Temporary Prosthetic Shunt to Permanent Aortic Prosthesis in a Patient with an Infected Thoracoabdominal Aneurysm to Shorten Ischemia Time

High operative mortality of infected thoracoabdominal aortic aneurysms (ITAA) is partly attributable to ischemic injury during aortic clamping. We report a 62-year-old man with biliary cirrhosis, who developed a rapidly enlarging ITAA secondary to thoracolumbar osteomyelitis. Additional infectious foci were found in the pubic and ischial bones and in the left lung. Blood cultures gave growth of streptococcus pneumoniae. The aneurysm was repaired through a thoracoabdominal incision with a Dacron prosthesis. Prior to aneurysm repair, a prosthetic shunt was anastomosed end – to- side to the aortic prosthesis and to the descending aorta using a side-biting clamp. The shunt allowed perfusion of the lower body and of renal and visceral vessels after 45 minutes, the time needed to resect infected tissue and complete the distal anastomosis. The proximal anastomosis and orthopedic treatment of the spinal osteomyelitis could be performed, while the lower body and visceral organs were perfused. Postoperatively, the patient developed hypotension and increasing lactacidosis. Laparotomy revealed intestinal infarction, and gut resection was performed. Following a temporary improvement, he developed multiorgan failure and candida sepsis and died after 32 days. No atheroemboli were found in arteries of resected intestines. Portal hypertension most likely was present and it could be calculated that minimum intestinal perfusion pressure the night after the operation could have been in the range of 30-37 mm Hg, which probably was not enough to maintain aerobic metabolism. In the presence of aortic atheromas it may be advisable to divert blood to the shunt from an axillary artery

Temporary Prosthetic Shunt to Permanent Aortic Prosthesis in a Patient with an Infected Thoracoabdominal Aneurysm to Shorten Ischemia Time

High operative mortality of infected thoracoabdominal aortic aneurysms (ITAA) is partly attributable to ischemic injury during aortic clamping. We report a 62-year-old man with biliary cirrhosis, who developed a rapidly enlarging ITAA secondary to thoracolumbar osteomyelitis. Additional infectious foci were found in the pubic and ischial bones and in the left lung. Blood cultures gave growth of streptococcus pneumoniae. The aneurysm was repaired through a thoracoabdominal incision with a Dacron prosthesis. Prior to aneurysm repair, a prosthetic shunt was anastomosed end – to- side to the aortic prosthesis and to the descending aorta using a side-biting clamp. The shunt allowed perfusion of the lower body and of renal and visceral vessels after 45 minutes, the time needed to resect infected tissue and complete the distal anastomosis. The proximal anastomosis and orthopedic treatment of the spinal osteomyelitis could be performed, while the lower body and visceral organs were perfused. Postoperatively, the patient developed hypotension and increasing lactacidosis. Laparotomy revealed intestinal infarction, and gut resection was performed. Following a temporary improvement, he developed multiorgan failure and candida sepsis and died after 32 days. No atheroemboli were found in arteries of resected intestines. Portal hypertension most likely was present and it could be calculated that minimum intestinal perfusion pressure the night after the operation could have been in the range of 30-37 mm Hg, which probably was not enough to maintain aerobic metabolism. In the presence of aortic atheromas it may be advisable to divert blood to the shunt from an axillary artery.publishedVersio

Homocysteine Levels, Haemostatic Risk Factors and Patency Rates after Endovascular Treatment of the Above-Knee Femoro-Popliteal Artery

AbstractObjectives. To investigate the relationship between plasma homocysteine and other haemostatic variables and restenoses or reocclusions after endovascular treatment of symptomatic atherosclerosis of the above-knee femoro-popliteal artery.Design. Prospective observational study.Setting. University hospital.Patients and methods. The study included 103 patients (116 limbs), treated with subintimal angioplasty in 58 cases (50%) and with intraluminal PTA in 58 (50%): 39 (34%) patients were treated for critical limb ischaemia. Blood samples for analyses of fasting plasma values of homocysteine, fibrinogen, D-dimer, activated protein C resistance were drawn upon admission. Median follow-up for all procedures was 11 months (range 0–42 months). Outcome events (arterial patency) were defined as ≥50% restenosis or reocclusion in the treated arterial segment. Patency rates were estimated with the product limit method and Kaplan–Meier curves. Variables found to be related significantly to patency were included in multivariate analysis performed with the Cox proportional hazard model.Results. The 1-year cumulative primary patency rate for all procedures was 48%. One-year limb salvage rate in cases of critical ischaemia was 74%. Multivariate analysis demonstrated significant independent associations between patency rates and plasma D-dimer, diabetes mellitus, the nature of the lesion treated (stenosis vs. occlusion) and antithrombotic therapy with aspirin after the procedure. Plasma levels of homocysteine, fibrinogen or activated protein C resistance were not associated with patency rates. Homocysteine levels were higher in patients with critical limb ischaemia than those with intermittent claudication.Conclusions. Early restenosis or reocclusion after endovascular intervention of lesions in the above-knee femoro-popliteal artery was more frequent following treatment of occlusion (versus stenosis), for patients with diabetes, patients with elevated D-dimer and those without antithrombotic therapy after the procedure. Plasma homocysteine did not appear to influence the outcome of endovascular intervention

