L'inhalation pulmonaire du contenu gastrique représente l'une des principales causes de mortalité liée à l'anesthésie en France. La physiopathologie de cette complication fait intervenir, entre autres, la présence d'un contenu gastrique à l'origine d'une augmentation de la pression intragastrique favorisant la survenue de régurgitations et d'inhalations pulmonaires lors de l'anesthésie générale. La prévention de cette complication repose sur l'identification des patients à risque, ainsi que sur l'établissement de stratégies permettant de réduire le contenu gastrique. Suivant ces deux objectifs, nous avons conduit quatre études. Nous avons décrit et évalué l'apport de la mesure échographique de l'aire de section antrale pour l'estimation du volume du contenu gastrique en période préopératoire afin d'identifier les patients à risque d'inhalation pulmonaire. Nous avons montré chez des volontaires sains que la perfusion de 250 mg d'érythromycine est efficace pour accélérer la vidange gastrique des aliments solides lors de la gastroparésie induite par un stress douloureux. Enfin, nous avons déterminé le niveau de pression inspiratoire minimisant l'insufflation d'air dans l'estomac tout en assurant une ventilation satisfaisante lors de la ventilation au masque facial précédant l'intubation trachéale. Ce dernier résultat doit contribuer à modifier les recommandations afin d'améliorer la sécurité des patients lors de la ventilation au masque facial en anesthésie. En perspective d'avenir, l'échographie antrale permettra la réalisation d'études cliniques visant à préciser chez les patients opérés en urgence le risque d'inhalation pulmonaire et évaluant l'efficacité des mesures de prévention / Pulmonary aspiration of gastric content is one of the main causes of mortality related to anesthesia in France. The pathophysiology of this complication involves, among others, the presence of gastric content causing an increase in intragastric pressure leading to regurgitation and pulmonary inhalation during general anesthesia. Prevention of this complication is based on both identifying patients at risk and developing strategies to reduce the gastric contents. Following these two objectives, we conducted four studies. We have described and assessed the contribution of the ultrasound measurement of the antral cross-sectional area for estimating the preoperative volume of gastric content, in order to identify patients at risk of pulmonary aspiration. We have shown in healthy volunteers that the infusion of erythromycin 250 mg was effective in accelerating gastric emptying of solids during gastroparesis related to acute painful stress. Finally, we determined the level of inspiratory pressure that minimizes the risk of gastric insufflation while providing adequate ventilation during facemask ventilation performed prior to tracheal intubation. This result should contribute to the revision of the current recommendations, in order to improve the patient safety during facemask ventilation. In the future, ultrasound measurement of antral area can be used in clinical studies in order to clarify the risk of pulmonary aspiration of gastric content in emergency surgical patients, and to assess the effectiveness of preventive measures

Author: Bc. Anežka Zasadilová Title: The effect of physiotherapy on patients with gastroesophageal reflux disease Objectives: The aim of this thesis is to design a therapeutic unit and evaluate its effect on long-term treatment in the therapy of selected patients with gastroesophageal reflux disease Methods: The group of patients treated for esophageal reflux disease was examined using a standardized questionnaire, esophageal manometry and postural tests. This was followed by a two-month therapy aimed at stretching and strengthening the diaphragm using several physiotherapeutic methods. After completing the therapy, the probands were measured again as in the same way as in the initial examination. The obtained data were evaluated by statistical analysis using a nonparametric test for one selection (Wilcoxon test). Results: The evaluation of the questionnaire survey resulted in the value of p-value = 0.007265, ie less than the selected level of alpha significance (= 0.05). Based on the Wilcoxon test, it was confirmed that the input score was statistically significantly higher than the output score. The evaluation of the esophageal manometry gave the value of p-value = 0.6956, ie greater than the selected level of significance alpha (= 0.05). Based on the Wilcoxon test, it was not confirmed that the...

