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[en] We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.
[en] Spontaneous subclavian artery dissections are rare, with very few cases described in the literature. We report an unusual case of a 62-year-old female who presented with ischemia of the left arm secondary to spontaneous dissection of the first part of the left subclavian artery. We describe the imaging findings on both aortic arch angiogram and CT angiogram and discuss management by endovascular means.
[en] Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm.Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route.Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheterrelated phlebitis occurred.Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.
[en] A robotic arm development platform will provide the tools for SRNL to increase its competency in this area and allow customer demonstrations to be performed so they can visualize how the technology relates to their application. The objective is to set up an adaptable development platform that can easily be re-configured for a variety of demonstrations for collecting data that will help engage the customer. Collaborative robots are designed with built in features allowing them to safely operate alongside employees.
[en] The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts
[en] To establish radiographic criteria to choose the most appropriate technique of reduction for each type of anterior glenohumeral dislocation, and to determine the type of dislocation which requires general anesthesia. Material and Methods: Radiography in two different projections was performed in 67 patients with antero-inferior shoulder dislocations before a reduction attempt. The method proposed by Boss-Holzach-Matter was used as the primary technique for all shoulder dislocations. Results: Most subcoracoid dislocations (84.4%) could be reduced by the Boss-Holzach-Matter method while only a few subglenoid dislocations (15.8%) were reducible by this technique. Displaced associated fractures significantly reduced the success rate of the reduction attempts. Conclusion: Anterior dislocations of the shoulder require different methods of reduction depending upon the type (sub-group) of dislocation. Reduction of subglenoid dislocations with associated greater tuberosity fracture should be performed under general anesthesia to avoid head-splitting fracture
[en] Since 1988 the routine shoulder examination at our department has consisted of the anteroposterior projection (AP), the transthoracic projection (TT) and the apical oblique projection (AO). To save discomfort to the patients - incuding unnecessary X-rays - as well as time and money, we wanted to see, whether one of the projections could be omitted from the primary examination without losing diagnostic information. Retrospectively, 125 acute shoulder examinations were reevaluated - each projection separately - and the findings from the three radiographs of each shoulder compared. In 47 patients the examinations were normal. The remaining 78 patients had a total of 112 lesions. The AO alone showed 17 of 112 lesions (15%) of which eight were isolated lesions. The AO together with the AP presented 111 of 112 lesions and with a supplementary TT obtained in case of fracture, no lesions were overlooked. Based on this present material and the literature, we recommend that the routine radiographic examination of the acute shoulder includes the AO and the AP, to be supplementee with the TT - or another lateral projection - in case of humeral fracture. (author). 9 refs.; 5 figs.; 2 tabs
[en] This paper reports on the objective of a nuclear freeze which is to slow down or stop the so-far inexorable development and deployment of more and more (read destructive and deadly) nuclear warheads. The essential notion is not new. The proposed treaty for a comprehensive ban on nuclear tests that was very nearly negotiated in 1959 was perhaps the first serious effort to obtain a nuclear freeze, albeit a partial one. Growing concern about the nuclear arms race has led to greatly increased interest in much broader and more effective freezes. A comprehensive nuclear freeze, one that would stop all stages in the manufacture, testing, and deployment of nuclear warheads, would clearly be very desirable and have a great impact. It would not, however, deal with the other worrisome aspects of nuclear weapons, which is the very large number of such weapons that already exist
[en] The memoirs of the author traces his life from his first-year graduate studies in physics at the University of Rochester in 1942 to his present position as Director of the University of California's Institute on Global Conflict and Cooperation. The part of his life involved in making weapons extends from 1942 to 1961. During this period, he worked with E.O. Lawrence on the Manhattan Project and served as director of Livermore after it became the Atomic Energy Commission's second nuclear weapons laboratory. He also served on many government advisory boards and commissions dealing with nuclear and other weapons. In 1961, the combination of a heart attack and changes in administration in Washington led York too return to the University of California for the talking peace portion of his life. He has since become a public exponent of arms control and disarmament and the futility of seeking increased security through more and better nuclear weapons. York's explanation of his move from making weapons to talking peace leaves the reader with a puzzle
[en] In this paper, a three dimensional catenary model was developed using a cable element based on the absolute nodal coordinate formulation (ANCF). The formulation of the lower order cable element was derived and verified using a simple example. A three dimensional catenary model was created using the cable element which includes a contact, messenger wire, droppers and steady arms. Detailed characteristics including slackening of the dropper, pre sag and stagger were considered. In order to verify the reliability of the developed catenary model, the static and dynamic behavior such as the static uplift, pre-sag, wave propagation speed, natural frequency and deflection by side wind were evaluated by comparing the results of the analysis model with the theoretical values, step by step. Finally, by presenting a curved track catenary model, the possibilities of a differentiated analysis extended from the existing two dimensional catenary model were proposed