Littérature scientifique sur le sujet « Severe complicanze »
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Articles de revues sur le sujet "Severe complicanze"
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Caputo, N., M. Hamam, R. Scatolini, G. Giordano et E. Ciorba. « Ruolo delle lesioni carotidee tandem nell'incidenza dell'ictus perioperatorio e nella recidiva dell'ictus ». Rivista di Neuroradiologia 9, no 1 (février 1996) : 53–58. http://dx.doi.org/10.1177/197140099600900106.
Texte intégralRésumé :
Gli autori riferiscono i risultati relativi ad uno studio effettuato su una casistica di 45 pazienti vascolari sintomatici, sottoposti ad intervento di TEA carotideo e controllati clinicamente per 5 anni con lo scopo di verificare se la presenza di lesioni ateromasiche intracraniche associate a quelle delle biforcazioni carotidee era in grado di condizionare l'incidenza dell'ictus perioperatorio o della recidiva dell'ictus. Sugli 85 assi carotidei valutati angiograficamente in fase preoperatoria 53 erano portatori di lesioni tandem; 55 assi carotidei sono stati operati e 30 non sono stati operati; dei casi operati 7 hanno presentato complicanze neurologiche (un solo caso aveva lesioni tandem) e 7 complicanze non neurologiche (5 avevano lesioni tandem). Gli autori concludono che le lesioni tandem non influenzano l'incidenza dell'ictus perioperatorio o della recidiva dell'ictus nei pazienti operati. Severe stenosing atheromatous lesions in the intracranial vessels constitute a significant perioperative risk factor and are commonly considered a major exclusion criterion for carotid endarterectomy.
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Tison, Tiziana, Piero Marson et Giustina De Silvestro. « Lo scambio eritrocitario ». Giornale di Clinica Nefrologica e Dialisi 25, no 4_suppl (23 juillet 2013) : S27—S29. http://dx.doi.org/10.33393/gcnd.2013.1086.
Texte intégralRésumé :
Lo scambio eritrocitario è una procedura in cui, utilizzando un separatore cellulare, si rimuovono i globuli rossi anomali del paziente, che vengono rimpiazzati con globuli rossi di un donatore volontario. Lo scambio eritrocitario può essere effettuato sia utilizzando accessi venosi periferici che un catetere venoso centrale. Dal momento che spesso si tratta di pazienti pediatrici è importante valutare attentamente le indicazioni ed è necessario considerare alcuni aspetti particolari della procedura aferetica. Lo scambio eritrocitario è indicato in caso di complicanze severe della drepanocitosi, quali l'ictus e l'acute chest syndrome, e nel caso di alcune infezioni quali la malaria e la babesiosi, in cui si verifica, ad opera dei parassiti, un danno eritrocitario.
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SAPONARO, G., G. GASPARINI, D. CERVELLI, L. DALL’ASTA, G. D’AMATO, M. FORCIONE, S. PELO et A. MORO. « Il lembo libero osteoperiosteo di Fibula come opzione ricostruttiva preprotesica nelle atrofie severe e nei difetti post oncologici dei mascellari ». Acta Otorhinolaryngologica Italica 35, no 6 (décembre 2015) : 394–99. http://dx.doi.org/10.14639/0392-100x-763.
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Il gold standard nella ricostruzione dei mascellari nelle atrofie severe, siano esse di natura idiopatica o iatrogena, come nei casi di chirurgia resettiva oncologica, deve essere incentrato verso tecniche di ricostruzione immediata che consentano un veloce recupero funzionale ed estetico. I pazienti considerati in questo studio sono stati trattati durante un periodo di 5 anni (2010-2014) con ricostruzione immediata del deficit dei mascellari, eseguito per mezzo di lembo libero di fibula osteo-periosteo. Sono stati pertanto selezionati 14 pazienti sottoposti a ricostruzione con tale tecnica, senza riportare complicanze a medio e lungo termine. Il principale vantaggio di questo tipo di ricostruzione va ricercato nella formazione di gengiva cheratinizzata sovrastante il lembo libero che consente la migliori condizione possibile per una ricostruzione implantoprotesica. L’unico svantaggio di questa tecnica è da imputare alla necessità di lasciare che la ferita chirurgica intraorale guarisca per seconda intenzione in modo da promuovere la formazione di gengiva cheratinizzata dai bordi della ferita stessa, per tale ragione però il pazente necessita di un rigido follow up per il primo mese dopo l’intervento. Lo scopo di questo lavoro è valutare l’efficacia di tale tecnica nelle ricostruzioni ossee dei mascellari.
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Scavuzzo, A., A. Granata, A. Saita et F. Fiorini. « Complicanze della nefrolitotrissia percutanea ». Giornale di Clinica Nefrologica e Dialisi 23, no 2 (24 janvier 2018) : 38–43. http://dx.doi.org/10.33393/gcnd.2011.1436.
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L'obiettivo di questo studio è descrivere “step-by-step” la nefrolitotrissia percutanea e le sue complicanze. A tale proposito sono stati valutati i casi di calcolosi renale da noi trattati con nefrolitotrissia percutanea (PCNL) dal 2001 al 2010 ed è stata al contempo rivista la letteratura circa l'incidenza e il management delle complicanze legate a tale procedura. La percentuale globale di complicanze registrate durante e dopo le PCNL possono raggiungere anche l'83% dei casi e comprendono ematomi (7,2%), trasfusioni (11,2%-17,5%) e febbre (21,0%-32,0%). Molte di queste complicazioni, se riconosciute precocemente, possono essere gestite con trattamenti conservativi o mininvasivi. Le complicanze maggiori sono rare (setticemia (0,3–0,4%), lesioni intestinali (0,2–0,8%), lesioni pleuriche (0,0–3,1%)). Le co-morbilità (insufficienza renale, diabete mellito, obesità severa, malattie polmonari) sembrano incrementare il rischio di complicanze. Nella nostra casistica la percentuale complessiva di complicanze è stata pari al 26%, molte delle quali si sono risolte senza sequele. In conclusione, la PCNL rappresenta una metodica sicura e con basso rischio di complicanze specifiche specie se a seguito di un'accurata selezione e preparazione dei pazienti, tecnica appropriata e attento follow-up nel post-operatorio al fine di assicurare tempestivo intervento se/quando necessario.
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Ianache, Irina, et Cristiana Oprea. « COMPLICAŢIE NEUROLOGICĂ SEVERĂ LA O TÂNĂRĂ CU INFECŢIE HIV ». Romanian Journal of Infectious Diseases 19, no 4 (31 décembre 2016) : 266–72. http://dx.doi.org/10.37897/rjid.2016.4.11.