In dieser retrospektiven Studie wurden die Befunde von 88 Kindern ausgewertet, die wegen eines Vesikoureteralen Refluxes in der Klinik und Poliklinik für Kinderchirurgie der Charité zwischen 1980 und 1995 einem diagnostischen oder operativen Eingriff unterzogen wurden. Es wurden drei Gruppen hinsichtlich des Diagnosezeitpunktes des Refluxes (pränatal-im ersten Lebensjahr-nach dem ersten Lebensjahr) gegenübergestellt und jeweils der primäre und sekundäre Reflux getrennt betrachtet. Das Ziel der Studie war, einerseits statistisch signifikante Unterschiede zwischen Indikationen, Komplikationen und Ergebnissen der konservativen und operativen Therapie herauszufinden, andererseits sollte der Stellenwert der pränatalen Diagnostik erläutert werden. Hinsichtlich der Therapiemöglichkeiten zeigten sich keine signifikanten Unterschiede, d.h. retrospektiv konnten nur Tendenzen gezeigt werden. Vom Operationszeitpunkt her wurde ein primärer Reflux statistisch signifikant früher opereriert, als ein sekundärer Reflux. Generell sollte ein Reflux zunächst konservativ behandelt werden und bei Komplikationen eine Korrekturoperation erfolgen. Bei einem sekundären Reflux muß zuerst die Grunderkrankung behoben werden. In der pränatalen Diagnostik stellt die Hydronephrose kein spezifisches Korrelat des Reflux dar, der Reflux ist aber immer eine wichtige Differentialdiagnose. Hinsichtlich des postnatalen Vorgehens bei pränatalem Verdacht auf einen Reflux schließen wir uns der Konsensgruppe (Beetz 2002) an. / This retrospective study analysed the results off 88 children, who got a diagnostic procedure or were operated because of a vesicoureteral reflux in the Klinik und Poliklinik für Kinderchirurgie der Charité between 1980 and 1995. Regarding the time of diagnosis three groups were opposed (prenatal-in the first year of life-after the first year of life) and in each group the primary and secondary reflux was separately regarded. The aim of the study was on the one hand to find statistical differences concerning indications, complications and results comparing the conservative and operative therapy, on the other hand the importance of the prenatal diagnostic should be discussed. The results showed no significant differences regarding the possibilities of therapy, only tendencies were retrospective shown. Concerning the time of operation a primary reflux was operated significant earlier than a secondary reflux. In general a reflux should be treated first conservative and if complications appear the reflux should be operated. In the case of a secondary reflux first the underlying disease should be eliminated. The hydronephrosis in the prenatal ultrasound is not specific for the reflux, but the reflux is an important differential diagnosis. Regarding the postnatal procedure in the case of prenatal suspicion of a reflux, we agree with the study of Beetz 2002.

The search for efficient and economical ways to beneficiate fine coal remains an active research area. Recent developments have shown that the reflux classifier can successfully be used on Australian coals, and based on that, a number of pilot plant investigations have been done in South Africa. While pilot scale units are usually used to test the applicability of a new technology on specific coals, a need exists to gather more fundamental data at a laboratory scale in order to save manpower, costs and time. This study has aimed at introducing a way to pre-test material prior to pilot plant trials in the design chain. The study shows that a laboratory water only reflux classifier can be used as a density fractionator, which accurately produces washability data for coal – this was also investigated by Callen et al. (2008). There is also a linear correlation between density cut-point and fluid velocity within the plates. Only when looking at the model proposed in Walton (2011:68), does it become clear that the relationship is indeed slightly curved. Many investigations from laboratory and pilot tests accept the linear relationship, and describe it as slightly curved due to the settling being in the intermediate settling regime (Iveson et al., 2014; Galvin & Lui, 2011). The separation procedures that produce two products – an overflow and underflow – compare well with fractionation results produced. Thus, fractionation results can generate washability data and predict batch separation operations. The laboratory reflux classifier setup is also dependent on particle size, where individual size ranges achieve e.p.m. values of 0.012 and 0.030, while the combined separation efficiency is 0.039. It was, however, found that the respective laboratory scale reflux classifier that was designed and built was not suitable for continuous operation. The vertical fluidisation section was not high enough to enable a steady fluidised bed. This was necessary for density separation within the bed and to produce a significant pressure differential. It is also recommended to obtain a PID controller. / MIng (Chemical Engineering), North-West University, Potchefstroom Campus, 2015

