The role of the deep femoral artery in the treatment of thigh claudication in case of hypogastric occlusion

BACKGROUND: This study evaluated the clinical and functional efficiency of deep femoral artery (DFA) revascularization in treating thigh claudication associated with ipsilateral internal iliac artery (IIA) occlusion. PATIENTS AND METHODS: The files of patients presenting with proximal claudication, ipsilateral IIA occlusion, and conventional surgical revascularization of DFA were retrospectively reviewed. Each patient benefited from preoperative and postoperative measurement of dynamic transcutaneous pressure of oxygen (TcPO2) and presented with preoperative proximal stress-related ischemia and with the clinical symptoms of buttock, thigh, or groin pain. RESULTS: Between May 2001 and December 2009, 23 DFA revascularizations were performed on 19 patients. Proximal stress-related pain disappeared in 17 lower limbs (74%). No postoperative thromboses were noted. Mean maximum walking distance (MWD) significantly improved (149+/-113 vs. 414+/-257 m; P<0.025), as did the ankle to arm systolic pressure index (0.71+/-0.17 vs. 0.90+/-0.19; P<0.005). Disappearance of proximal stress ischemia, revealed through postoperative dynamic TcPO2, measurement, occurred in 6 lower limbs (26%). Patency of ipsilateral superficial femoral artery, ipsilateral to the symptoms, seemed to be a predictive factor of MWD improvement (P<0.05). CONCLUSIONS: DFA revascularization is an efficient treatment for thigh claudication in case of IIA occlusion, even if the results are less satisfactory than those obtained through direct revascularizations of this artery

Infections du site opératoire sur ablation de varices d’après une série continue de 408 interventions réalisées dans un centre hospitalier universitaire

But de l’étudeNotre objectif était de déterminer l’incidence des infections du site opératoire (ISO) consécutives à des interventions sur varices dans le service de chirurgie vasculaire d’un centre hospitalier universitaire. Patients et méthodes Une surveillance prospective des ISO a été mise en place pendant un an, avec un suivi postopératoire des patients de 30 jours. Le diagnostic d’ISO a été réalisé suivant les définitions des Centers for Disease Control (CDC, États-Unis). La saisie et l’analyse des données ont été réalisées à l’aide du logiciel Epi-Info des CDC. Résultats Les trois-quarts des 408 interventions incluses étaient caractérisées par un score de NNISS égal à 0. Une dépilation a été effectuée pour tous les patients, avec des modalités très variables et souvent non conformes (rasage mécanique dans 44,6 % des cas) aux recommandations nationales. L’incidence des ISO était de 1,2 % (intervalle de confiance à 95 % = [0,2–2,2]). Toutes les infections ont été diagnostiquées après retour au domicile. Quatre patients infectés sur cinq présentaient des problèmes de surpoids ou d’obésité et deux d’entre eux étaient diabétiques. L’âge moyen des patients était plus élevé chez les patients infectés (70,4 ans versus 52,0 ; p < 0,01). Les cinq ISO ont eu des conséquences (réhospitalisation et/ou reprise chirurgicale et/ou antibiothérapie). Conclusion D’après ces résultats, les ISO consécutives à des interventions sur varices sont rares et concernent principalement des patients à haut risque. Dans un but de prévention, il semble cependant nécessaire d’homogénéiser les pratiques de dépilation dans ce service

Frequency of the Pectoralis Minor Compression Syndrome in Patients Treated for Thoracic Outlet Syndrome

BACKGROUND: Pectoralis minor compression syndrome (PMCS) is a compression of the neurovascular structures in the subpectoral tunnel and remains underestimated in the management of patients with thoracic outlet syndrome (TOS). Its underdiagnosis may be responsible for incomplete or failed treatment. The aim of the study was to evaluate the frequency of PMCS in our experience. METHODS: We retrospectively reviewed all patients treated for TOS in our department. We selected those in whom PMCS was diagnosed with a systematic dynamic arteriography. Surgery was performed using the Roos axillary approach when a first rib resection was associated or an elective approach when a first rib resection was not associated. RESULTS: From January 2004 to December 2014, 374 surgeries for TOS were performed in 279 patients, which included 90 men (sex ratio = 0.48) with a mean age of 40.1 ± 10 years old. Among these patients, 63 (22.5%) underwent 82 interventions (21.9%) for PMCS, including 26 men (sex ratio = 0.70, P < 0.05) with a mean age of 37.9 ± 9.4 years old. Tenotomy of the pectoralis minor muscle was performed using axillary approach if it was associated with a first rib resection in 74 cases (90.2%) or through an elective approach in 8 cases (9.8%) if it was isolated. Four (4.9%) postoperative complications were found (1 hematoma [1.2%], 1 hemothorax [1.2%], 1 scapula alata [1.2%], and 1 subclavian vein thrombosis [1.2%]), all after an axillary approach. In 63 cases (79.7%), preoperative symptoms were resolved. In 14 cases (17.7%), symptom resolution was incomplete, and 2 patients (2.6%) had recurrent symptoms. CONCLUSIONS: Evaluation of PMCS in TOS is justified by its frequency and the simplicity and low morbidity of the surgical procedure

