Middle Meningeal artery Embolization of Septated Chronic Subdural Hematomas

INTRODUCTION: Middle meningeal artery embolization (MMAE) has emerged as a promising new treatment for patients with chronic subdural hematomas (cSDH). Its efficacy, however, upon the subtype with a high rate of recurrence-septated cSDH-remains undetermined. METHODS: From our prospective registry of patients with cSDH treated with MMAE, we classified patients based on the presence or absence of septations. The primary outcome was the rate of recurrence of cSDH. Secondary outcomes included a reduction in cSDH thickness, midline shift, and rate of reoperation. RESULTS: Among 80 patients with 99 cSDHs, the median age was 68 years (IQR 59-77) with 20% females. Twenty-eight cSDHs (35%) had septations identified on imaging. Surgical evacuation with burr holes was performed in 45% and craniotomy in 18.8%. Baseline characteristics between no-septations (no-SEP) and septations (SEP) groups were similar except for median age (SEP vs no-SEP, 72.5 vs. 65.5, p CONCLUSION: MMAE appears to be equal to potentially more effective in preventing the recurrence of cSDH in septated lesions. These findings may aid in patient selection

Return to Active Duty Lifestyle After Modified Brostrom

Category: Ankle Introduction/Purpose: Ankle sprains are a common sports related injury and typically treated conservatively. Chronic ankle instability, however, may require surgical management when non-operative measures fail. The Brostrom procedure with Gould modification is the most frequently employed operation for chronic ankle instability with a record of good to excellent treatment outcomes. The purpose of our study was to evaluate the clinical outcomes of this procedure in an active duty population. Methods: A retrospective review of our electronic surgery records for a cohort of active duty patients aged 18-45 who were indicated for operative treatment of chronic ankle instability and who underwent surgical repair consisting of a standard Brostrom procedure with Gould modification at Madigan Army Medical Center between January 1,2010 through April 30, 2014 was performed. All patients were treated by a single surgeon and had a minimum of one year follow-up. The electronic medical record was reviewed for each patient to determine their ability to remain on active duty status as well as their permanent lower extremity activity restrictions. Results: 127 total patients who met the inclusion criteria underwent Brostrom procedures with Gould modification during the study period. 23 out of 127 (18.1%) underwent Medical Evaluation Board (MEB) and separation from active duty for reasons related to their ankle. Another 11 patients underwent military separation for reasons unrelated to their ankle. 67 patients (52.7%) currently have permanent lower extremity profiles in the electronic record. 38 patients with permanent profiles have been able to meet retention standards and remain on active duty status. Of the 93 patients who were able to remain on active duty status, only 2 individuals changed their military occupational specialty (MOS). The remainder of patients remain on active duty status in their current MOS, completed their active duty obligation or reached planned retirement. Conclusion: Chronic ankle instability in active duty service members can be severely limiting. Brostrom procedure with Gould modification can provide significant improvement in symptoms and allow patients to remain on active duty status. However, in our high demand population approximately 50% of patients required some form of permanent activity restriction with nearly 20% requiring military separation. This is important information when counseling an active patient population about the expectations from surgical intervention for chronic ankle instability

Industriekernkraftwerk mit Hochtemperaturreaktor PR 500 - „OTTO-Prinzip" - zur Erzeugung von Prozeßdampf: Abschlußbericht über eine Gemeinschaftsstudie

In Zusammenarbeit zwischen der STEAG AG, Essen, und der KFA Jülich wurde diese Studie durchgeführt, um die Eignung des HTR-Systems für die Erzeugung von Prozeßdampf zu untersuchen. Als Wärmequelle wurde ein Kugelhaufenreaktorcore mit Einweg-(OTTO)Beschickung und Loopbauweise der Wärmetauschersysteme gewählt. In diesem Bericht sind eine möglichst detaillierte technische Beschreibung der gesamten Anlage, eine Analyse der sicherheitstechnjschen Eigenschaften sowie Kostenkalkulationen enthalten. Die Studie kommt zu dem Ergebnis, daß aufbauend auf dem heutigen* Kenntnisstand eine solche Anlage selbst bei einer relativ kleinen Leistung von 500 MWth schon fast mit konventionellen Anlagen wirtschaftlich konkurrieren könnte