The search for efficient and economical ways to beneficiate fine coal remains an active research area. Recent developments have shown that the reflux classifier can successfully be used on Australian coals, and based on that, a number of pilot plant investigations have been done in South Africa. While pilot scale units are usually used to test the applicability of a new technology on specific coals, a need exists to gather more fundamental data at a laboratory scale in order to save manpower, costs and time. This study has aimed at introducing a way to pre-test material prior to pilot plant trials in the design chain. The study shows that a laboratory water only reflux classifier can be used as a density fractionator, which accurately produces washability data for coal – this was also investigated by Callen et al. (2008). There is also a linear correlation between density cut-point and fluid velocity within the plates. Only when looking at the model proposed in Walton (2011:68), does it become clear that the relationship is indeed slightly curved. Many investigations from laboratory and pilot tests accept the linear relationship, and describe it as slightly curved due to the settling being in the intermediate settling regime (Iveson et al., 2014; Galvin & Lui, 2011). The separation procedures that produce two products – an overflow and underflow – compare well with fractionation results produced. Thus, fractionation results can generate washability data and predict batch separation operations. The laboratory reflux classifier setup is also dependent on particle size, where individual size ranges achieve e.p.m. values of 0.012 and 0.030, while the combined separation efficiency is 0.039. It was, however, found that the respective laboratory scale reflux classifier that was designed and built was not suitable for continuous operation. The vertical fluidisation section was not high enough to enable a steady fluidised bed. This was necessary for density separation within the bed and to produce a significant pressure differential. It is also recommended to obtain a PID controller. / MIng (Chemical Engineering), North-West University, Potchefstroom Campus, 2015

Thesis (PhD)--Stellenbosch University, 1997 / ENGLISH ABSTRACT: An experimental investigation on gas-liquid counterflow in inclined rectangular ducts is conducted. The pressure drop across the sharp-edged gas inlet and the pressure gradient inside the duct are measured. Combinations of water, methanol, propanol, air, argon, helium and hydrogen are tested. The duct height and width are varied from 50 mm to 150 mm and 10 mm to 20 mm respectively. The emphasis is on high void fraction flow, i.e. low liquid flow rates as encountered in air-cooled reflux condensers. At low to moderate gas flow rates the pressure gradient is gas Reynolds number related while it becomes dependent on the superficial densimetric gas Froude number as the gas flow is increased. According to experiment the hydraulic diameter is the required length dimension in the gas Reynolds number while the duct height becomes the characteristic dimension in the Froude number regime. Flooding curves are generated for duct inclinations from close to the horizontal to the vertical. The data correlate in terms of the phase Froude numbers and a dimensionless liquid property parameter containing the hydraulic diameter, density, surface tension and the viscosity. The flooding gas velocity is found to be strongly dependent on the duct height, the phase densities and the duct inclination. The liquid viscosity has a stronger effect than the surface tension. Both these properties however playa secondary role. Flooding is not related to the gas Reynolds number. A theoretical model, based on the phenomenological findings of the adiabatic counterflow investigation, is derived to evaluate the performance of an air-cooled reflux condenser. Field tests are conducted on a full scale reflux condenser and the measured performance is compared to the model prediction. The reflux condenser is found to achieve only 60% of the predicted heat rejection rate due to the existence of