Double discharge feasibility summary report

Acceleration of rocket propellant by double electric discharge

A study to compare continuous epidural infusion and intermittent bolus of bupivacaine for postoperative analgesia following renal surgery

Background: Extradural administration of local anaesthetics, opioids or a combination of both is now a well-established technique for managing postoperative pain following upper abdominal, pelvic and thoracic procedures or orthopaedic procedures on the lower extremities. There are two techniques of administration of drugs via epidural catheter – one isby continuous infusion and the other is by intermittent boluses. At present there is controversy in the literature regarding the analgesic effects of the techniques.Methods: This study was conducted in a prospective, randomised manner on 60 patients of either sex of ASA class I or II, scheduled to undergo elective renal surgery. The general anaesthetic technique was standardised. The patients were divided randomly into two groups of 30 each. The patients in group 1 received a continuous infusion of 0.166% bupivacaine, while the patients in group 2 received intermittent boluses through epidural catheter. The efficacy of postoperative analgesia was assessed using pulmonary function tests up to 12 hours. The generated data were analysed statistically.Results: There were no significant changes in pulse rate and arterial pressure at different time intervals from the preoperative values. Respiratory rates in both the groups were found to be significantly higher than the preoperative values in the two groups (p < 0.05). Forced vital capacity (FVC) and peak exploratory flow rate (PEFR) were significantly lower than the preoperative values at all points in time in both groups, but the drop was greater in group 2 and pain scores on movement were also found to be significantly higher than those in group 1 at the times when the effect of the bupivacaine bolus was wearing off (p < 0.05). Pain scores at rest were found to be comparable in both groups postoperatively.Conclusions: We conclude that continuous infusion of bupivacaine (8.3 mg/h) provides better analgesia at rest and on movement than intermittent boluses, and is not associated with fluctuations in the level of analgesia. Incidences of adverse effects are similar and not insignificant with both schedules

Coeliac Plexus Neurolysis for Upper Abdominal Malignancies Using an Anterior Approach: Review of the Literature

Background: Coeliac plexus neurolysis (CPN) helps to diminish pain arising from malignancy of upper abdominal viscera. Imaging modalities have increased the success rates by enhancing technical accuracy including fluoroscopy, computed tomography and ultrasound. Advancement in the imaging modalities used has helped in the accurate depiction of anatomy and position of the needle tip.Methods: In an anterior approach, the patient lies supine and the needle is inserted through the anterior abdominal wall into the retropancreatic space. The needle often traverses the stomach, liver or pancreas before reaching the coeliac plexus due to anatomical considerations. The literature has been reviewed regarding various imaging modalities using an anterior approach to coeliac plexus block with regard to success rate, improvement in pain scores, duration of pain relief and analgesic consumption.Results: Successful pain relief in abdominal malignancies with an anterior approach using various imaging modalities varies between 54% and 94% of patients. Following neurolysis, many patients can be weaned off opioids. This procedure improves quality of life and reduces the risk of drug-related side effects. The duration of pain relief after an anterior approach is six to eight weeks.Conclusion: The use of various imaging modalities in an anterior approach has improved the technical accuracy in reaching the coeliac plexus, thereby avoiding the needle piercing crucial structures and avoiding deposition of drug in the retrocrural space, thereby reducing the risk of neurological complications. Coeliac plexus neurolysis via an anterior approach using different imaging modalities does not completely abolish pain, rather it diminishes pain, helping to reduce opioid requirements and improving survival in patients with upper abdominal malignancy.Keywords: Coeliac Plexus, Coeliac Plexus Block, Imaging Modalities, Neurolytic Techniques, Pancreatic Pain, Upper Abdominal Malignanc

Mediastinitis after oesophagoscopy: A case report

A 50-year-old male presented with signs and symptoms of oesophageal perforation after a biopsy. Suggestive symptoms and signs were pain in the neck radiating to the back, a rise in temperature and pulse, emphysema in the neck and widening of the mediastinum or a pneumothorax revealed by a chest X-ray. He survived with medical managemen

Addition of adenosine to hyperbaric bupivacaine in spinal anaesthesia does not prolong postoperative analgesia in vaginal hysterectomy

