scholarly journals O-EGS08 Endoluminal Vacuum Therapy (EVT) for leaks in the upper gastrointestinal (UGI) tract; 10-years’ experience in a specialist Oesphagogastric centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Zeeshan Afzal ◽  
Stavros Gourgiotis ◽  
Richard Hardwick ◽  
Peter Safranek ◽  
Vijayendran Sujendran ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Length Of Hospital Stay ◽  
Median Number ◽  
Apache Ii Score ◽  
Vacuum Therapy ◽  
Delayed Presentation ◽  
Vacuum Device ◽  
Wide Range ◽  
Open Cell Foam ◽  
Successful Resolution

Abstract Background Endoluminal vacuum therapy (EVT) is an emerging treatment strategy for UGI leaks. When compared to traditional treatments strategies EVT is reported to reduce morbidity and mortality, especially in patients with delayed presentation and established sepsis. We report the outcomes for patients with UGI leaks and perforations treated with EVT using an ad-hoc endoluminal vacuum device (EVD) in a tertiary UK hospital over a 10-year period. Methods Sixty-seven patients with UGI leaks from disparate causes were treated with EVT between April 2011 and July 2021. The ad-hoc EVD was constructed using a piece of open cell foam sutured around the distal end of a nasogastric tube, and placed endoscopically either through the perforation and into the extra-luminal leak cavity OR intraluminally depending on the morphology of the leak cavity. Continuous negative pressure (125mmHg) was applied. Endoscopic re-evaluation of the leak cavity with change of EVD was performed every 48-120 hours depending on the patients clinical condition. Information related to treatment and outcome was recorded prospectively. Results Patients had a median age of 66 years (range 23-92), and median Apache II score of 21 (range 4-36) at presentation. Fifty-two leaks were oesophageal (78%), 12 gastric (18%), 2 duodenal (3%), and 1 pharangeal (1%). The leak cause was anastomotic in 26 (39%), iatrogenic in 20 (30%), spontaneous in 19 (28%), and traumatic in 2 (3%). The median number of EVD changes required to heal the leak was 6 (range 1-27), and median length of hospital stay was 42 days (range 1-182). Successful resolution of the leak was achieved in 59 patients (88%). Eight (12%) patients died during treatment. There were no complications related to insertion of the EVD. Conclusions EVT is an effective treatment for UGI leaks which can be delivered safely in a tertiary oesophagogastric centre, and used to treat a wide range of leak causes in critically unwell patients. Further studies are required to develop a standardized procedure to improve the ease with which EVT can be delivered. This will enable broader adoption of EVT for this group of patients.

scholarly journals 698 ENDOLUMINAL VACUUM THERAPY (EVT) AS A TREATMENT FOR ESOPHAGEAL LEAKS; 10-YEARS’ EXPERIENCE FROM A TERTIARY UK ESPHAGOGASTRIC CENTRE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Zeeshan Afzal ◽  
Stavros Gourgiotis ◽  
Richard Hardwick ◽  
Peter Safranek ◽  
Vijay Sujendran ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Length Of Hospital Stay ◽  
Median Number ◽  
Apache Ii Score ◽  
Vacuum Therapy ◽  
Delayed Presentation ◽  
Median Length ◽  
Vacuum Device ◽  
Successful Resolution ◽  
Management Challenge

Abstract   Esophageal leaks present a significant management challenge, especially in patients with delayed presentation and established sepsis. Endoluminal vacuum therapy (EVT) is an emerging treatment strategy which may reduce morbidity and mortality compared to traditional treatments in this patient group. We report the outcomes for patients with esophageal leaks from a range of different causes that were treated with EVT in a tertiary UK hospital over a 10-year period. Methods Between April 2011 and March 2021, 45 patients with a median age of 67 years (31–92) who had an esophageal leak were treated with EVT. All patients were treated with an ad-hoc endoluminal vacuum device (EVD) constructed using V.A.C GRANUFOAMTM (KCI) and a standard nasogastric (Ryles) tube. The median Apache II score for patients at the time of leak diagnosis was 20 (6–36). The cause of the leak was anastomotic in 16 patients (36%), iatrogenic in 14 patients (31%), spontaneous in 14 patients (31%), and traumatic in 1 patient (2%). Information related to treatment and outcome was recorded prospectively. Results Successful resolution of the leak was achieved in 39 (87%) patients. The median number of EVD changes required to heal the leak was 6 (1–17). There were no complications related to insertion of the EVD. The median length of hospital stay was 49 days (1–108). Six (13%) patients died during treatment. Six (13%) patients had complications during treatment requiring further intervention; 2 (4%) had a significant bleed requiring angiography and aortic stent placement, 1 (2%) had a stroke, 1 (2%) had a pulmonary embolism, 1 (2%) had a myocardial infarction, and 1 (2%) contracted COVID-19. Conclusion EVT is a safe and effective treatment that can be used successfully to treat esophageal leaks from a disparate range of leak causes in selected critically unwell patients. Further studies are required to develop a standardized procedure and management pathway which will enable broader adoption of EVT in this group of patients.