so-called cold or dead zones. Indications are that excessive entraiment in the bottom header and the subsequent accumulation of condensate in the finned tubes causes a maldistribution of the steamside flow. In the process noncondensable gases accumulate and form dead zones, causing ineffective performance. Flooding as found in single-ducts does not appear to contribute to the formation of the dead zones. / AFRIKAANSE OPSOMMING: Die teenvloei van gas en vloeistof in reghoekige skuins buise is eksperimenteel ondersoek. Die drukverlies oor die skerp gasinlaat en die drukval in die buis is gemeet vir verskillende kombinasies van water, propanol, metanol, lug, argon, helium en waterstof. Buishoogtes en breedtes van 50 mm tot 150 mm en 10 mm tot 20 mm respektiewelik is getoets. Die klem van die ondersoek is op lae vloeistofvloeitempos soos teenwoordig tydens kondensasie van stoom in lugverkoelde teenvloeikondensors. Vir lae tot matige gasvloeitempos is die drukval afhanklik van die gas Reynolds-getal terwyl die densimetriese gas Froude-getal die heersende parameter word soos die gasvloei toeneem. Die hidrouliese diameter verteenwoordig die dimensie in die Reynolds-getal maar die buishoogte word die karakteristieke dirnensie in die Froude-getal gebied. Vloedingskurwes is vir 'n reeks van buishoeke gegenereer. Die vloedingdata korreleer in terme van die Froude-getal en 'n dimensielose parameter bestaande uit die hidrouliese diameter, oppervlakspanning, vloeistofdigtheid en die vloeistofviskositeit. Die vloeidingsnelheid is primêr van die buishoogte, vloeierdigthede en die buishoek afhanklik. Die vloeistofviskositeit-effek is sterker as die van die oppervlakspanning. Beide die eienskappe speel egter 'n sêkondere rol. Die gas Reynolds-getal beïnvloed nie die vloeidingsproses nie. Die fundamentele bevindinge van die teenvloeiondersoek is toegepas om die werkverigting van 'n lugverkoelde teenvloeikondenser teoreties te modelleer. Werkverigtingstoetse is uitgevoer op 'n volskaal teenvloeikondenser. Die toetsresultate word vergelyk met die teoretiese voorspelling. Die teenvloeikondensor behaal slegs sowat 600% van die voorspelde warmteoordrag omdat van die gevinde buise gedeeltelik by omgewingstemperatuur is. Hierdie verskynsel heet koue of dooie sones. Dit blyk dat die kondensaat in die onderste spruitstuk nie vrylik kan dreineer nie en in die vorm van druppels deur die stoom opgesleur word. Gevolglik versamel kondensaat binne die buise en sodoende kan nie-kondenseerbare gasse nie effektief uit die teenvloeikondensor verwyder word nie. Soos die gasse versamel word koue sones gevorm. Dit blyk dat vloeding soos waargeneem in enkelbuise nie tot die vorming van koue sones bydra nie.

Reflux condensation occurs in a vertical tube when there is an upward core flow of vapour (or gas-vapour mixture) and a downward flow of the liquid film. The understanding of this condensation configuration is crucial in the design of reflux condensers and in loss-of-coolant safety analyses in nuclear power plant steam generators. A range of modelling approaches exists for co-current film condensation from gas-vapour mixtures in parallel-plate channels and tubes. These methods are based on marching from the inlet down the tube and do not apply to the reflux condensation. In this research, however, a two-dimensional two-phase model was developed that solves the steady, full elliptic governing equations in both the film and the gas-vapour core flow on a non-orthogonal mesh that dynamically adapts to the phase interface. Gas-vapour shear and heat and mass transfer at the interface were accounted for fundamentally. This modelling is a big step ahead of current capabilities by removing the limitations of previous reflux condensation models which inherently cannot account for the detailed local balances of shear, mass, and heat transfer at the phase interface. The model was developed and applied for co-current and counter-current flows in vertical parallel-plate channels, followed by vertical tubes. In each stage, the model results were compared against the available experimental and numerical data for validation purposes. A wide range of boundary conditions and geometries have been studied to examine the details of co-current and counter-current condensation phenomena. Velocity, temperature, pressure, and gas mass fraction profiles along with the axial variation of various parameters such as local Nusselt number, film thickness, interface and centre-line temperature and gas mass fraction are presented in parametric studies. / February 2017

No description available.