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Introducere: Managementul pacienţilor cu infecţie HIV şi sindrom inflamator de reconstituţie imună (IRIS) reprezintă încă o provocare, în special la pacienţii cu infecţii oportuniste cerebrale. Prezentare de caz: Prezentăm cazul unei tinere în vârstă de 26 de ani, diagnosticată cu infecţie HIV într-un serviciu de hematologie şi internată în clinică noastră cu anemie severă, anxietate şi depresie. Probele biologice la internare au evidenţiat o anemie importantă, imunodepresie severă (CD4+ 63/mm3) şi o viremie HIV crescută (6,25 log10 copii/mL). După o lună de la iniţierea terapiei antiretrovirale cu schemă lamivudina 3TC, tenofovir (TDF) şi raltegravir (RAL), s-a observat o creştere importantă a imunităţii celulare (limfocite CD4+ 192/mm3) şi o scădere semnificativă a încărcăturii virale HIV la 1.5 log10 copii/mL. Evoluţia clinică a fost dificilă, pacienta prezentând multiple episoade de convulsii tonico-clonice generalizate, halucinaţii auditive şi instalând hemipareză dreaptă. Examenul LCR a evidenţiat 2 celule/mmc, proteinorahie normală (0,42 g/l), ARN- HIV de 82 copii/mL iar culturile bacteriene şi fungice nu au fost crescute. Examenul IRM cerebral a evidenţiat leziuni hiperintense în secvenţele T2 şi FLAIR, hipointense în T1, localizate în ariile fronto-temporale, în emisferul cerebelos drept şi în punte. Deşi PCR ADN-JC a fost pozitiv în LCR, sugerând diagnosticul de leucoencefalopatie multifocală progresivă (PML), aspectul neuro-imagistic atipic şi simptomatologia psihiatrică asociată au făcut iniţial dificilă stabilirea diagnosticului. Starea generală s-a agravat treptat în special prin accentuarea simptomatologiei psihiatrice şi neurologice (tremor sever, hipotonie axială, slăbiciune musculară generalizată, insomnie şi anxietate marcată). Progresia semnificativă a leziunilor în substanţa albă subcorticală cu priză de contrast, în contextul ameliorării statusului imunologic, a scăderii importante a viremiei HIV şi a prezenţei ADN-JC în LCR, au orientat diagnosticul spre IRIS-PML. Pacienta a primit corticoterapie în doze mari, tratament antipsihotic şi a continuat terapia antiretrovirală, cu evoluţie clinică treptat favorabilă, cu ameliorarea treptată a simptomatologiei neuropsihice. Concluzii: Diagnosticul afecţiunii neurologice a fost dificil în special din cauza debutului atipic, a prezenţei concomitente a simptomelor psihice şi a aspectului neuro-imagistic necaracteristic.
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Rajendram, Rajkumar, Arif Hussain, Naveed Mahmood et Gabriele Via. « Dynamic right-to-left interatrial shunt may complicate severe COVID-19 ». BMJ Case Reports 14, no 10 (octobre 2021) : e245301. http://dx.doi.org/10.1136/bcr-2021-245301.
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Right-to-left (RTL) interatrial shunt (IAS) may complicate select cases of COVID-19 pneumonia. We describe the use of serial imaging to monitor shunt in critically ill patients. A 52-year-old man presented with COVID-19 pneumonia. Hypoxia worsened despite maximal medical therapy and non-invasive ventilation. On day 8, saline microbubble contrast-enhanced transthoracic echocardiography revealed a patent foramen ovale (PFO) with RTLIAS. Invasive ventilation was initiated the next day. The course was complicated by intermittent severe desaturation without worsening aeration or haemodynamic instability, so PFO closure was considered. However, on day 12, saline microbubble contrast-enhanced transoesophageal echocardiography excluded RTLIAS. The patient was extubated on day 27 and discharged home 12 days later. Thus, RTLIAS may be dynamic and changes can be detected and monitored by serial imaging. Bedside echocardiography with saline microbubble contrast, a simple, minimally invasive bedside test, may be useful in the management of patients with severe hypoxia.
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Foresman, Ryan N., et Christopher W. Connors. « Severe Pulmonary Hypertension and Right Ventricular Failure Complicate a Total Abdominal Hysterectomy ». Seminars in Cardiothoracic and Vascular Anesthesia 15, no 4 (24 octobre 2011) : 179–82. http://dx.doi.org/10.1177/1089253211424223.
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Objective: The 2007 American College of Cardiology/American Heart Association guidelines report that no significant studies have been conducted assessing the perioperative risk of pulmonary hypertension in noncardiac surgery. However, the presence of right ventricular failure has been well documented to have poor prognostic implications. The presence of pulmonary hypertension and right ventricular failure present unique perioperative challenges. These include maintenance of adequate cardiac function, acid–base management, intraoperative monitoring, and postoperative pain management. Case report: The authors report the case of a patient with severe pulmonary hypertension who underwent an open total abdominal hysterectomy. The case was complicated by known right ventricular failure, severe portal hypertension, obstructive sleep apnea, extensive smoking history, and systemic anticoagulation therapy. The patient was not a candidate for postoperative neuraxial analgesia because of the timing and dose of systemic anticoagulation. Two-dimensional transesophageal echocardiography was used for real-time visualization and intraoperative cardiac monitoring. The patient was transferred to the intensive care unit for careful titration of opioids and slow ventilator wean to extubation. The postoperative course proceeded without significant morbidity or mortality. Clinical challenges: ( a) Preoperative assessment of pulmonary hypertension, ( b) postoperative pain control, ( c) cardiovascular stability, and ( d) intraoperative monitoring. Conclusions: This case illustrates the unique challenges associated with pulmonary hypertension and right ventricular failure in the setting of noncardiac surgery. This case also demonstrates that continuous, real-time data provided by transesophageal echocardiography can be used to successfully manage a complicated patient with pulmonary hypertension.
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Barbera, V., G. Barbera, G. Otranto, R. Faiola, C. Feliziani, A. Villani et A. Santoboni. « Calcifilassi peniena : una rara complicanza in corso di emodialisi ». Giornale di Clinica Nefrologica e Dialisi 24, no 1 (24 janvier 2018) : 9–12. http://dx.doi.org/10.33393/gcnd.2012.1106.
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La calcifilassi rappresenta una condizione clinica severa ed assai grave che si manifesta prevalentemente - ma non esclusivamente - in pazienti affetti da malattia renale cronica (CKD) sottoposti a terapia sostitutiva. Colpisce circa 1′1– 4% della popolazione dialitica (1, 2) e presenta una mortalità assai elevata (60–80%) (3). È caratterizzata clinicamente dalla presenza di ulcerazioni ischemiche a carico della cute e da necrosi conseguente allo sviluppo di calcificazioni distrofiche delle arteriole sottocutanee. L'interessamento penieno è assai raro ed in letteratura ne sono riportate - fino ad oggi - circa 40 segnalazioni. A tale proposito viene descritto il caso di un paziente di 50 anni, seguito presso la nostra UOC che sviluppò tale grave e, purtroppo fatale, complicanza clinica.
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Hardeman, A., A. Finley et M. Huntwork. « M303 LANGUAGE BARRIERS COMPLICATE FOOD ALLERGY TESTING IN CASES OF SEVERE ATOPIC DERMATITIS ». Annals of Allergy, Asthma & ; Immunology 127, no 5 (novembre 2021) : S125—S126. http://dx.doi.org/10.1016/j.anai.2021.08.402.
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Carvalho, Joana, Rita Moinho, Patricia Macao et Guiomar Oliveira. « When snakebites complicate : a paediatric case with shock and compartment syndrome ». BMJ Case Reports 14, no 2 (février 2021) : e240206. http://dx.doi.org/10.1136/bcr-2020-240206.