Preparation and characterization of activated carbon from plantain peel and coconut shell using biological activators

A concern over the toxicity of chemicals used during the activation stage in the preparation of activated carbon is beginning to gain attention. The study therefore looked into the possibility of using bio-activators (lemon juice and potash leached from the peel of unripe plantain) as activating chemicals, for environmentally friendly activated carbon. Coconut shell and the peel from unripe plantain were used as feedstock and pyrolyzed at 400 and 450 0c. An impregnation ratio of 0.25:1 was used while laboratory grade potassium hydroxide was used as a base activating agent as a control setup. Characterization of the activated carbon was carried out using parameters like bulk density and yield which were obtained using standard procedures. Results showed that activating carbon using bio-activators as activating agents had very good characteristics when compared with the control. Bio-activators are therefore recommended for the production of bio based activated carbon especially in the fields of medicine, food and pharmaceuticals. The effect of carbonization temperature on adsorption efficiency and pore structure were investigated using methylene blue as adsorbate and SEM respectively

Synergy of Siam weed (Chromolaena odorata) and poultry manure for energy generation: Effects of pretreatment methods, modeling and process optimization

The co-digestion of Chromolaena odorata with poultry manure was evaluated in this study. Two samples of the weed: (A: which was pre-treated with mechanical, chemical and thermal methods) and (B: which was pretreated using mechanical and chemical methods only) were separately digested with poultry manure. Biogas generation started from the 2nd to 4th and 4th to 7th day for samples ‘A’ and ‘B’ respectively. The most desired actual biogas yield from samples ‘A’ and ‘B’ were 3884.20 and 2544.70 (10�4 m3/kg VS) respectively and the gas composition was 68 ± 2% Methane and 20 ± 2% Carbon dioxide for sample A while it was 62 ± 3% Methane and 22 ± 2% Carbon dioxide for sample B. In all, there was a 38.06% increase in gas generation in ‘A’ over ‘B’. The coefficient of determination (R2) for the Response Surface Methodology (RSM) model (0.9009) was high suggesting high accuracy in the modeling and prediction. The worldwide usage of C. odorata is encouraged

Mesophilic anaerobic co-digestion of poultry dropping and Carica papaya peels: Modelling and process parameter optimization study

The study evaluated anaerobic co-digestion of poultry dropping and pawpaw peels and the optimization of important process parameters. The physic-chemical analyses of the substrates were done using standard methods after application of mechanical, thermal and chemical pre-treatments methods. Gas chromatography analysis revealed the gas composition to be within the range of 66–68% methane and 18– 23% carbon dioxide. The study equally revealed that combination of the different pre-treatment methods enhanced enormous biogas yield from the digestion. Optimization of the generated biogas data were carried out using the Response Surface Methodology and the Artificial Neural Networks. The coefficient of determination (R2) for RSM (0.9181) was lower compare to that of ANN (0.9828). This shows that ANN model gives higher accuracy than RSM model for the current. Further usage of Carica papaya peels for biogas generation is advocated

Cancer cachexia: Measured and predicted resting energy expenditures for nutritional needs evaluation

