Cerebral monitoring with transcranial Doppler ultrasonography improves neurologic outcome during repairs of acute type A aortic dissection

ObjectiveNeurologic complications after repair of acute type A aortic dissection remain significant. The use of power M-mode transcranial Doppler monitoring to verify cerebral blood flow during these repairs might decrease cerebral ischemia by correcting malperfusion. The purpose of this study was to analyze the use of power M-mode transcranial Doppler monitoring during repairs of acute type A dissection with regard to neurologic outcome.MethodsWe performed a prospective study of patients undergoing repairs of acute type A aortic dissection. Repairs included profound hypothermic circulatory arrest and retrograde cerebral perfusion. Patients in whom transcranial Doppler monitoring was used to monitor cerebral blood flow and modify operative technique during repair (study group) were compared with those without monitoring and modification (control group).ResultsBetween September 2001 and October 2003, we repaired 56 cases of acute type A dissection. Power M-mode transcranial Doppler monitoring was used in 50% (28/56) of cases. Power M-mode transcranial Doppler monitoring altered operative cannulation and guided retrograde cerebral perfusion flow in 28.5% (8/28) and 78.6% (22/28) of cases, respectively. Two patients presented with preoperative stroke, one in each group. One operative death occurred in each group. In-hospital mortality and the occurrence of new stroke were not significantly different between the 2 groups. Temporary neurologic dysfunction occurred less often in the study group (14.8% [4/27] vs 51.8% [14/27], P = .008).ConclusionsIdentification of cerebral malperfusion requires cerebral monitoring. By ensuring cerebral blood flow by using power M-mode transcranial Doppler monitoring and correcting cerebral malperfusion by modifying operative technique, neurologic outcome was improved during repairs of acute type A aortic dissection

Chapter 10 - Industry

This chapter provides an update to developments on mitigation in the industry sector since the IPCC (Intergovernmental Panel on Climate Change) Fourth Assessment Report (AR4) (IPCC, 2007), but has much wider coverage. Industrial activities create all the physical products (e.g., cars, agricultural equipment, fertilizers, textiles, etc.) whose use delivers the final services that satisfy current human needs. Compared to the industry chapter in AR4, this chapter analyzes industrial activities over the whole supply chain, from extraction of primary materials (e.g., ores) or recycling (of waste materials), through product manufacturing, to the demand for the products and their services. It includes a discussion of trends in activity and emissions, options for mitigation (technology, practices, and behavioural aspects), estimates of the mitigation potentials of some of these options and related costs, co-benefits, risks and barriers to their deployment, as well as industry-specific policy instruments. Findings of integrated models (long-term mitigation pathways) are also presented and discussed from the sector perspective. In addition, at the end of the chapter, the hierarchy in waste management and mitigation opportunities are synthesized, covering key waste-related issues that appear across all chapters in the Working Group III contribution to the IPCC Fifth Assessment Report (AR5)

Recent Trends in Residential Energy Use in OECD Countries and their Impact on Carbon Dioxide Emissions: A Comparative Analysis of the Period 1973–1992

residential energy use, residential CO 2 emissions,

Carbon dioxide emission reduction scenarios in Mexico for year 2005: Industrial cogeneration and efficient lighting

CO 2emissions, CO 2mitigation costs, cogeneration, efficient lighting, Mexico,

Carbon Dioxide Emission Reduction Scenarios in Mexico for Year 2005: Industrial Cogeneration and Efficient Lighting

CO 2emissions, CO 2mitigation costs, cogeneration, efficient lighting, Mexico,