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We report the case of an 11-year-old boy brought to our emergency department 2 hours after a viper bite to his right hand. He suffered severe pain and rapidly progressive swelling with signs of haemodynamic compromise in keeping with distributive shock. The oedema progressed from his right wrist upwards to his forearm and upper arm with compartment syndrome ultimately resulting. He underwent fasciotomy of the right upper limb and antivenom serum was given. The patient required vasopressors for 48 hours and a total of nine surgical interventions were necessary. In the event of a snakebite, it is essential to promptly recognise the signs of severity, complications and indications for the administration of antivenom serum. We intend to highlight this rare shock aetiology and the need for emergency management if severe clinical signs are present. Early administration of antivenom serum is essential and it should be available in all emergency departments.
Thèses sur le sujet "Severe complicanze"
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Battistoni, Giovanna Irene. « Prematurità severa : ruolo ed incidenza delle complicanze ostetriche materno-fetali nell' outcome neonatale ». Doctoral thesis, Università Politecnica delle Marche, 2016. http://hdl.handle.net/11566/242518.
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Oggetto: Lo scopo dello studio è quello di stabilire una relazione, nella prematurità severa, fra complicanze materno-fetali e outcome neonatale.
Materiali e Metodi: Studio retrospettivo che analizza la percentuale di sopravvivenza e l’ incidenza di complicanze a breve termine nei neonati pretermine nati tra le 22+0 e le 31+6 settimane di gestazione nel periodo compreso tra Luglio 2003 e Dicembre 2008 presso l’ Ospedale Salesi di Ancona e successivamente ricoverati presso l’ Unità di Terapia Intensiva dello stesso Nosocomio. L’ outcome neonatale è stato relazionato alle condizioni patologiche materne che hanno indotto la severa prematurità.
Risultati: La sopravvivenza neonatale è risultata maggiore dell’ 80% in ogni condizione patologica materna analizzata e la bronco displasia la complicanza più osservata. L’ outcome neonatale è stato valutato considerando il ruolo delle patologie infiammatorie ed ischemiche placentari determinanti la prematurità severa, mentre i neonati analizzati per l’ epoca gestazionale alla nascita e la stima del peso fetale (= 1500 gr). I dati mostrano che i nati tra le 28,7-28,9 settimane di gestazione, di peso < 1500 gr, a causa di patologie ischemiche placentari hanno un più alto rischio di enterocolite necrotizzante, emorragia intraventricolare di III-IV grado, leucomalacia periventricolare, broncodisplasia e mortalità. I nati con patologie infiammatorie placentari, di peso < 1500 gr, sono a maggior rischio di setticemia e di pervietà del dotto arterioso. Infine unicamente i nati da patologie ischemiche placentari, >1500 gr, hanno mostrato una predisposizione nello sviluppare setticemia.
Conclusioni: Le patologie materno-fetali che intercorrono durante la gravidanza, condizionano l’ outcome neonatale nella prematurità severa congiuntamente all’ epoca gestazionale alla nascita ed al peso stimato fetale.Objective: The study investigate the extent to which maternal and fetal conditions are implicated on neonatal outcome in severe preterm births. Methods: Neonates born in the ranging period 2003-2008, from singleton pregnancies between 22+0 and 31+6 gestational age, have been studied for surviving rate and early-onset neonatal complications. Neonatal outcome has been compared to maternal conditions inducing very preterm births. Results: Neonatal surviving rate was more than 80% in all groups of obstetric pathologies and bronchopulmonary dysplasia was the major complication observed. Neonatal outcome was analyzed considering the role of ischemic and Inflammatory placental diseases while neonates, born by cesarean section, were estimated both for gestational age and fetal weight (= 1500 gr). Data concluded that neonates, from 28,7-28,9 gestational age, weighted < 1500 gr, born by ischemic placental diseases have a higher risk for necrotizing enterocolitis, grade III-IV intraventricular hemorrhage, periventricular leukomalacia,bronchopulmonary dysplasia and mortality. Neonates born because of Inflammatory placental diseases, weighted < 1500 gr, have a major risk for patent ductus arteriosus and early-onset septicemia. Neonates >= 1500 gr, born after placental ischemic diseases show only early-onset septicemia as neonatal complication . Conclusions: Maternal-fetal complications influence neonatal outcome in very preterm births as well as fetal gestational age and ultrasound estimated fetal weight.
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COLCIAGO, ELISABETTA. « Near miss ostetrici in Italia : la sepsi, l’eclampsia, l’embolia di liquido amniotico e l’emoperitoneo spontaneo in gravidanza ». Doctoral thesis, Università degli Studi di Milano-Bicocca, 2021. http://hdl.handle.net/10281/304755.
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Stato dell'arte: gli studi che indagano la mortalità materna offrono preziose informazioni per migliorare la salute di donne e neonati. Tuttavia, in Paesi come l'Italia la mortalità materna è rara. Per ogni donna deceduta, molti altre vanno incontro a gravi complicanze durante il percorso nascita che comportano diversi conseguenze. Le condizioni pericolose per la vita, definite near miss, possono quindi arricchire la conoscenza in campo ostetrico fornendo dati relativi a fattori di rischio, prevenzione e trattamento di qeuste patologie ostetriche, per migliorare l'assistenza ostetrica e la salute di madre e neonati. Il Sistema di Sorveglianza Ostetrico Italiano (ItOSS) è stato generato per monitorare condizioni ostetriche rare in Italia. Nel 2017 ItOSS ha attivato un progetto per raccogliere near miss materni dovuti a sepsis, eclampsia, embolia di liquido amniotico (AFE) e emoperitoneo spontaneo in gravidanza (SHiP) in 9 Regioni italiane.
Scopo: stimare l'incidenza di eclampsia, sepsi, AFE e SHiP e descrivere l'assistenza erogata alle donne.
Metodi: studio descrittivo population-based, associato a studio caso-controllo per i casi di spesi nel post-partum con l'obiettivo di valutare i fattori di rischio associati al tale complicanza. I dati sono stati raccolti prospetticamente tramite schede di raccolta dati appositamente sviluppate all'interno di una piattaforma on-line tramite il seguente link: http://www.salutedonnabambino.it/ITOSS/login.asp. La conferma dello "zero mensile" era richiesta nel caso non fossero avvenuti casi. La raccolta dati ha avuto inizio in data 1/11/2017, concludendosi in data 31/10/2019 per i casi di sepsi e proseguendo fino al 31/3/2020 per i casi dovuti alle altre complicanze. L'analisi statistica è stata condotta considerando i casi di eclampsia e sepsi peripartum; i dati raccolti relativi ad AFE e SHiP saranno utilizzati per partecipare ad uno studio multi-nazione, promosso dall'International Obstetric Surveillance System Network (INOSS) per fornire dati validi su queste complicanze estremamente rare. La presente tesi fornirà i risultati relativi ad eclampsia e sepsi, poichè il numero di casi raccolti permette di restituire dati significativi ai professionisti sanitari
Risultati: lo studio ha raggiunto un buon tasso di partecipazione. Sono stati raccolti 109 casi di near miss dovuti ad eclampsia per un'incidenza di 0.15 ogni 1000 parti. I risultati indicano che vi è ampio spazio per il miglioramento nell'utilizzo profilattico di magnesio solfato nelle donne con precedente pre-eclampsia e di aspirina a basso dosaggio nelle donne alto rischio. Più di 3 donne ogni 10 hanno sviluppato una complicanza grave dopo l'episodio di eclampsia, probabilmente a causa di un'inappropriata stabilizzazione prima dell'espletamento del parto. L'incidenza di sepsi è stata stimata di 0.87 casi ogni 1000 parti. I risultati mostrano che 1 donna ogni 4 sviluppa gravi complicanze a seguito della sepsi. Questo potrebbe trovare una spiegazione nelle diverse criticità rilevate: diagnosi tardiva, trattamento tardivo ed inappropriato, numero eccessivo di esplorazioni vaginali in travaglio e mancata tecnica asettica durante le procedure.