scholarly journals P-EGS19 Complete oesophageal transection during thyroidectomy; Successful management of anastomotic leak using endoluminal vacuum therapy (EVT) following failed primary repair

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Zeeshan Afzal ◽  
Stavros Gourgiotis ◽  
Richard Hardwick ◽  
Peter Safranek ◽  
Vijayendran Sujendran ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Anastomotic Leak ◽  
Ad Hoc ◽  
Primary Repair ◽  
Organ Support ◽  
Vacuum Therapy ◽  
Team Approach ◽  
Cervical Oesophagus ◽  
Complete Transection ◽  
Wide Range

Abstract Background Perforation of the cervical oesophagus is an extremely rare but recognised complication of thyroidectomy. As with all oesophageal perforations management depends on timing of diagnosis in relation to the timing of injury, the size of the oesophageal wall defect, extent of extraluminal contamination, and how unwell the patient is with respect to sepsis. We report a case of complete transection of the cervical oesophagus during total thyroidectomy and its subsequent management. Methods A previously well 32-year-old female had a complete cervical oesophageal transection during total thyroidectomy and neck dissection for papillary carcinoma of thyroid. This was recognised by her ENT surgeon who repaired the oesophagus primarily. Subsequently, she developed sepsis with cellulitis of her anterior chest wall. Cross-sectional imaging demonstrated a leak at the site of the cervical oesophageal repair. Gastroscopy confirmed a 50% dehiscence of the oesophageal anastomosis. Control and management of her oesophageal leak was achieved with EVT delivered using an ad-hoc endoluminal vacuum device (EVD) constructed from open cell foam sutured around the distal end of a nasogastric tube. Results The patient was managed in the intensive care unit (ICU) with appropriate organ support and antimicrobial cover. A surgical jejunostomy was placed to facilitate enteral feeding. EVT was delivered using the ad-hoc EVD which was placed endoscopically and situated intraluminally across the anastomotic leak site. Continuous negative pressure (125 mmHg) was applied. Six EVD changes were required to heal the leak. Her total length of stay was 41 days, of which 38 days were in ICU. There were no periprocedural complications related to using the EVD or EVT, although the patient subsequently developed an oesophageal stricture which required endoscopic dilatation. Conclusions Accidental complete transection of the cervical oesophagus is extremely rare. This case highlights the importance of a multidisciplinary team approach for managing such cases. EVT is an emerging treatment option for upper gastrointestinal (UGI) leaks and is reported to be safe and effective for leaks from a wide range of causes throughout the UGI tract.  Successful resolution of the oesophageal leak in this unusual case demonstrates the utility of EVT in difficult clinical situations which may otherwise pose a formidable management challenge using traditional treatment strategies.

scholarly journals The Cryptographic Complexity of Anonymous Coins: A Systematic Exploration

Cryptography ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Niluka Amarasinghe ◽  
Xavier Boyen ◽  
Matthew McKague
Keyword(s):  
Ad Hoc ◽  
Significant Rise ◽  
Security Models ◽  
Systematic Exploration ◽  
Wide Range ◽  
Distributed Transaction ◽  
Common Framework