Introdução: A doença do refluxo gastroesofágico (DRGE) refratária pode estar relacionada à maior sensibilização a alimentos pelo dano ácido-péptico às junções intercelulares e/ou pelo aumento do pH gástrico pelos inibidores de bomba de prótons (IBPs). A falha na resposta ao tratamento da DRGE tem sido atribuída, entre outras causas, à esofagite eosinofílica (EE). Objetivo: O objetivo principal do estudo foi avaliar a sensibilização a alimentos nos pacientes com DRGE refratária. Como objetivos secundários, comparamos as características dos pacientes sensibilizados com os não sensibilizados e verificamos a resposta clínica da DRGE à dieta de restrição aos alimentos aos quais o paciente estava sensibilizado. Métodos: Os pacientes com DRGE refratária realizaram dieta de restrição baseada no resultado de teste cutâneo de leitura imediata (TCLI) e teste cutâneo de contato (TCC) com alimentos. As características dos pacientes sensibilizados foram comparadas com os não sensibilizados com relação à atopia e número de eosinófilos na mucosa esofágica. Resultados: A prevalência de sensibilização a alimentos nos pacientes com DRGE refratária foi de 27,7%, sendo 15,3% pelo TCLI e 12,3% pelo TCC. Os asmáticos apresentaram maior sensibilização a alimentos (p=0,008). Foi identificada a presença de eosinófilos na mucosa esofágica em 15,8% dos pacientes e esta correlacionou-se com maior sensibilização a alimentos (p=0,011). Foi confirmado um caso de EE. A dieta de exclusão aos alimentos identificados promoveu melhora clínica dos sintomas da DRGE (p=0,004). Conclusão: A presença de eosinófilos na mucosa esofágica associada à maior sensibilização a alimentos e a resposta à dieta de exclusão em pacientes com testes positivos sugere que a DRGE refratária pode representar um estágio inicial da EE. / Abstract: Refractory gastroesophageal reflux disease (GERD) can be related to greater sensitization to foods due to peptic acid damage to intercellular junctions and/or due to the increase in gastric pH by proton pump inhibitors (PPIs). The lack of response to treatment of GERD has been attributed to, among other causes, eosinophilic esophagitis (EE). Objective: The principal objective of the study was to evaluate the sensitization to foods in patients with refractory GERD. As secondary objectives, we compared the characteristics of sensitized patients with those non-sensitized and found a clinical response of GERD to a diet restricting foods to which the patient was sensitized. Methods: Patients with refractory GERD were put on a restriction diet based on the results of skin prick test (SPT) and atopy patch test (APT) with foods. The characteristics of the sensitized patients were compared to those non-sensitized in relation to atopia and number of eosinophils in the esophageal mucosa. Results: The prevalence of sensitization to foods in patients with refractory GERD was 27.7%, where 15.3% were determined by SPT and 12.3% by APT. Asthmatics showed higher sensitization to foods (p=0.008). The presence of eosinophils in the esophageal mucosa was determined in 15.8% of patients, and this correlated with greater sensitization to foods (p=0.011). One case of EE was confirmed. A diet excluding identified sensitizing foods led to clinical improvement with regard to GERD symptoms (p=0,004). Conclusion: The presence of eosinophils in esophageal mucosa associated with greater sensitization to foods and the response to restriction diet in patients with positive tests suggest that refractory GERD can represent an initial stage of EE.