Conclusioni: questa ricerca offre informazioni significative sulla popolazione italiana, non disponibili in precedenza. Lo studio rappresenta una fonte di informazioni unica per permettere l'identificazione delle criticità relative all'assistenza, che orientino verso strategie di intervento mirate al miglioramento della qualità delle cure e alla promozione di una pratica ostetrica basata sulle evidenze.Background: Data on maternal mortality offers valuable information to improve women’s health. In countries such as Italy maternal mortality is a rare event. For each death, many other women survive serious complications during pregnancy, birth and the post-natal period that lead to different degree of sequelae. Life-threating conditions, defined as near miss, could provide additional information on disease risk factors, prevention and treatment for promoting best practices, improving quality of care and achieving better health for mothers and babies. The Italian Obstetric Surveillance System (ItOSS) was set up to monitor the maternal morbidity rate in Italy. In 2017 ItOSS activated a project to collect maternal near miss cases due to sepsis, eclampsia, amniotic fluid embolism (AFE) and spontaneous haemoperitoneum in pregnancy (SHiP) in 9 Italian Regions. Aim: To estimate the incidence rate of eclampsia, sepsis, amniotic fluid embolism and spontaneous haemoperitoneum in pregnancy and to describe the care provided during the near miss episode. Method: A Population-based descriptive study was conducted, a case-control design was applied only on post-partum sepsis cases to evaluate risk factors associated to the complication. Data were obtained through a prospective active collection of cases by a monthly call according to the principle of nothing-to-report, along with data collection forms that confirm the diagnosis and gather detailed information. Data collection occurred web-based since November 2017 through http://www.salutedonnabambino.it/ITOSS/login.aspx and was completed on the 31st of October 2019 for the sepsis cases, while the remaining complications were investigated until the 31st of March 2020. Statistical analysis was performed on eclampsia and peripartum sepsis cases; data collected on AFE and SHiP will be used to participate into a multi-national study promoted by INOSS, with the aim to give a stable incidence about this extremely rare conditions. For this reason this thesis will present findings regarding Eclampsia and Sepsis, of which there are sufficiently enough cases to give a useful feedback to healthcare professionals. Results: Our study achieved good participation and response rates. A total of 109 near misses of eclampsia were identified, representing an estimated incidence rate of 0.15 cases per 1,000 births. Findings indicated that there is space to improve the use of magnesium sulphate as prophylactic treatment in women diagnosed with pre-eclampsia and underlighted the importance of population risk stratification to administer low-dose aspirin to high risk women and at the appropriate time. More than 3 women in 10 developed sever complications after the eclamptic episode, this could be due to an inappropriate stabilization before birth. Sepsis estimated incidence rate was 0.87 cases per 1,000 births. The high rate of women who developed severe complications, might reflect the inappropriate time of diagnosis and treatment prescribed to our population. Findings reported different major criticisms during the care of women with sepsis: delayed diagnosis and treatment, the administration of inappropriate antibiotic therapy, the high number of vaginal examinations in labour and the need of correct aseptic technique during all procedures. This might reflect the high rate of women, 1 in 4, with severe complications after sepsis. Conclusions: This research developed significant information concerning obstetric disorders related to the Italian population, prior to this project no Italian data were available. The present study offers an unique source of information and allows to identify the Italian system or clinical practice related-failures, in order to address strategies and strengths to improve the quality of maternal health care and promote an evidence-based practice.
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DATI, STEFANO. « Mesh sintetica vs biosintetica : studio comparativo nel trattamento dei prolassi genitali severi ». Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2009. http://hdl.handle.net/2108/931.
Texte intégralRésumé :
L’autore, dopo una breve esposizione sulle strutture anatomiche di supporto del pavimento pelvico e sulla fisiopatologia ed eziopatogenesi del prolasso genitale, enfatizza l’utilizzo di materiali protesici nel loro trattamento chirugico. Evidenzia le indicazioni nella terapia sostitutiva fasciale e l’evoluzione dei diversi materiali utilizzati, elencandone caratteristiche e limiti. Esamina dettagliatamente le complicanze mesh-related, la loro prevenzione e gestione. Nello studio comparativo condotto su 158 pazienti, affette da prolassi severi, verifica i risultati confrontando materiali dalle diverse proprietà fisico-chimiche attraverso 2 procedure chirurgiche con accesso transvaginale. Le pazienti selezionate e divise in 2 gruppi sono state sottoposte a scrupoloso work-up uroginecologico preoperatorio e follow-up a 3-6-12-24 mesi.
Conclude riportando gli esiti anatomici e funzionali delle 2 procedure e gli effetti sulla qualità di vita deducendone alcune considerazioni, legate all’utilizzo dei materiali protesici nella correzione dei difetti del pavimento pelvico.After providing a brief outline of both the anatomical support structures of the pelvic floor and the pathophysiology and etiopathogenesis of genital prolapse, the Author emphasises the use of prosthetic materials in prolapse surgery. The indications for fascial replacement are described and the evolution of the different materials used is discussed, including their characteristics and constraints. Mesh-related complications, as well as their prevention and management, are examined in detail. In the comparative study of 158 female patients with severe prolapse, the results are verified by comparing two transvaginal procedures using materials with different physical-chemical properties. The patients selected were divided into 2 groups and underwent a thorough preoperative urogynecological work-up as well as a follow-up at 3, 6, 12, and 24 months. In conclusion, the anatomical and functional outcomes of both procedures and the effects on the quality of life are reported. Some considerations are drawn concerning the use of prosthetic materials in the repair of pelvic floor defects.
Livres sur le sujet "Severe complicanze"
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Szabova, Alexandra, et Kenneth R. Goldschneider. Opioid-Tolerant Patient. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0043.
Texte intégralRésumé :
Caring for patients who are taking chronic opioids may present several challenges for clinicians in the operating room and in the immediate postoperative period. Factors such as tolerance and opioid-induced hyperalgesia can complicate perioperative pain management.
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Chong, Ji Y., et Michael P. Lerario. Hypertension and Confusion. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190495541.003.0025.
Texte intégralRésumé :
Posterior reversible encephalopathy syndrome is a clinical–radiographic syndrome of progressive headaches, blurred vision, confusion, and seizures in the setting of vasogenic edema on brain imaging, which is often localized to the posterior white matter. The symptoms are classically triggered by severe hypertension, pregnancy and the puerperium, or exposure to immunosuppressive medications. The symptoms can be reversible if the offending etiology is quickly removed, but permanent deficits can remain if strokes or hemorrhage complicate the clinical course.
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Jayne, David. The patient with vasculitis. Sous la direction de Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0157.
Texte intégralRésumé :
The definition of vasculitis syndromes relies on clinical, serological, and pathological descriptions. A number of primary syndromes are recognized, of presumed autoimmune aetiology, but vasculitis may also occur as a secondary disease process. The heterogeneity of clinical presentation, low specificity of many clinical features, and mimics of other diseases complicate vasculitis diagnosis. The kidney is the most common severe manifestation for small vessel vasculitis syndromes and the severity of renal involvement predicts end-stage renal failure risk and death. Suspicion of vasculitis is key to early diagnosis and improving outcomes of vasculitis patients.The current understanding of the classification of vasculitis syndromes is presented in this chapter along with descriptions of clinical presentations, and approaches to diagnosis.