The modern financial world has seen a significant rise in the use of cryptocurrencies in recent years, partly due to the convincing lure of anonymity promised by these schemes. Bitcoin, despite being considered as the most widespread among all, is claimed to have significant lapses in relation to its anonymity. Unfortunately, studies have shown that many cryptocurrency transactions can be traced back to their corresponding participants through the analysis of publicly available data, to which the cryptographic community has responded by proposing new constructions with improved anonymity claims. Nevertheless, the absence of a common metric for evaluating the level of anonymity achieved by these schemes has led to numerous disparate ad hoc anonymity definitions, making comparisons difficult. The multitude of these notions also hints at the surprising complexity of the overall anonymity landscape. In this study, we introduce such a common framework to evaluate the nature and extent of anonymity in (crypto) currencies and distributed transaction systems, thereby enabling one to make meaningful comparisons irrespective of their implementation. Accordingly, our work lays the foundation for formalizing security models and terminology across a wide range of anonymity notions referenced in the literature, while showing how “anonymity” itself is a surprisingly nuanced concept, as opposed to existing claims that are drawn upon at a higher level, thus missing out on the elemental factors underpinning anonymity.

Quantitative Content Analysis of the United Nations Seabed Debate: Methodology and a Continental Shelf Case Study

1970 ◽  
Vol 24 (3) ◽  
pp. 479-502 ◽  
Author(s):  
R. L. Friedheim ◽  
J. B. Kadane
Keyword(s):  
United Nations ◽  
Continental Shelf ◽  
Ad Hoc ◽  
Mineral Resources ◽  
Outer Edge ◽  
General Assembly ◽  
Wide Range ◽  
The Subject ◽  
The United Nations

International arrangements for the uses of the ocean have been the subject of long debate within the United Nations since a speech made by Ambassador Arvid Pardo of Malta before the General Assembly in 1967. Issues in question include the method of delimiting the outer edge of the legal continental shelf; the spectrum of ocean arms control possibilities; proposals to create a declaration of principles governing the exploration for, and the exploitation of, seabed mineral resources with the promise that exploitation take place only if it “benefits mankind as a whole,” especially the developing states; and consideration of schemes to create international machinery to regulate, license, or own the resources of the seabed and subsoil. The discussions and debates began in the First (Political and Security) Committee of the 22nd General Assembly and proceeded through an ad hoc committee to the 23rd and 24th assembly plenary sessions. The creation of a permanent committee on the seabed as a part of the General Assembly's machinery attests to the importance members of the United Nations attribute to ocean problems. Having established the committee, they will be faced soon with the necessity of reaching decisions. The 24th General Assembly, for example, passed a resolution requesting the Secretary-General to ascertain members' attitudes on the convening of a new international conference to deal with a wide range of law of the sea problems.

Bilateral Nervus Intermedius Sectioning for Geniculate Neuralgia: Case Report and Operative Video

2021 ◽  
Author(s):  
Keaton Piper ◽  
Qizhi Victoria Zheng ◽  
Robert S Heller ◽  
Siviero Agazzi
Keyword(s):  
Side Effects ◽  
Microvascular Decompression ◽  
Treatment Options ◽  
Rare Condition ◽  
Contralateral Side ◽  
Wide Range ◽  
Successful Resolution ◽  
Surgical Options ◽  
Vascular Loop ◽  
Nervus Intermedius

Abstract BACKGROUND AND IMPORTANCE Geniculate neuralgia is a rare condition characterized by excruciating ear pain. Surgical options for geniculate neuralgia include microvascular decompression and sectioning of the nervus intermedius. We report herein a case of bilateral geniculate neuralgia treated by nervus intermedius sectioning without prior microvascular decompression. To our knowledge, this is the first report of this treatment strategy with a subsequent description of the side effects of bilateral nervus intermedius disruption. CLINICAL PRESENTATION A 54-yr-old woman presented with bilateral geniculate neuralgia, worse on the left, refractory to medical therapy. Surgical treatment options were reviewed, including microvascular decompression and sectioning of the nervus intermedius. She opted for left nervus intermedius sectioning. The procedure was uncomplicated and no compressive vascular loop was identified during surgery. Postoperatively, she had complete symptom resolution with no discernable side effects. Three years later, the patient developed worsening geniculate neuralgia on the contralateral side. After the discussion of treatment options, she opted again for sectioning of the contralateral nervus intermedius with successful resolution of all symptoms after surgery. Following surgery, the patient identified partial impairment of lacrimation and gustation. She continued to have functional taste of the anterior two-thirds of the tongue, lacrimation, and hearing bilaterally. CONCLUSION Bilateral sectioning of nervus intermedius may provide benefit in patients with bilateral geniculate neuralgia without egregious side effects. However, lacrimatory and gustatory alterations are a potentially significant side effect with a wide range of symptomatology.

