Onset Of Leak Research Articles

Status of Laparoscopic Sleeve Gastrectomy in China: A National Survey.

Laparoscopic sleeve gastrectomy (LSG) is a favorable bariatric procedure. This study evaluated the status of LSG in China. During the 4th International Forum of Bariatric and Metabolic Surgery in May 2016, Nanjing China, an on-the-spot questionnaire was filled out by 105 attending surgeons with experience of LSG. The feedback data was collected and analyzed. For preoperative preparations, surgeons preferred blood glucose control with insulin (61.0%), bowel cleaning (33.3%), and fasting and water deprivation (75.2%). For surgical techniques, surgeons preferred 36/38F bougie (86.7%), greater curvature mobilization with ultrasonic energy device (89.5%), direct transection of short gastric vessels (80%), antrum resection within 2-6cm to the pylorus (84.8%) with 4.8mm height stapler (72.4%), and 3.5mm for corpus (94.3%). Whole stapler-line reinforcement, gastric sleeve fixation, leaking test, and abdominal drainage were preferred by 48.6, 62.9, 39, and 47.6% surgeons. For postoperative managements, surgeons preferred nasogastric tube insertion (33.3%), early liquid diet (69.6%), 4weeks of liquid diet (55.2%), 2000ml daily water intake before discharge (79%), 4weeks of PPI (69.5%), and multi-vitamin supplementation 1 week after operation (77.1%). For postoperative complications, preferences were tachycardia as the onset of leak (81.0%) and oral contrast radiography for leak diagnosis (72.4%). Leak managements include US-guided percutaneous drainage (68.6%), nasogastric tube (87.6%), and parenteral nutrition (61%). For prolonged leak, enteral nutrition (87.6%) and Roux-en-Y bypass (84.8%) as the salvage procedure were preferred. 95.2% preferred endoscopic dilation for stricture. LSG is gaining its wide application in China, but standardization of LSG is urgently needed.

The detection of flaws in optoelectronic systems

Potentially dangerous spots (PDSs), for example, leaks in product pipelines (oil and gas pipelines), are revealed using optoelectronic systems (OESs) that are usually mounted on airborne vehicles (e.g., helicopters). Earlier, a relevant problem consisted of revealing the onset of leaks in PDSs; however, today it is necessary to detect the PDSs of leaks in order to prevent their development. The complexity of the problem is related to the fact that product pipelines are most often located near densely populated areas and near reservoirs with drinking water. The appearance of PDSs is usually characterized by deviations in the temperature and other physical parameters from standard values in small areas. The detection of such spots necessitates decreasing the flying height of an OES carrier. As a rule, this yields a deterioration of imaging quality and OES overheating, which decreases the efficiency of this PDS detection method. Conservative OES developers believe that a low imaging quality and OES overheating result from random flaws in the OES assembly. Contrary to this, it is shown that failures occur due to a deterministic flaw at the stage of designing drives for an OES platform.

Risk of Meningitis with Cerebrospinal Fluid Rhinorrhea

The annual risk of meningitis in unrepaired fistulas is widely quoted to be approximately 10% per annum. Our aim was to review our experience with cerebrospinal fluid (CSF) leaks and to calculate the overall risk and the annual incidence of meningitis, and to correlate our findings with the causation and the effect of operative intervention in a subgroup of patients who had a history of meningitis. We prospectively collected data on all patients referred with a CSF leak to our tertiary referral center over a 12-year period between 1994 and 2006. We had a follow-up rate of 91%. One hundred eleven patients had a proven leak on endoscopy, beta-2 transferrin, imaging, and/or fluorescein lumbar puncture. The accumulated duration of an active CSF leak in the cohort was 190 years. The total number of episodes of meningitis was 57 in 21 patients, giving an overall risk of developing meningitis of 19%, with an overall incidence of 0.3 episodes per year. There was a progressive reduction in the incidence of meningitis with time, and most episodes occurred within the first year following the onset of the CSF leak. However, the risk persisted as long as the CSF leak was active. The overall risk of meningitis in patients with persistent CSF rhinorrhea was 19%. The annual incidence of meningitis was 0.3 episodes per year, with most episodes occurring within the first year following the onset of the leak. Endoscopic closure is the treatment of choice in most CSF leaks; if successful, it reduces the risk of meningitis.