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Hodgkiss, Andrew. Psychiatric consequences of particular cancers. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198759911.003.0004.
Texte intégralRésumé :
Certain tumour types can cause psychopathology through direct biological mechanisms such as metastatic spread to the brain, release of onconeuronal antibodies, ectopic hormone secretion, or release of pro-inflammatory cytokines. Lung cancers, adenocarcinoma of the pancreas, brain tumours, and ovarian tumours are considered in detail. Confusional states due to brain metastases, syndrome of inappropriate ADH secretion, hypercalcaemia of malignancy, and anti-Hu encephalitis are found in lung cancers. Severe depression, due to interleukin-6 release and its actions on the HPA axis and tryptophan metabolism, is common in adenocarcinoma of the pancreas. Anti-NMDA-receptor limbic encephalitis, clinically indistinguishable from acute schizophrenia, can complicate teratomas. Gliomas, pituitary tumours, and thyroid, adrenal, and testicular tumours can also disrupt mental health through various biological mechanisms described here.
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Hodgkiss, Andrew. Further clinical issues. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198759911.003.0012.
Texte intégralRésumé :
The clinical challenges arising when a person with a severe mental illness, such as schizophrenia or bipolar disorder, develops a cancer are surveyed. Delayed diagnosis and access to oncological treatment, factors contributing to reduced adherence, and the interruption of specialist community psychiatric care are discussed. Long-term psychotropic medication may complicate end-of-life care, and access to palliative care is usually limited for those in secure mental health inpatient units. The striking inverse relationship between neurodegenerative disorders (Alzheimer-type dementia) and proliferative disorders (cancers) is considered.Psychiatric aspects of haematopoietic stem cell transplantation (HSCT) are reviewed, including psychopathology arising from drugs used to prevent graft-versus-host disease and from infections complicating chronic immunosuppression. Cognitive impairment and suicide after HSCT are considered.
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Anderson, John A., Pierre-Antoine Laloë et Derek J. Tuffnell. Hypertension in pregnancy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0036.
Texte intégralRésumé :
The hypertensive disorders of pregnancy encompass a spectrum of disease, including gestational hypertension, haemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), and acute fatty liver of pregnancy through to pre-eclampsia and eclampsia. These conditions can pose significant problems for clinicians and are associated with significant morbidity and mortality for both mother and baby. Pre-eclampsia and eclampsia remain one of the leading causes of maternal death worldwide. The majority of fatalities occur in settings with low healthcare resources. In the developed world, improvements over the last 60 years in antenatal and intrapartum care, along with national surveillance and audit, have led to tenfold and fivefold reductions in absolute mortality and severe morbidity from eclampsia and pre-eclampsia respectively. Conversely, the incidence of pre-eclampsia has been rising in the developed world as the average age of first maternity increases and rates of obesity and other medical conditions rise. It is therefore increasingly likely that hypertension may complicate the obstetric and anaesthetic management of pregnant women.
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Carney, Colleen E., et Taryn G. Moss. Sleep Disorders and Depression. Sous la direction de C. Steven Richards et Michael W. O'Hara. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199797004.013.012.
Texte intégralRésumé :
Major depressive disorder (MDD) commonly occurs with several sleep disorders, including hypersomnia, breathing or limb-related sleep disturbances, and most notably chronic insomnia. A bidirectional relationship exists between sleep and mood problems, and both issues often warrant timely clinical management. However, there are several assessment- and treatment-related complexities that complicate the clinical management of such patients. For example, there are several overlapping symptoms for MDD and both insomnia and hypersomnia, and the two sleep conditions are both listed as possible symptoms in the diagnostic criteria for MDD. This has led to a well-documented problem of underrecognizing and undertreating these significant disorders in the context of MDD. Moreover, certain effective depression treatments can actually worsen the coexisting sleep disorder. Understanding and treating both disorders (i.e., MDD and the co-occurring sleep disorder) is imperative for effective clinical care. Almost all (i.e., up to 90%) of those with depression report sleep problems. This chapter provides an overview of the etiologic, assessment, and treatment issues inherent in this very large, highly prevalent group.
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Bonazzi, Mauro. Plato Systematized : Doing Philosophy In The Imperial Schools. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198815655.003.0006.
Texte intégralRésumé :
The paper is an examination of an anonymous Latin text, which has been tentatively attributed by its editor, Justin A. Stover, to Apuleius. This text contains the summaries of several of Plato’s dialogues, but its proper function seems to be the identification of the main doctrines that constitute his philosophical system. Clearly it is a typical school product, whose content belongs to Middle Platonism. But it also presents some interesting and distinctive features. Particularly noteworthy is the heavy presence of Stoic terms and doctrines and the emphasis on Plato’s political philosophy. These can be paralleled with what we read in Apuleius’ De Platone et eius dogmate. At the same time there are also some important differences which complicate the hypothesis of Apuleian authorship.
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Kar, Robin Bradley, et John Lindo. Race and the Law in the Genomic Age. Sous la direction de Roger Brownsword, Eloise Scotford et Karen Yeung. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780199680832.013.55.
Texte intégralRésumé :
Despite the ‘Age of Genomics’, many scholars who study race and the law resist biological insights into human psychology and behaviour. Contemporary developments make this resistance increasingly untenable. This chapter synthesizes recent findings in genomics and evolutionary psychology, which suggest cause for concern over how racial concepts function in the law. Firstly, racial perceptions engage a ‘folk-biological’ module of psychology, which generates inferences poorly adapted to genomic facts about human populations. Racial perceptions are, therefore, prone to function in ways more prejudicial than probative of many issues relevant to criminal and civil liability. Secondly, many folk biological inferences function automatically, unconsciously, and without animus or discriminatory intent. Hence, current equal protection doctrine, which requires a finding of discriminatory intent and is a central mechanism for guaranteeing people equal treatment under the law, is poorly suited to that task. These facts support but complicate several claims made by Critical Race Theorists.
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Dhand, Rajiv, et Michael McCormack. Bronchodilators in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0033.
Texte intégralRésumé :
Inhaled beta-agonists and anticholinergic agents, as well as systemically administered methylxanthines, are frequently employed to achieve bronchodilation in critically-ill patients. Inhaled agents are given by pressurized metered dose inhaler (pMDI), nebulizer, or dry powder inhaler. In ventilator-supported patients, aerosolized agents are generally only administered by pMDI or nebulizer. The ventilator circuit, artificial airway, and circuit humidity complicate the delivery of aerosolized agents, and there is a wide variability in drug delivery efficiency with various bench models of mechanical ventilation. Aerosolized drug by pMDI is affected by the use of spacer devices, synchronization of pMDI actuation and ventilator breath delivery, and appropriate priming of the pMDI device. The efficiency of aerosolized drug delivery by jet nebulization is also affected by device placement in the circuit, as well as by a number of other factors. Several investigators have demonstrated comparable efficiency of aerosol delivery with mechanically-ventilated and ambulatory patients when careful attention is given to the technique of administration. Appropriate administration of aerosolized bronchodilators in patients receiving invasive or non-invasive positive pressure ventilation produces significant therapeutic effects.