scholarly journals Validation of modeled snow properties in Afghanistan, Pakistan, and Tajikistan

2019 ◽  
Author(s):  
Edward H. Bair ◽  
Karl Rittger ◽  
Jawairia A. Ahmad ◽  
Doug Chabot
Keyword(s):  
Snow Depth ◽  
Snow Water Equivalent ◽  
Median Number ◽  
In Situ Measurements ◽  
Snow Properties ◽  
Wide Range ◽  
Spatial Estimates ◽  
Snow Water ◽  
Critical Layers

Abstract. Ice and snowmelt feed the Indus and Amu Darya rivers, yet there are limited in situ measurements of these resources. Previous work in the region has shown promise using snow water equivalent (SWE) reconstruction, which requires no in situ measurements, but validation has been a problem until recently when we were provided with daily manual snow depth measurements from Afghanistan, Tajikistan, and Pakistan by the Aga Khan Agency for Habitat (AKAH). For each station, accumulated precipitation and SWE were derived from snow depth using the SNOWPACK model. High-resolution (500 m) reconstructed SWE estimates from the ParBal model were then compared to the modeled SWE at the stations. The Alpine3D model was then used to create spatial estimates at 25 km to compare with estimates from other snow models. Additionally, the coupled SNOWPACK and Alpine3D system has the advantage of simulating snow profiles, which provide stability information. Following previous work, the median number of critical layers and percentage of facets across all of the pixels containing the AKAH stations was computed. For SWE at the point scale, the reconstructed estimates showed a bias of −42 mm (−19 %) at the peak. For the coarser spatial SWE estimates, the various models showed a wide range, with reconstruction being on the lower end. For stratigraphy, a heavily faceted snowpack is observed in both years, but 2018, a dry year, according to most of the models, showed more critical layers that persisted for a longer period.

scholarly journals A Framework for Secure Data Acquisition In VANET

2021 ◽  
Vol 9 (9) ◽  
pp. 1139-1143
Author(s):  
Dr. B. Balakumar
Keyword(s):  
Data Acquisition ◽  
Ad Hoc Network ◽  
Traffic Management ◽  
Ad Hoc ◽  
Safety Information ◽  
Mobile Network ◽  
Vehicular Ad Hoc Network ◽  
Real Time Traffic ◽  
Wide Range ◽  
Types Of Information

Abstract: Recent advances in software, hardware communication technologies are enabling the design and implementation of whole range of different type of network that are various environments. Vehicular Ad-Hoc network is received a lot of interest in the couple years in the one of the networks. A Vehicular Ad-Hoc Network or VANET is a technology that uses moving cars as nodes in a network to create a mobile network. In VANET improving the driving comfort and safety information message are broadcasted regularly. VANET turns every participating car approximately 100 to 300 meters to connect and turn create network with a wide range. In enable vehicle to communicate which other with roadside units (RSUs). Vehicular network are special types of VANET that supported infrastructure based real time traffic management, including internet access, video streaming and content distribution. Privacy - preserving data Acquisition and forwarding scheme by introducing the novel cryptographic algorithm for key generation and powerful encryption. This paper introduces system that takes Advantages of the RSUs that are the connected to the internet provide various types of information to VANET users. Keywords: VANET, RSU, Ad-Hoc Network, URE, ITS

scholarly journals Syndrome of inappropriate secretion of antidiuretic hormone in the practice of endocrinologist

2021 ◽  
Vol 14 (3) ◽  
pp. 4-12
Author(s):  
Agunda V. Dzagaxova ◽  
Nino N. Katamadze ◽  
Ekaterina A. Pigarova
Keyword(s):  
Clinical Practice ◽  
Antidiuretic Hormone ◽  
Clinical Guidelines ◽  
Length Of Hospital Stay ◽  
Interdisciplinary Approach ◽  
Electrolyte Balance ◽  
Electrolyte Disorders ◽  
Inappropriate Secretion ◽  
Wide Range ◽  
Water And Electrolyte Balance