ObjectiveCancer cachexia is associated with weight loss, poor nutritional status, and systemic inflammation. Accurate nutritional support for patients is calculated on resting energy expenditure (REE) measurement or prediction. The present study evaluated the agreement between measured and predicted REE (mREE and pREE, respectively) and the influence of acute phase response (APR) on REE. Methods Thirty-six patients with cancer were divided into weight-stable (WS; weight loss <2%) and weight-losing (WL; weight loss >5%) patients. Measured REE was measured by indirect calorimetry and adjusted for fat-free mass (FFM). The Bland-Altman approach was used to assess the agreement between mREE and pREE from the Harris-Benedict equations (HBE). Blood levels of C-reactive protein were assessed. Results There was no difference in mREE between groups (WS 1677 ± 273, WL 1521 ± 305) even when mREE was adjusted for FFM (WS 1609 ± 53, WL 1589 ± 53). In WL patients, FFM-adjusted REE correlated with blood C-reactive protein levels (r = 0.471, P = 0.048). HBEs tend to underestimate REE in both groups. Conclusion WL and WS patients with cancer had similar REEs but were different in terms of APR. APR could contribute to weight loss through enhancing REE. In a clinical context, HBE was in poor agreement with mREE in both groups

Gasific: A Python Tool for Biomass Gasification Process

Biomass gasification and the production of syngas are important in the production of biohydrogen, a green fuel and an energy carrier for the fuel cell. The tool for the prediction of biohydrogen production from any biomass should be readily available to determine the viability of such biomass for gasification. The software implementing a robust gasification model is complex, proprietary, and expensive. In order to solve this problem, we developed Gasific, a software module for simple, free, and accurate biomass gasification product gas prediction. Gasific, implemented biomass gasification, stoichiometric equilibrium models, in Python and runs on a variety of platforms. We discussed the application of Gasific on biomass wastes, namely, Imperata cylindrica; the simulation shows good performance in predicting the gas composition product of gasification. The developed software and the code can be modified and applied to other scientific models and transform the models into software applications

Two randomised and placebo-controlled studies of an oral prostacyclin analogue (Iloprost) in severe leg ischaemia [The Oral Iloprost in severe Leg Ischaemia Study Group]

Two separate studies are described using the same prostacyclin analogue in a similar group of patients. Objectives: to assess the tolerability and efficacy of two dose regimens of oral Iloprost compared with placebo in the treatment of patients with ischaemic ulcers, gangrene or rest pain due to severe arterial disease over a period of 4 weeks (Study A) and one year (Study B). Design: multicentre, placebo controlled, double-blind, randomized prospective studies. Subjects & Methods: 178 (study A) and 624 (study B) patients with trophic skin lesions (ulcers or gangrene) or ischaemic rest pain due to severe arterial disease. To confirm severe arterial disease patients were required to have a systolic ankle Doppler pressure of 70 mmHg or less or a toe systolic Doppler pressure of 50 mmHg or less in one leg.In both studies patients were randomly allocated to three treatment groups: placebo, low dose Iloprost (50\u2013100 g twice a day) or high dose (150\u2013200 g twice a day) In Study A the main outcome measures were tolerability of different doses of Iloprost and death, major amputation, healing of trophic lesions and relief of rest pain at the end of the follow up, which was 5 months after the end of the treatment. In Study B the primary end point was time to major amputation and stroke or death up to 12 months. Secondary pre-defined end points included the combined end point of patients alive without amputation, no trophic skin changes, no rest pain and not on regular analgesics. Results: the proportion of patients who completed the 4-week treatment period in Study A at the intended dose was 58%, 43%, 45% respectively in the placebo, low dose and high dose Iloprost groups. In an intention to treat analysis the proportion of patients who survived without major amputation, ulcers or gangrene and had no rest pain was 11% in the placebo group, 19% in the low dose iloprost group and 28% in the high dose Iloprost group. The pooled Iloprost groups showed a statistically significantly better result than the placebo group (p=0.04), as did the high dose Iloprost group compared to the placebo (p=0.014). In Study B there was no treatment benefit in terms of a primary end point of amputation and death. However the secondary combined end point of patients who survived without a major amputation, ulcers or gangrene and had no rest pain, nor a need for regular analgesia was favourable for Iloprost, with 18% of patients in the placebo group reaching this optimal secondary end point, compared to 23% in the low dose Iloprost group and 26% in the higher dose Iloprost group (p<0.05). Conclusions: oral Iloprost administered for a year showed no clear benefit in patients with advanced severe leg ischaemia (PAOD III and IV). The results obtained with 4 weeks\u2019 treatment in Study A and in previous trials of intravenous Iloprost could not be reproduce