Å fortelle så folk leser - Reportasje med video og tekst

De siste ti årene har reportasjer bestående av tekst og video blitt stadig vanligere hos nettavisene. Samtidig mangler mediebransjen kunnskap om hvordan tekst og video kan kombineres i disse reportasjene slik at begge deler blir lest. Særlig strever bransjen med å få publikum til å se videoene. I denne praktisk-teoretiske oppgaven ønsker jeg å prøve å finne ut hvordan tekst og video kan kombineres i en multimediereportasje for å engasjere leseren slik at begge deler blir lest. Jeg ønsker altså å eksperimentere med ulike fortellermåter, noe mediebransjen kritiseres for ikke å gjøre. I denne oppgaven gir den praktiske delen meg mulighet til slik eksperimentering. Ved hjelp av litteratur om kombinasjon av video og tekst, struktur og narrativ virkning på publikum, har jeg laget to multimediereportasjer som på ulike måter kombinerer video og tekst. Disse to reportasjene har så blitt presentert for ti informanter som har vurdert disse. Informantenes utsagn ser ut til å bekrefte det mediebransjen peker på, nemlig at det kan være vanskelig å motivere publikum til å lese både tekst og video i samme reportasje. Studien min viser imidlertid ikke at det er video publikum har lite interesse for, men tekst. Det kan se ut som at video ikke motiverer publikum til å lese en påfølgende tekst. Samtidig ser tekst ut til å gi noe mer motivasjon for å se en påfølgende video. Det kan derfor synes best å starte multimediereportasjer med en tekst som setter reportasjen inn i en kontekst. Videre tyder studien min på at den påfølgende teksten, som for eksempel kan stå mellom korte videosekvenser, bør være kort, unnværlig og aller helst inneholde annen informasjon enn videoen. Dersom video – og tekstsekvensene gir en lyst og nysgjerrighet til å lese/se det som kommer etter, synes dette ut til å fungere best for å holde på leserens interesse gjennom en lang reportasje. Ellers kan det se ut som at en lineær hoveddel må til for å tilfredsstille det som kan synes som et innlært, eller biologisk behov, for å lese lineært. Dersom denne lineære delen kombineres med muligheten til å velge en egen vei gjennom materialet, kan dette av enkelte personer oppleves som en bonus, og reportasjen vil for disse få ekstra verdi. Avslutningsvis i denne oppgaven peker jeg på mulige veier videre for dem som måtte ønske å undersøke andre aspekter knyttet til multimediereportasjen

The Association between Physical Fitness, Body Composition and Bone Mineral Density among Female Athletes

Background: Research have suggested that endurance female athletes tend to have lower bone mineral density (BMD) than power and strength athletes, as a result of maintaining low body weight in addition to perform. This study intends to investigate the association between physical fitness by power and endurance measurements, body composition and BMD. In addition, it will address the differences in BMD measured in female football players, handball players and cross-country skiers. Methods: A cross-sectional study of 57 Norwegian female athletes aged between 18 and 36 years (mean age 22.6 years) was conducted. The sample consisted of 24 football players, 17 handball players and 16 cross-country skiers. For physical fitness examinations, a graded VO₂max (ml/kg/min) test on treadmill, squat jump on a power plate and bench press with free weights were conducted. Body weight and height was measured and BMI calculated from the aforementioned variables. Lean body mass, body fat percentage and BMD (g/cm²) was measured using Dual- Energy X-ray Absorptiometry. BMD was obtained from four different regions, in addition to total body BMD: Ward’s triangle, Trochanter, femoral neck and lumbar region (L1-L4). Results: Significant association between body composition and BMD was observed for all subjects combined. Also, significant associations between the physical fitness tests and BMD were obtained. Differences in body composition and physical fitness level among the athletes indicated that the cross-country skiers had lower body weight, BMI, lean body mass and body fat percentage. Cross-country skiers also had the highest mean oxygen consumption among the female athletes and also the lowest BMD in all regions. Handball players had higher mean body weight, BMI, lean body mass and fat percentage. Handball players also had the higher mean BMD values for all regions measured. Conclusion: Body composition was strongly associated with BMD in all regions measured. Subjects with high oxygen had lower BMD measurements in all regions while subjects with high muscular power in lower body had the highest BMD measurements in all regions. Also, differences in BMD between the three sports suggested that cross-country skiers have lower BMD values than both football players and handball players, in all regions measured. Keywords: Female athletes, physical fitness, body composition, bone mineral density (BMD)