Chapitres de livres sur le sujet "Severe complicanze"
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Fries, Christian, Patricia Hölscher, Oliver Brützel, Gisela Lanza et Thomas Bauernhansl. « Approach for Evaluating Changeable Production Systems in a Battery Module Production Use Case ». Dans Lecture Notes in Mechanical Engineering, 207–16. Cham : Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-18326-3_21.
Texte intégralRésumé :
AbstractVolatile markets continue to complicate manufacturing companies’ production system design, leading to efficiency losses due to imperfect system setups. In such a market environment, a perfect system setup cannot be achieved. Therefore, changeable production systems that cope with immanent uncertainty gain interest in research and industry. For several decades, changeable production systems have been in the research and development stage. The advantages and disadvantages are well investigated. So far, however, they have gained only limited acceptance in industry. One of the reasons is the difficult evaluation of the benefits. Existing investment calculation methods either neglect many effects of changeability, such as easier adaptation to unpredictable events, or are too complex and therefore too time-consuming to become standard. Thus, a practical evaluation method is needed that considers these changeability aspects. This paper deviates the industry requirements regarding an evaluation method based on an industry survey and develops a practical approach for an evaluation method for a changeable production system considering monetary and non-monetary aspects. The approach is characterized by a calculation that is as accurate as possible considering the existing input factors. The method shows that changeable production systems excel in environments with frequent need for adaptation. The approach is applied to a battery module assembly in the ARENA2036 research campus.
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Rietjens, Sebastiaan. « Intelligence in Military Missions : Between Theory and Practice ». Dans Handbook of Military Sciences, 1–20. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-02866-4_96-1.
Texte intégralRésumé :
AbstractIntelligence is the primary mechanism that military organizations use to generate understanding and its main purpose is to provide information to decision-makers such as commanders that may help illuminate their decision options. This chapter assesses the role of intelligence in military missions, more specifically the counterinsurgency and stabilizations missions that took place in, for example, former Yugoslavia, Iraq, Afghanistan, and Mali.The chapter starts by addressing the changing and increasingly complex nature of many of the conflicts from the 1990s onwards. It explores how this has influenced the use of intelligence and presents two distinct schools of thought. The first school of thought, referred to as Jominian intelligence, tries to unravel the operational environment in a systematic way and regards the intelligence challenges as a series of problems with definite solutions. The second school of thought, referred to as Clausewitzian intelligence, argues that the goal of intelligence is to assess uncertainty and reach a deliberate judgment.The main body of the chapter then analyzes the intelligence process and identifies several of the main intelligence issues within military missions. The intelligence process starts with the direction phase in which policy makers, military commanders, or planners state their needs, often referred to as information requirements. Several issues complicate such direction, including (1) the comprehensive focus of many current military missions, (2) their abstract and ambiguous strategic objectives and expectations, and (3) the military’s unfamiliarity with the area of operations.In the second phase of the intelligence process, the necessary information is collected. In addition to consulting their archives and databases, military units often have a plethora of means, both technical and human, available to collect information. Cross-cultural competencies are of crucial importance, in particular, during the collection phase.The third phase of the intelligence process, labeled processing, turns raw data into intelligence. During the processing phase, the data are analyzed in order to gain understanding or insight. This exceeds the registration of events, but includes understanding the meaning of these events as well as their importance.The fourth and final phase is dissemination of intelligence. Here, the relationship between the producers and consumers of intelligence during military missions is explored. This includes the reasons why consumers sometimes do not fully accept the intelligence they receive.The chapter concludes with an agenda for research on military intelligence. It calls, for example, for a more eclectic author base; multidisciplinary as well as comparative research; increased attention to oversight, ethics, and open source intelligence; and more emphasis on intelligence within the navy, special forces, and constabulary forces.
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LaHue, Sara C., et Morris Levin. « Intracranial Mass in a Person with HIV ». Dans Emergency Neurology, sous la direction de Sara C. LaHue et Morris Levin, 83–90. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190064303.003.0015.
Texte intégral
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Bisson, Jonathan I. « Acute stress disorder, adjustment disorders, and post-traumatic stress disorder ». Dans Oxford Textbook of Medicine, sous la direction de Michael Sharpe, 6506–9. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0635.
Texte intégralRésumé :
Acute stress disorder, adjustment disorders, and post-traumatic stress disorder are all psychiatric consequences of traumatic experiences. Because trauma is so common in medical practice, in the form of accidents, severe illness, and sometimes medical and surgical treatments, these disorders are commonly seen by physicians. An initial severe reaction to a traumatic event such as severe accident is an acute stress disorder and is commonly characterized by dissociation. A more long-lasting emotional reaction to ongoing stress such as a new diagnosis of life-threatening illness is termed an adjustment disorder. An often longer-lasting and more severe psychological reaction associated with repeated mental re-experiencing of the traumatic event is called post-traumatic stress disorder. These trauma-related disorders are not only an important cause of suffering but may also complicate medical care, hence they require recognition and appropriate treatment.
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Schwarz, Maureen Trudelle. « How Age-Old Cultural Tenets Complicate the Care of Premature or Sick Navajo Newborns ». Dans Religion and Ethics in the Neonatal Intensive Care Unit, 155–83. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190636852.003.0010.
Texte intégralRésumé :
Each of the hundreds of indigenous groups in Native North America has its own beliefs about the body, personhood, health, and illness, which directly influence care and treatment of premature and sick newborns. This chapter is limited to how members of the Diné Nation (more commonly known as the Navajo) think about these issues. Differences of opinion invariably exist between biomedical practitioners’ and Navajo family members’ understandings of the causes, treatments, and appropriate care for the child. Several factors will be at play: among them are differences acknowledged between Navajo and non-Navajo people; notions of contamination; and medical and religious pluralism. Also relevant are numerous age-old Navajo tenets on the body and personhood, including relational notions of personhood; beliefs about how detached body parts retain lifelong influence; assumptions regarding the malleability of a newborn’s body; prohibitions against cardiopulmonary resuscitation and blood transfusions; and convictions about the power of language.
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Ricciardi, Lucia, Alan J. Carson et Mark J. Edwards. « Recognition and management of functional symptoms after traumatic brain injury ». Dans Oxford Textbook of Neurorehabilitation, sous la direction de Volker Dietz, Nick S. Ward et Christopher Kennard, 412–18. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198824954.003.0030.
Texte intégralRésumé :
Traumatic brain injury (TBI) is a common and disabling disorder. Most TBIs are ‘mild’, but in such patients a small proportion of people develop persistent, sometimes severe, symptoms. Here we present evidence that at least a proportion of these people, often labelled as having ‘post-concussion syndrome’, in fact have a functional neurological disorder. Psychiatric (e.g. anxiety, depression) and medical (migraine, side effects of medication) comorbidities are common and can complicate the clinical picture in such patients. Symptoms relating to an actual TBI and functional symptoms can also co-occur, a situation usually described as ‘functional overlay’. This chapter discusses the diagnosis and management of this common clinical scenario.
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Brooks, Peter. « Burns itch ». Dans Burns (OSH Surgery), 315–20. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780199699537.003.0036.
Texte intégralRésumé :
Post-burns itch, or pruritus, is one of the most common and distressing complications of burn injury. It typically begins in the first two weeks after the injury, and may last for several years. Post-burn pruritus can interfere with daily activities, and also complicate healing when scratched. This chapter outlines the causes, epidemiology, and biology of itching then provides an overview of therapies available. Assessment scales and the classification of types of pruritus are also outlined.