A literatura apresenta aspectos psicossociais e familiares como fatores de risco associados ao adoecimento crônico infantil. Considera-se a Doença do Refluxo Gastroesofágico (DRGE), patologia crônica de grande prevalência e incidência na população pediátrica, portanto, tema relevante nas questões e estudos de saúde pública. Este estudo levantou as possíveis associações de alterações psicológicas de cuidadores e de crianças, de 3 a 12 anos, com DRGE. Os instrumentos de coleta de dados foram: Questionário Sócio demográfico, Escala Hospitalar de Ansiedade e Depressão (HAD), Escala de Qualidade da Interação Familiar (EQIF), Inventário de Estilos Parentais, Escala de Comportamento Infantil (ECI-A2 de Rutter) e uma Entrevista Semiestruturada. Foram aplicados nos cuidadores de três grupos, de crianças com sexo e idades equitativas, distribuídos da seguinte forma: Grupo 1 - Experimental: crianças com DRGE primário; Grupo 2 - Controle 1: crianças sem DRGE, porém com constipação intestinal crônica funcional, e Grupo 3 - Controle 2: crianças hígidas. Para a análise dos dados, foi adotado índice de significância p<=0,005 e foram realizadas: análises quantitativas (Teste ?2, Teste Exato de Fisher e ANOVA) e análises qualitativas (Teste ?2, Teste Exato de Fisher) dos dados obtidos. Observou-se fatores de risco psicossociais, nível de ansiedade e depressão do cuidador, qualidade de interação negativa com a criança, e tendência maior ao estilo parental autoritário e menor ao estilo parental participativo, mais frequentes no grupo de crianças com DRGE. Por outro lado, encontrou-se maior frequência de uso/abuso de álcool e/ou drogas, nos cuidadores dos grupos de crianças adoecidas crônicas em relação ao de normais. Na análise final da escala de comportamento infantil, as crianças classificadas como \"com demanda de acompanhamento psicológico ou/e psiquiátrico\", representaram maiores índices no grupo de crianças com DRGE, quando comparado aos outros grupos. Também observou-se diferença significativa nos perfis comportamentais, neurótico e antissocial, das crianças em cada grupo. Na entrevista, observou-se, os cuidadores com percepção limitada em relação às questões afetivas das crianças ou de si mesmos, quando comparadas às dos outros instrumentos. Notou-se, também, diferença da percepção dos cuidadores sobre a relação entre a prática de cuidados exercida por eles e os fatores associados ao adoecimento da criança, quando se comparou o grupo de crianças adoecidas com o grupo de normais. Identificou-se diferenças e peculiaridades entre os grupos de crianças adoecidas e normais, bem como especificidades do grupo de crianças com DRGE, quando comparado aos demais. Dessa forma, sugere-se estudos mais aprofundados nas especificidades encontradas, principalmente, nas crianças com DRGE, visando direcionar a prática clínica interdisciplinar de assistência à saúde desta população. / The literature presents psychosocial and family aspects as risk factors associated with childhood chronic illness. Gastroesophageal Reflux Disease (GERD) is considered a chronic disease of great prevalence and incidence in the pediatric population, therefore, a relevant topic in public health issues and studies. This study raised the possible associations of psychological changes of caregivers and children, from 3 to 12 years old, with GERD. The instruments of data collection were: Demographic Socio Questionnaire, Hospital Anxiety and Depression Scale (HAD), Family Interaction Quality Scale (EQIF), Inventory of Parenting Styles, Infant Behavior Scale (ECI-A2 by Rutter) Semi structured interview. Group 1 - Experimental: children with primary GERD; Group 1 - Experimental: children with primary GERD; Group 2 - Control 1: children without GERD, but with functional chronic intestinal constipation, and Group 3 - Control 2: healthy children. For the data analysis, a significance level of p<=0.005 was adopted and quantitative analyzes (?2 Test, Fisher\'s Exact Test and ANOVA) and qualitative analyzes (?2 Test, Fisher\'s Exact Test) of the data were performed. Psychosocial risk factors, anxiety and depression of the caregiver, quality of negative interaction with the child, and a tendency towards authoritarian parental style and lesser participatory parental style, were more frequent in the group of children with GERD. On the other hand, there was a higher frequency of alcohol/drug use/abuse in the caregivers of the groups of children with chronic illness compared to normal ones. In the final analysis of the children\'s behavior scale, children classified as having \"psychological and/or psychiatric follow-up demand\" represented the highest rates in the group of children with GERD when compared to the other groups. There was also a significant difference in the behavioral, neurotic and antisocial profiles of children in each group. In the interview, it was observed, caregivers with limited perception regarding the affective issues of the children or of themselves, when compared to the other instruments. Differences in caregivers\' perceptions about the relationship between their care practice and the factors associated with the illness of the child were also observed when comparing the group of children who were ill with the normal group. Differences and peculiarities were identified between the groups of sick and normal children, as well as specificities of the group of children with GERD, when compared to the others. Thus, we suggest more in-depth studies on the specificities found, especially in children with GERD, in order to direct the interdisciplinary clinical practice of health care in this population.