The treatment of penetrating wounds of the inferior vena cava

During the last 5 years, 10 gunshot and 2 stab wounds of the inferior vena cava have been treated, with 11 survivals and 1 death. The lacerations were above the renal veins in 4 cases and below in the others. All patients had other serious visceral injuries. Treatment consisted of suture repair in 11 cases and ligation in the twelfth. Upon exploration, free intraperitoneal bleeding from the caval wound had ceased in every case. The signal finding was a retroperitoneal hematoma which was often deceptively small. Commonly, the surgeon explored the retroperitoneal space in order to treat other visceral injuries, only to be confronted with unexpected massive hemorrhage when the hematoma was entered. Difficulties in controlling the bleeding are often related to the well-developed collateral system by which different segments of the inferior vena cava are freely connected. When a hematoma is found in the vicinity of the great vessels and the retroperitoneal space is to be explored, certain precautions should be observed. These include provision for adequate exposure, procurement of blood, and adjustment of lighting. Additional help can be summoned and vascular instruments should be brought to the operating table. A large-bore needle or cut-down should be placed in an arm vein. The posterior peritoneal incision should be planned for maximum and rapid exposure, so that hemorrhage can be quickly controlled when the plane of the hematoma is entered. © 1962

Fast physical models for Si LDMOS power transistor characterization

A new nonlinear, process-oriented, quasi-two-dimensional (Q2D) model is described for microwave laterally diffused MOS (LDMOS) power transistors. A set of one-dimensional energy transport equations are solved across a two-dimensional cross-section in a “current-driven” form. The model accounts for avalanche breakdown and gate conduction, and accurately predicts DC and microwave characteristics at execution speeds sufficiently fast for circuit simulation applications

Fluid use in mountain bikers - self-reported practices

Background and objectives. Little is known of the fluid replacement habits of participants in mountain bike (MTB) endurance events. This survey set out to determine the current perceptions and practices of this group of endurance athletes. Method. Four hundred and twelve participants in the 3- day 2006 Sani2C (MTB) race completed questionnaires that elicited information regarding their regular fluid intake practices during competitive MTB endurance events. This included their general approach to fluid replacement, their fluid intake practices (type, amount and frequency), urine output and hydration status. Results. While 70% (N = 290) reported that they based their fluid intake practices on personal past experiences, less than half the group (N = 177, 43%) were aware of official sport-specific guidelines. Although 86% (N = 354) reported making use of commercially available sport-specific drinks, consumption of water alone was reported by 34% of respondents (N = 140). The majority (N = 225, 55%) of the mountain bikers reported drinking every 16 - 30 minutes during an endurance ride, while 35% (N = 144) reported drinking every 0 - 15 minutes. Fifty-three per cent (N = 182) of the male respondents and 45% (N = 23) of female respondents reported a routine intake of ≥ 750 ml per hour during endurance rides. This included 2 women who reported regular intakes of between 1 500 and 2 000 ml/hr. Only 7 (2%) reported receiving medical care for dehydration following their participation in previous MTB rides. Conclusions. This survey indicates that although more than half of the mountain bikers did not acknowledge specific awareness of the official fluid replacement guidelines, over 80% reported drinking regularly during a race, and 52% (N = 212) reported a usual intake of ≥ 750 ml/hr during endurance races. Until scientific studies have carefully examined the hydration status and fluid replacement needs of mountain bikers, MTB cyclists are cautioned against the practice of over-hydrating. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 52-5

Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

Effect of electrical muscle stimulation on prevention of ICU acquired muscle weakness and facilitating weaning from mechanical ventilation

Objective: ICU acquired muscle weakness (ICUAMW) is an acquired neuromuscular disorder associated with increased duration of mechanical ventilation and weaning suggesting a possible relation between the limb and respiratory neuromuscular involvement. There is no preventive tool and no specific treatment has been proposed for ICU acquired muscle weakness. Aim of this study was to assess the effect of electrical muscle stimulation on prevention of ICUAMW and in facilitating the weaning from mechanical ventilation in critically ill patients.Design: A prospective, randomized, placebo-controlled trial.Setting: Critical care department, main Alexandria university hospital.Patients: 80 Critically ill patients on mechanical ventilation for more than  24 h.Methods: They were randomly categorized into two groups: 40 patients received conventional lines of treatment only (control group) and 40 patients received in addition one daily session of Electrical Muscle Stimulation (EMS) (EMS group). Assessment of occurrence of ICUAMW was done through the MEDICAL RESEARCH COUNCIL SCALE (MRCS) which is a method for clinical assessment of muscle strength.Results: MRCS did not show any significant difference between the two groups in the first 3 days post mechanical ventilation while on day 4, MRCS mean value was 46.86± 10.88 in the EMS group versus 43.70 ±9.32 in the control group (p= 0.041). On day 21, MRCS mean value was 29.67± 8.87 in the EMS group versus 19.60 ± 4.34 in the control group (p=0.037). Significant difference was also noted in the duration of mechanical ventilation as the mean value in the EMS group was 9.01 ± 8.01 days versus 11.97 ± 8.07 in the control group (p= 0.048).Conclusions: Although the EMS could not prevent the occurrence of ICUAMW in critically ill mechanically ventilated patients it still has a role in minimizing the degree of muscular weakness and could be helpful in facilitating weaning from mechanical ventilation.Keywords: Mechanical ventilation – weaning; Neuro-polyneuropath