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Turner, Deborah, et Philip Helliwell. « Spondyloarthropathies ». Dans The Foot and Ankle in Rheumatology, 103–18. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198734451.003.0007.
Texte intégralRésumé :
The spondyloarthropathies include ankylosing spondylitis and psoriatic arthritis. The hallmark clinical features are inflammatory spinal disease, dactylitis, and enthesitis, together with an asymmetrical oligoarthritis, often of the lower limbs. Psoriaform skin and nail changes are also frequently seen, and, less commonly, but characteristically, a mutilating arthritis with severe deformity of the toes. These unique features often allow a diagnosis to be made purely on clinical examination of the lower limbs. However, these features also provide challenges for local treatments as skin disease may complicate the use of orthoses and percutaneous steroid injections. However, the importance of mechanical factors in the pathogenesis of these disorders almost mandates a combined mechanical and pharmacological approach to treatment.
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Villa García Ugarte, Susana, et Luis Enrique Miranda Calderón. « Anxiety, Depression, and Delirium in Terminally Ill Cancer Patient ». Dans Supportive and Palliative Care and Quality of Life in Oncology. IntechOpen, 2023. http://dx.doi.org/10.5772/intechopen.107325.
Texte intégralRésumé :
Most terminally ill cancer patients present some degree of anxiety, depression, or delirium. In many cases family concerns, the prognosis of the disease, the type of treatment, and its adverse effects aggravate these emotional symptoms to the point of turning them into severe affective disorders which severely complicate their emotional state, their physical condition and their disposition and response to treatment. Although these are high prevalence disorders in terminally ill cancer patients, they often go undiagnosed and therefore do not receive treatment. An early diagnosis and adequate treatment, that includes emotional accompaniment, can greatly help to maintain the quality of life or even improve it and make these patients and their families move in a dignified way toward death. The scope of this chapter is to establish the presence of anxiety, depression and delirium in terminally ill cancer patients through scientific evidence; review the opinion of experts in the field on the most appropriate treatment, and the influence on the beneficial impact of interventions with family members or support people to ensure a more positive approach to the circumstances of these patients and serve as support for the treatment of medical personnel.
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Nadeau, Kristen. « Case 8 : Metabolic Syndrome-Related Comorbidities Typical of Older Adulthood Complicate Diabetic Ketoacidosis in a Youth with Type 2 Diabetes ». Dans Diabetes Case Studies : Real Problems, Practical Solutions, 26–31. American Diabetes Association, 2015. http://dx.doi.org/10.2337/9781580405713.08.
Texte intégralRésumé :
A 13-year-old, obese boy initially presented with DKA and severe dehydration. He developed a sore throat 3 weeks prior to admission (PTA), which resolved without therapy. Concurrently, the family noted symptoms of polyuria and polydypsia, which did not remit. One week PTA, vomiting began, worsening 2 days PTA. On the day of admission, he was confused, sleepy, and complained of headache. Past medical history was positive for sickle cell trait and obesity. At age 6 years, he weighed 39 kg and blood pressure (BP) was recorded as 150/80 mmHg and at 138/83 mmHg on repeat. He was seen by his primary care provider 4 months PTA at which time blood glucose (BG) was normal. Family history included type 2 diabetes in multiple relatives.
Actes de conférences sur le sujet "Severe complicanze"
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Danehy, Paul M., Ernest J. Friedman-Hill et Roger L. Farrow. « Population and Thermal Grating Contributions to Degenerate Four-Wave Mixing Line Shapes ». Dans Laser Applications to Chemical Analysis. Washington, D.C. : Optica Publishing Group, 1994. http://dx.doi.org/10.1364/laca.1994.wd.4.
Texte intégralRésumé :
Degenerate four-wave mixing (DFWM) is a laser-induced grating technique that shows increasing potential as a diagnostic probe for reactive environments. Traditionally, the development of DFWM as a diagnostic for gaseous systems has focused on using the population-grating (PG) mechanism to measure concentration and temperature. Recently, several authors have observed a thermal-grating (TG) mechanism in gases. This mechanism is similar to that observed for many years in liquids and solids.1 The gas-phase thermal-grating mechanism deserves further study since it can complicate population-grating measurements, or can itself be useful for making quantitative measurements.
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Ali, Liaqat, Shan Jin et Yong Bai. « Risk Assessment and Reliability Analysis of Subsea Production Systems ». Dans ASME 2020 39th International Conference on Ocean, Offshore and Arctic Engineering. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/omae2020-19283.
Texte intégralRésumé :
Abstract In past years, offshore oil and gas accidents have often occurred. Environmental hazards have the capability of turning into very difficult to manage in addition with the modern technology limits and lack of a fail-safe operation that can identify, control and terminate the accidents. However, the offshore crude oil also natural gas search and development is expanding to deep-water and moving promptly to the subsea production systems. (SPS). Though, the complicate subsea equipment material besides frequency offshore disasters stimulated the consideration onto the risk analysis of subsea systems. Detection of the impact of deep-water oil and gas reserves in the subsea production system. However, loss of SPSs can contribute to massive industrial failure, severe natural pollution, and indeed serious disasters. Therefore, the reliability analysis and safety of SPS have turned into a dominant consideration. This study addresses on the hazards and risk conditions which must be concentrated in the subsea machinery associated within surface equipments. Furthermore, the risks identification also the risk investigation onto subsea “Xmas tree” system is brought out. An over-all risk avert procedure of subsea “Xmas tree” system is represented, also the reliability evaluation method. Moreover, several recommendations on subsea production maintenance and detection are given in this research. This paper is reviewing the following section, subsea production system, hazards or risk identification, environmental issues, hydrate problems, corrosion problems, safety issues, risk assessment on subsea “Xmas tree”, reliability issues of a subsea system.
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Timusk, Markus A., Michael G. Lipsett et Chris K. Mechefske. « Automated Duty Cycle Classification for Online Monitoring Systems ». Dans ASME 2007 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. ASMEDC, 2007. http://dx.doi.org/10.1115/detc2007-34666.
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Transient operation of machinery can greatly complicate the task of vibration-based online condition monitoring. Because the operating mode of a machine affects the physical response and hence the diagnostic parameters, real-time information regarding the operating mode is likely to improve the performance of an online fault detection system. This paper proposes a method for automated duty cycle classification to augment the performance of vibration-based online condition monitoring systems for applications such as gearboxes, motors, and their constituent components. Experimental work is carried out on the swing machinery of an electromechanical excavator, which demonstrates how such a method might function on actual dynamic signals gathered from an operating machine. Several variations of the system are tested.
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Rowan, Olga K., et Michael A. Pershing. « Best Practice for Metallurgical Quality Evaluation of Nitrided Components ». Dans HT2019. ASM International, 2019. http://dx.doi.org/10.31399/asm.cp.ht2019p0177.
Texte intégralRésumé :
Abstract Surface hardening by nitriding is a commonly used heat treatment to enhance tribological characteristics, fatigue, and corrosion resistance of ferrous components. Nitrided white layer is known for its high hardness but also for its brittle nature. It is not uncommon to see white layer chipping or breakaway during metallurgical sample preparation that may complicate the analysis of the ‘true’ white layer characteristics in the microstructure of the nitrided load. This paper discusses the results of the several studies performed to evaluate the effect of cutting and polishing operation, polishing pressure, use of foils, and Ni plating. Best practice procedure has been developed for metallurgical sample preparation to minimize uncertainty in parts quality evaluation.