Temporary Vascular Occlusion by Rapid Reverse Phase Polymer: A Preliminary In Vitro Study of Retrograde Injection

During vascular surgical operations, there is a need for a simpler and more reliable method of temporary arterial occlusion than those currently employed, especially of heavily calcified arteries. A thermosensitive polymer, LeGoo (LG) (Pluromed, Woburn, MA), has been used successfully for temporary vascular occlusion. It has hitherto been injected by a cannula that has been introduced into the artery to be occluded, here henceforth called the “cannulation method.” Injection into arterial ostia without cannulation, using an injection device that arrests blood flow during the injection, here henceforth called “a retrograde method” may enable temporary hemostasis when ostial stenoses render it impossible to inject LG using the cannulation method. The objective of the present study was to study the feasibility of a retrograde method and to compare it with the cannulation method in an in vitro model, incorporating a narrow orifice to simulate ostial stenosis, using tap water at 37°C instead of blood. The retrograde method of LG injection, using a modified paediatric Foley catheter, turned out to be feasible to produce a durable LG plug more reliably, at higher water pressure and with less deep LG injection than with the cannulation method

Bargaining Power in Hydro's Global Production Network. Implications of Path Dependence and Local Context in the Alunorte Crisis.

Dette kasusstudiet omhandlar gruveindustri. Alumina-fabrikken Alunorte i Barcarena i Nord-Brasil er ein del av Hydro sitt Globale Aluminium Produksjonsnettverk (aluminium-GPN). Etter ein kraftig regnskur i februar 2018, vart lokale innbyggjarar bekymra for utslepp av giftig rødslam frå Alunorte til omkringliggjande natur. I kontrast til tidlegare tilfelle av mistenkte utslepp, reagerte brasilianske myndigheiter umiddelbart, og innførte produksjonsembargo for Alunorte. Alunorte måtte redusere produksjonskapasiteten med femti prosent, noko som førte til store operasjonelle og økonomiske vanskar. Det tok nitten månader før alle embargo var oppheva. Denne forskinga er basert på dokument, og inneheld ei analyse av forhandlingsprosessen mellom myndigheitene og Hydro som fann stad etter hendinga i februar 2018. For å tilføre forklaringskraft, har eg anvendt stiavhengigheit (path dependence) i kombinasjon med GPN-teori. Difor er òg den lokale historia og konteksten i Barcarena ein del analysen. Resultata syner at GPN-konsepta territorialitet og forankring kan forklare kvifor forhandlingsmakta først favoriserte brasilianske myndigheiter. Vegen tilbake til normale operasjonar var langdryg og kostbar for Hydro, i kontrast til ei liknande, men meir alvorleg, sak om utslepp i 2009, då Vale var majoritetseigar i Alunorte. Hydro si makt var avgrensa av forankring, innlåsing (lock in) og irreversible kostnader (sunk costs). På den andre sida hadde myndigheitene fleire grunnar for å gjere dette til ein vanskeleg situasjon for Hydro. Utsleppa frå Alunorte braut gitte lisensar, noko som opna for moglegheita til å ta grep mot Hydro. Lokal kontekst og historie, kombinert med internasjonal politikk og nasjonalt val, inkludert personleg prestisje, var øydeleggjande for Hydro sine operasjonar i Pará. Nedarva tilstandar og manglande nettverksforankring forsterka dei negative konsekvensane for Hydro. Omsider synte det seg at ressursen arbeid endra forhandlingsposisjonen til Hydro. Alle embargoane var oppheva etter nitten månadar med økonomisk tap og skiftande forhandlingsmakt. Utfallet av forhandlingsprosessen var stiavhengig, understøtta av historie, arv, tidlegare hendingar og irreversible kostnadar, akkumulert over tid. Denne forskinga illustrerer kvifor stiavhengigheit kombinert med GPN er nyttig å anvende ved analyser av forhandlingsprosessar og forklaringsmekanismar