The treatment of penetrating wounds of the inferior vena cava

During the last 5 years, 10 gunshot and 2 stab wounds of the inferior vena cava have been treated, with 11 survivals and 1 death. The lacerations were above the renal veins in 4 cases and below in the others. All patients had other serious visceral injuries. Treatment consisted of suture repair in 11 cases and ligation in the twelfth. Upon exploration, free intraperitoneal bleeding from the caval wound had ceased in every case. The signal finding was a retroperitoneal hematoma which was often deceptively small. Commonly, the surgeon explored the retroperitoneal space in order to treat other visceral injuries, only to be confronted with unexpected massive hemorrhage when the hematoma was entered. Difficulties in controlling the bleeding are often related to the well-developed collateral system by which different segments of the inferior vena cava are freely connected. When a hematoma is found in the vicinity of the great vessels and the retroperitoneal space is to be explored, certain precautions should be observed. These include provision for adequate exposure, procurement of blood, and adjustment of lighting. Additional help can be summoned and vascular instruments should be brought to the operating table. A large-bore needle or cut-down should be placed in an arm vein. The posterior peritoneal incision should be planned for maximum and rapid exposure, so that hemorrhage can be quickly controlled when the plane of the hematoma is entered. © 1962

Pengaruh Latihan Gerakan Dasar Rool Kiep dan Usia Terhadap Teknik Gerakan Dasar Senam Lantai Handspring

Tujuan dari penelitian ini adalah mengetahui perbedaan gerakan senam lantai handspring berdasarkan periode progam latihan rollkiep 3x1 minggu dan 4x1 minggu, mengetahui perbedaan gerakan senam lantai handspring berdasarkan usia 7-10 tahun dan 11-13 tahun dan mengetahui interaksi progam latihan rollkiep periode 3x1 minggu dan 4x1 minggu dengan usia 7-10 tahun dan 11-13 tahun dalam menentukan gerakan dasar senam handspring. Penelitian ini menggunakan metode eksperimen, dengan kelompok uji coba perlakuan latihan roll kiep terhadap teknik dasar gerakan dasar senam handspring. Sampel dalam penelitian ini adalah anak SELABORA UNY dan senam lantai Bantul. Desain penelitian yang digunakan adalah Anava dua jalur pada taraf signifikansi a = 0,05. Metode yang digunakan adalah metode penelitian dan teknik pengumpulan datanya menggunakan tes dan pengukuran. Insturmen yang digunakan adalah tes keterampilan gerakan senam lantai handspring dengan penilai seorang juri. Analisis data menggunakan Anava . Hasil penelitian menunjukan bahwa terdapat pengaruh signifikan pada metode latihan rollkiep 3x1 minguu dan 4x1 minggu terhadap gerakan dasar senam handspring, terdapat pengaruh signifikan pada usia 7-10 tahun dan 11-14 tahun terhadap gerakan dasar senam lantai handspring dan terdapat interaksi yang signifikan dan kuat antara pengaruh metode latihan rollkiep (3x1 minggu dan 4x1 minggu) dan perbedaan usia terhadap gerakan dasar senam lantai handspring

PENGARUH LATIHAN KOORDINASI TERHADAP GERAKAN DASAR SENAM LANTAI (ROLL KIEP) ANAK USIA 7-11 TAHUN

Tujuan dari penelitian ini adalah untuk mengetahui adanya pengaruh latihan koordinasi terhadap gerakan dasar senam (roll kiep) pada anak usia 7-11 tahun. Penelitian ini menggunakan metode eksperimen, dengan kelompok uji coba perlakuan latihan koordinasi dan gerakan dasar senam roll kiep. Sampel dalam penelitian ini adalah anak usia 7-11 tahun. Desain penelitian yang digunakan adalah One Groups Pretest-Posttest Design. Metode yang digunakan adalah metode survei dan teknik pengumpulan datanya menggunakan tes dan pengukuran. Insturmen yang digunakan adalah tes keterampilan gerakan senam lantai roll kiep dengan penilai seorang juri. Analisis data menggunakan uji t. Hasil penelitian menunjukan bahwa terdapat pengaruh signifikan pada metode latihan koordinasi terhadap gerakan dasar senam lantai roll kiep untuk anak usia 7-11 tahun yang ditunjukan dengan nilai t hitung= -3,85 < t tabel 2,77 dan nilai signifikansi sebesar 0,018 < 0,05

Visual search in ecological and non-ecological displays: Evidence for a non-monotonic effect of complexity on performance

Copyright @ 2013 PLoSThis article has been made available through the Brunel Open Access Publishing Fund.Considerable research has been carried out on visual search, with single or multiple targets. However, most studies have used artificial stimuli with low ecological validity. In addition, little is known about the effects of target complexity and expertise in visual search. Here, we investigate visual search in three conditions of complexity (detecting a king, detecting a check, and detecting a checkmate) with chess players of two levels of expertise (novices and club players). Results show that the influence of target complexity depends on level of structure of the visual display. Different functional relationships were found between artificial (random chess positions) and ecologically valid (game positions) stimuli: With artificial, but not with ecologically valid stimuli, a “pop out” effect was present when a target was visually more complex than distractors but could be captured by a memory chunk. This suggests that caution should be exercised when generalising from experiments using artificial stimuli with low ecological validity to real-life stimuli.This study is funded by Brunel University and the article is made available through the Brunel Open Access Publishing Fund