Hyponatremia is the most common disorder of water and electrolyte balance encountered in clinical practice. Conditions associated with hyponatremia require hospitalization in 15–20% of cases. Hyponatremia is a predictor of poor outcome in a wide range of diseases and therefore requires an interdisciplinary approach. This problem leads to an increase in complications and the length of hospital stay and mortality. The review focuses on the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which accounts for approximately one third of all cases of hyponatremia and is more common in endocrinology than other fluid and electrolyte disorders along with central diabetes insipidus. The article presents modern approaches to the treatment of SIADH based on international clinical guidelines.

scholarly journals Monitoring System-Based Flying IoT in Public Health and Sports Using Ant-Enabled Energy-Aware Routing

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Inam Ullah Khan ◽  
Muhammad Abul Hassan ◽  
Mohammad Dahman Alshehri ◽  
Mohammed Abdulaziz Ikram ◽  
Hasan J. Alyamani ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Residual Energy ◽  
Base Station ◽  
Rapid Decline ◽  
Energy Aware ◽  
Remote Communication ◽  
Aerial Vehicles ◽  
Wide Range ◽  
Hoc Networks ◽  
High Level

In recent decades, the Internet of flying networks has made significant progress. Several aerial vehicles communicate with one another to form flying ad hoc networks. Unmanned aerial vehicles perform a wide range of tasks that make life easier for humans. However, due to the high frequency of mobile flying vehicles, network problems such as packet loss, latency, and perhaps disrupted channel links arise, affecting data delivery. The use of UAV-enabled IoT in sports has changed the dynamics of tracking and working on player safety. WBAN can be merged with aerial vehicles to collect data regarding health and transfer it to a base station. Furthermore, the unbalanced energy usage of flying things will result in earlier mission failure and a rapid decline in network lifespan. This study describes the use of each UAV’s residual energy level to ensure a high level of safety using an ant-based routing technique called AntHocNet. In health care, the use of IoT-assisted aerial vehicles would increase operational performance, surveillance, and automation optimization to provide a smart application of flying IoT. Apart from that, aerial vehicles can be used in remote communication for treatment, medical equipment distribution, and telementoring. While comparing routing algorithms, simulation findings indicate that the proposed ant-based routing protocol is optimal.

Systematic bibliometric analysis on Kaizen in scientific journals

2018 ◽  
Vol 30 (4) ◽  
pp. 356-370 ◽  
Author(s):  
José Álvarez-García ◽  
Amador Durán-Sánchez ◽  
María de la Cruz del Río-Rama
Keyword(s):  
Ad Hoc ◽  
Bibliometric Study ◽  
Scientific Journals ◽  
Content Type ◽  
Current State ◽  
Wide Range ◽  
Depth Analysis ◽  
State Of Research ◽  
Japanese Companies ◽  
Specific Search

Purpose Since Masaaki Imai coined the term Kaizen in the mid-1980s, it has been seen as a key element for the competitiveness of Japanese companies, and it is currently a widely discussed philosophy and is applied in a wide range of organizations throughout the world. The purpose of this paper is to serve as guidance for researchers who are developing their studies in the field of the Kaizen philosophy, in order to improve their knowledge on the most relevant articles, the most productive authors or the key scientific journals that make up this subject. Design/methodology/approach In order to fulfill the proposed objective, a descriptive bibliometric study was carried out with the analysis of citations from 138 articles included in the multidisciplinary database Scopus (Elsevier) until 2016. For the search of documents, a tracking strategy was chosen that allowed for the development of the ad hoc database required to analyze each of the basic variables of the bibliometric indicators. Findings The results obtained show a growing interest of the scientific community in its study in the last decade, as shown by the significant increase in citations received by articles, despite the reduction in the number of papers published in the last two years. Research limitations/implications The main limitations are derived from the choice of a specific database, as well as the specific search equation. Originality/value The study presents an in-depth analysis of the current state of research regarding the Kaizen philosophy through its bibliometric study, providing useful information for academics and professionals by providing a series of significant indicators to measure the bibliographic material.

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