Background: Systemic administration of adenosine produces anti-nociception. Although literature supports intrathecal adenosine for neuropathic pain, its efficacy in postoperative pain remains unproven. There has been no study on the efficacy of adenosine on postoperative pain when administered with hyperbaric bupivacaine. The aim of our present study was to evaluate the efficacy of two different doses of intrathecal adenosine as an adjunct to 0.5% hyperbaric bupivacaine in patients undergoing vaginal hysterectomy under spinal anaesthesia. Method: Seventy-five women, aged 40-60 years and scheduled for vaginal hysterectomy under spinal anaesthesia, were included. Patients were allocated to three groups of 25 patients each to receive 500 &mu;g adenosine (group I), 1000 &mu;g adenosine (group II) and normal saline (group III) with 2.6 ml of 0.5% hyperbaric bupivacaine. Postoperative analgesia was provided with patient-controlled fentanyl. Time of administration of rescue analgesia and total dose of fentanyl were recorded. The times to full recovery of sensory and motor block were noted. Results: There were no differences in time to rescue analgesia and postoperative fentanyl consumption over 24 hours among the groups. There was no significant difference in onset of sensory and motor block or regression of sensory block, although statistically significant difference was noted in the time taken for regression of motor block. Conclusion: Intrathecal adenosine does not affect the postoperative analgesic requirement when administered with hyperbaric bupivacaine.Keywords: spinal anaesthesia, intrathecal adenosine, vaginal hysterectomy,postoperative analgesia, patient-controlled analgesi

Gorlin Goltz syndrome: a rare case report

Gorlin-Goltz syndrome is uncommon multisystemic disease with an autosomal dominant trait, with complete penetrance and variable expressivity, though sporadic cases have been described. We report a case of 18 years old male patient having features of Gorlin Goltz syndrome. Gorlin-Goltz syndrome is characterized by multiple basal cell nevi or carcinomas, odontogenic keratocysts, palmar and/or plantar pits, calcification of the falx cerebri, and is associated with internal malignancies. It is important to know the major and minor criteria for the diagnosis and early preventive treatment of this syndrome

Nonlinear dynamics and transport driven by energetic particle instabilities using a gyro-Landau closure model

Energetic particle (EP) destabilized Alfvén eigenmode (AE) instabilities are simulated for a DIII-D experimental case with a pulsed neutral beam using a gyro-Landau moments model which introduces EP phase-mixing effects through closure relations. This provides a computationally efficient reduced model which is applied here in the nonlinear regime over timescales that would be difficult to address with more complete models. The long timescale nonlinear evolution and related collective transport losses are examined including the effects of zonal flow/current generation, nonlinear energy cascades, and EP profile flattening. The model predicts frequencies and mode structures that are consistent with experimental observations. These calculations address issues that have not been considered in previous modelling: The EP critical gradient profile evolution in the presence of zonal flows/currents, and the dynamical nature of the saturated state. A strong level of intermittency is present in the predicted instability-driven transport; this is connected to the zonal flow growth and decay cycles and nonlinear energy transfers. Simulation of intermittent AE-enhanced EP transport will be an important issue for the protection of plasma facing components in the next generation of fusion devices.This material is based upon work supported by the US Department of Energy, Office of Science using the DIII-D National Fusion Facility, a DOE Office of Science user facility, under Awards DE-AC05-00OR22725, DE-FC02-04ER54698, and the US DOE SciDAC ISEP Center. Support is also acknowledged from project 2019-T1/AMB-13648 founded by the Comunidad de Madrid and Comunidad de Madrid (Spain)&#8212;multiannual agreement with UC3M Excelencia para el Profesorado Universitario EPUC3M14 Fifth regional research plan 2016-2020. This research used resources of the National Energy Research Scientific Computing Center (NERSC), a US Department of Energy Office of Science User Facility located at Lawrence Berkeley National Laboratory, operated under Contract No. DE-AC02- 05CH11231. We would like to thank Matt Beidler of Oak Ridge National Laboratory for helpful suggestions on this manuscript