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McDuff, Glen. « Electrical considerations of high average power pulsed lasers ». Dans OSA Annual Meeting. Washington, D.C. : Optica Publishing Group, 1989. http://dx.doi.org/10.1364/oam.1989.tuaa1.
Texte intégralRésumé :
Many power conditioning aspects not considered or ignored in low average power pulsed lasers can complicate and degrade performance and operation in higher power systems. With electrical to optical conversion efficiencies of the order of a few percent, to achieve an output of several hundred watts requires many tens of kilowatts input power. In the case of high repetition rate machines, the associated high rms currents accentuate the effect of component equivalent series resistance (I2R) and design of interconnecting conductors. If high average power is achieved by increasing the peak pulse power, mechanical stress, component mounting, and layout become critical design issues. These effects greatly impact the cost, longevity, reliability, availability, and maintainability of the laser system.
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Reynolds, Whitney D., Sungeun K. Jeon, Jeremy A. Banik et Thomas W. Murphey. « Advanced Folding Approaches for Deployable Spacecraft Payloads ». Dans ASME 2013 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/detc2013-13378.
Texte intégralRésumé :
Radio communications apertures for spacecraft have long been implemented using deployable architectures in order to fit within the allowable launch vehicle volume. Apertures for optics missions have traditionally not been segmented because of the tight requirements on the deployed surface. By the nature of the problem, larger apertures are generally better, but complicate orbital delivery. While there are several reflectors commercially available, high packing ratios come at very high cost due to the extremely complex nature of the designs. Researchers at the Space Vehicles Directorate have been investigating ways to enable high packing ratios while reducing the design, integration, and testing complexity of deployable systems, thereby driving down cost and enabling greater mission capabilities. Recent advances in flexible composites have opened up the possibilities of packaging apertures using either distributed or concentrated strain. This paper offers an overview of recent work done to enable lower complexity deployable apertures. Several origami-inspired designs are presented including a flat spiral folding membrane, a parabolic antenna reflector, and a phased array structure.
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Zheng, Zhaoli, Zixuan Li, Di Zhang, Yonghui Xie et Zheyuan Zhang. « Numerical Investigation on the Nonlinear Dynamics of Anisotropic Breathing Cracked Rotor Systems ». Dans ASME Turbo Expo 2020 : Turbomachinery Technical Conference and Exposition. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/gt2020-14415.
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Abstract The nonlinear breathing crack behaviors and anisotropy of the bearing are important sources of severe vibration of rotor systems. However, the rotor system considering both of these factors has not gained sufficient attention in the existing studies. In this paper, the nonlinear dynamics of such anisotropic breathing cracked rotor system is investigated based on three-dimensional finite element model (FEM). Firstly, the equations of motion of the rotor system are established in the rotating frame to facilitate the modeling of the breathing crack. The fixed-interface component mode synthesis (CMS) is used to reduce the system’s degrees of freedom (DOFs). Then, in the process of solving the equations by harmonic balance method (HBM) and Newton-Raphson method, an original method for fast calculating tangent stiffness matrix is proposed. Finally, the effects of the crack depth, the anisotropy of bearing and relative angle between bearings on the nonlinear dynamics of the system are studied. The results show that the breathing behavior will complicate the vibration and introduce additional transverse stiffness. The increase of crack depth will deteriorate the vibration. The anisotropy and relative angle of bearing will lead to the splitting and merging of the resonant peaks, respectively.
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Wagersten, Ola, Casper Wickman et Rikard So¨derberg. « Non-Rigid Behavior Prediction Based on Styling Data for Evaluation of Perceived Quality ». Dans ASME 2009 International Mechanical Engineering Congress and Exposition. ASMEDC, 2009. http://dx.doi.org/10.1115/imece2009-11191.
Texte intégralRésumé :
In the automotive industry it is of great importance to manage the impact of part and assembly variation as it affects aesthetical aspects of the final Perceived Quality, such as the appearance of flush, parallelism and gaps in split-lines. By using a CAT (Computer Aided Tolerancing) software simulating tolerances, in combination with a high-end visualization tool, evaluations are made to judge a predicted outcome of the final Perceived Quality. When a new styling concept needs to be evaluated the data used for analysis and visualization will be less mature and the fact that several vehicle components are non-rigid will further complicate the realization of non-nominal visualization. The deformation behavior of non-rigid components is dependent on several parameters such as part shape, position of reference points, flanges, reinforcements etc. Such information is most likely not available when evaluating a new styling concept, represented only by a surface skin. This paper discusses the possibility to use this limited information, defined as styling data, as a basis when performing non-nominal visualization and evaluation of Perceived Quality based on deformable non-rigid components. The insufficient information is supplemented by collecting and comparing data from prior projects to enable non-rigid behavior prediction of components as such.
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Zhao, Danyang, Yujie Li, Minjie Wang, Chunzheng Duan et Zhong You. « Fabrication of Polymer Origami-Based V-Type Folded Core ». Dans ASME 2015 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2015. http://dx.doi.org/10.1115/detc2015-46686.
Texte intégralRésumé :
The origami-based folded core has a broad prospect in applications. However, the fabrication difficulties limit its developments due to the complicate structures with multiple zigzags and fluctuations. In this study, several feasible methods to fabricate polymer origami-based folded core were proposed. Based on the analysis of folded structural features, the vacuum forming process of polymer V-type folded core was deeply investigated. Wall thickness distributions of the folded structure on polyvinyl chloride (PVC) and polyethylene terephthalate (PET) sheets were measured. The results showed that the wall thickness along the straight crease line presents a single peak distribution, while that along the zigzag one shows a dual peak distribution, and the wall thickness of the top zigzag crease line is more uniform and large than that of the bottom one. The mold temperature, polymer sheet temperature and material properties of polymer have great influence on product thickness. Vacuum forming is a feasible way to fabricate polymer origami-based folded core, and the high-quality fabrication of folded structure may be accomplished by designing more reasonable forming mold and selecting optical process parameters.
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Ostenfeld, Klaus H. « New trends and requirements in bridge and structural engineering ». Dans IABSE Symposium, Guimarães 2019 : Towards a Resilient Built Environment Risk and Asset Management. Zurich, Switzerland : International Association for Bridge and Structural Engineering (IABSE), 2019. http://dx.doi.org/10.2749/guimaraes.2019.0028.
Texte intégralRésumé :
<p>Traffic infrastructure and buildings represent the biggest investments in the modern society, and life expectancy is expected to be several hundreds of years. At the same time traffic and housing needs increase and mode of use changes faster than ever - a trend that is expected to increase. Also the societal requirements for safety increase and to complicate matters the technologies and ma- terials available are increasing and new technologies appear at short intervals. Further, the future developments are expected by society to meet rapidly increasing sustainability requirements and limitation on use of resources, all with minimal climatic footprint.</p><p>These trends will change the role of the structural engineer and the way he/she adresses this much more complicated and demanding environment in close cooperation with specialists in other do- maines.</p><p>The lecture will address these subjects and hopefully create a basis for debates and meaningful discussions with innovative solutions in our various structural engineering fora including IABSE.</p>