative in five patients (16%), and was indeterminate in 11 patients (34%). In addition, we saw 57 extraurinary calcifications in 18 patients (11 patients with ureteral calculi and seven patients without ureteral calculi). None of the 57 extraurinary calcifications was associated with a positive tissue rim sign. The tissue rim sign was negative in 39 (68%) of the 57 extraurinary calcifications and indeterminate in the remaining 18 (32%). Ureteral calculi with a negative tissue rim sign were larger than ureteral calculi with a positive tissue rim sign (p < .01). A high degree of obstruction was present in four of five patients with ureteral calculi for which CT showed a negative tissue rim sign. Conversely, six of 16 patients in whom CT revealed a positive tissue rim sign also had a high degree of obstruction. Therefore, no clear relationship was found between the degree of obstruction and the presence of a positive tissue rim sign. A positive tissue rim sign is specific for the diagnosis of ureterolithiasis. However, a negative tissue rim sign does not preclude such a diagnosis. The presence or absence of this tissue rim sign correlates with the size of a calculus but not with the degree of urinary obstruction. When CT reveals an indeterminate tissue rim sign, careful inspection for other CT findings, such as ipsilateral ureteral dilatation, perinephric edema, dilatation of the intrarenal collecting system, and renal swelling, is necessary.

Primary localized amyloidosis of urethra

Abstract A case is presented of distal urethral obstruction caused by localized amyloidosis. Because of the high degree of obstruction, internal urethrotomy was performed and followed by topical application of dimethyl sulfoxide.

Cold air challenge of airway hyperreactivity in children: Dose-response interrelation with a reaction plateau

A previous study of cold air challenge (CACh) in children with asthma produced indirect evidence for the existence of a reaction plateau. To examine directly this phenomenon, 17 children, mean age 13 1/2 years, were challenged by isocapnic hyperventilation with -10 degrees C air at 75% of maximal voluntary ventilation for 10 minutes (extended CACh [ECACh]). Each minute FEV1 and maximum expiratory flow at 25% remaining vital capacity (V25) were measured. During "recovery" these measurements were repeated every minute for 10 minutes. Analysis of the cumulative dose-response curves constructed from the measurements revealed that a reaction plateau was reached in the last minutes of the challenge by both functions in each child. Induced changes in absolute terms were similar for both functions (FEV1: -28 +/- 12% predicted; V25: -29 +/- 17% predicted), but V25 started at a lower baseline (FEV1: 81 +/- 15% predicted; V25: 48 +/- 27% predicted) and thus arrived at a higher degree of obstruction (FEV1: 53 +/- 19% predicted; V25: 19 +/- 13% predicted). Together with the reaction plateau developing faster for V25, this indicated a dose-response influenced by baseline small airway obstruction. Although the size of the reaction differed from one child to the other (FEV1: -5% to -50% predicted; V25: -4% to -77% predicted), interindividual variability in the development of the reaction decreased toward the end of the challenge and was minimal at the plateau and in the early minutes of "recovery."(ABSTRACT TRUNCATED AT 250 WORDS)

Experience with intracoronary streptokinase in 36 patients with acute evolving myocardial infarction.

Acute angiography was performed in 36 consecutive patients with evolving myocardial infarction admitted within 3 h after onset of symptoms. No fatal complication occurred. Angiography revealed a total occlusion in 32 patients (89%), a subtotal stenosis in three (8%), and a 90% stenosis in one patient (3%). Anterior infarction was exclusively related to left anterior descending, and inferior infarction to right coronary or circumflex obstruction. After identification of the ‘infarct-vessel’, nifedipine 10 mg was administered sublingually. In no patient was anterograde flow affected with this treatment. In 35 patients an attempt to lyse clot was made with intracoronary streptokinase; an infusion of 2000–4000 U/min, preceded by a bolus of 10 000–20 000 U was infused into the ‘infarct-vessel’. In 26 patients (74%) reperfusion was achieved, two combined with guidewire perforation. The mean duration of onset of symptoms to reperfusion was 3.6 h (range 1.8–5.6). The mean duration of lysis was 1.2 h (range 0.3–3), and the mean dosage of streptokinase was 200 000 U (50 000–400 000 U]. In 25 out of 26 patients (96%) a high degree of obstruction remained immediately after lysis and at repeat angiography 6–8 weeks after the acute event. Despite treatment with aspirin 200 mg daily and nifedipine 30 mg daily four re-occlusions occurred. Coronary bypass surgery was performed electively in five patients. Thus, we conclude that in patients with evolving myocardial infarction, the infarct-vessel can be recanalized in 74% of patients by intracoronary streptokinase. The true benefit of this treatment must await a controlled study.