Semarang urban coastal areas are experiencing tidal flood. In addition, land subsidence of 5 to 10 centimetres per year is taking place. The climate change phenomenon provokes land areas that are lower than sea water ...Semarang urban coastal areas are experiencing tidal flood. In addition, land subsidence of 5 to 10 centimetres per year is taking place. The climate change phenomenon provokes land areas that are lower than sea water level from time to time. This makes the situation with respect to flooding increasingly risky. Semarang Old City （heritage） as part of principal Semarang area is suffering also from regular flooding and pollution that hamper the revitalisation of the old city. These areas used to be productive lands, but flooding make the existing public infrastructure does no longer function, and residential areas have changed into unhealthy slams. To overcome these problems, the Government of Semarang chooses a polder drainage system to address the flooding in Semarang. In the framework of the cooperation between Indonesia and the Netherlands, these activities consist of research and workshops on Urban Heritage. The scope consists basically of five components： experiences with urban drainage and flood protection in Semarang with a focus on Semarang Old City, field visit to relevant places with respect to urban drainage and flood protection of Semarang Old City, lectures on the relevant aspects of urban drainage and flood protection, exercises to get an insight in the processes that can take place under normal and extreme conditions, formulation of a preliminary plan to improve the situation with respect to urban drainage and flood protection of Semarang Old City. In this paper, the various relevant points are described, such as scenarios analysis as well as the findings and recommendations for improvement of the urban drainage system and flood protection of Semarang Heritage City.展开更多
Objective To assess the clinical value of duodenal circular drainage operation to treat superior mesenterie artery syndrome（SMAS）. Methods Forty two cases of SMAS were treated with duodenal circular drainage operati...Objective To assess the clinical value of duodenal circular drainage operation to treat superior mesenterie artery syndrome（SMAS）. Methods Forty two cases of SMAS were treated with duodenal circular drainage operation from 1959 to 2001. Clinical data were analyzed retrospectively. Results In this group, 37 cases were treated with duodenal circular drainage operation,and had good effect after follow- up of 1-15 years, the other 5 cases were first treated with anterior repositioning of the duodenum （ 1 case）, gastroieiunostomy （ 1 case）, duodeojejunostomy （2 cases）, subtotal gastrectomy and Billroth 11 gastrojejunostomy（1 case） ,but vomiting was not relieved until duodenal circular drainage operation was performed again. Follow - up of 9- 10 years revealed good effect. Conclusion In SMAS, if the reversed peristalsis is stronger and continuous, and vomiting appears frequently, the symptom can not be relieved even if the obstruction of duodenum is removed by operation. The key treatment is the relief of reversed peristalsis. Only the duodenal circular drainage operation could resolve the drainage direction of duodenal content and relieve the symptom of vomiting.展开更多
AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pa...AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.展开更多
In recent years, the invert anomalies of operating railway tunnels in water-rich areas occur frequently,which greatly affect the transportation capacity of the railway lines. Tunnel drainage system is a crucial factor...In recent years, the invert anomalies of operating railway tunnels in water-rich areas occur frequently,which greatly affect the transportation capacity of the railway lines. Tunnel drainage system is a crucial factor to ensure the invert stability by regulating the external water pressure(EWP). By means of a threedimensional(3D) printing model, this paper experimentally investigates the deformation behavior of the invert for the tunnels with the traditional drainage system(TDS) widely used in China and its optimized drainage system(ODS) with bottom drainage function. Six test groups with a total of 110 test conditions were designed to consider the design factors and environmental factors in engineering practice,including layout of the drainage system, blockage of the drainage system and groundwater level fluctuation. It was found that there are significant differences in the water discharge, EWP and invert stability for the tunnels with the two drainage systems. Even with a dense arrangement of the external blind tubes, TDS was still difficult to eliminate the excessive EWP below the invert, which is the main cause for the invert instability. Blockage of drainage system further increased the invert uplift and aggravated the track irregularity, especially when the blockage degree is more than 50%. However, ODS can prevent these invert anomalies by reasonably controlling the EWP at tunnel bottom. Even when the groundwater level reached 60 m and the blind tubes were fully blocked, the invert stability can still be maintained and the railway track experienced a settlement of only 1.8 mm. Meanwhile, the on-site monitoring under several rainstorms further showed that the average EWP of the invert was controlled within 84 k Pa, while the maximum settlement of the track slab was only 0.92 mm, which also was in good agreement with the results of model test.展开更多
AIM To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter(SPC) vs those drained by 2-way urethral catheter only...AIM To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter(SPC) vs those drained by 2-way urethral catheter only.METHODS A total of 84 participants undergoing Freyer's simple prostatectomy over an 18-mo period were randomized into 2 groups(n=42). Subjects in group 1 were managed with 2-way urethral catheter and in situ 2-way SPC while subjects in group 2 had a 2-way urethral catheter drainage only. In group 1 subjects, the SPC was spigotted and only used for drainage if there was clot retention. The primary outcomes were number of clot retention episodes, and number of clot retention episodes requiring bladder syringe evacuation. Other secondary outcomes evaluated were blood loss, requirement of extra analgesics, duration of surgery, hospital stay and presence or absence of post-op complications. RESULTS The mean age in the groups was 65.7(± 7.6) in group 1 vs 64.8(±6.8) in group 2.The groups were similar with respect to age, prostate specific antigen, prostate volume, blood loss, duration of surgery, blood transfusion and overall complication rate. However statistically significant differences were observed in clot retention episodes between group 1 and 2:0.8(±1.5)vs3.5(±4.4), P<0.000, clot retention episodes requiring evacuation with bladder syringe 0.4(± 0.9) vs 2.6(± 3.8), P = 0.001, requirement of extra analgesics 0.4(±0.5)vs4.0(±1.5), P<0.000 and duration of admission 8.6d(± 1.2) vs 7.3 CONCLUSION Subjects drained with a combination of urethral and SPCs have fewer clot retention episodes and reduced requirement of extra analgesics but slightly longer hospital stay.展开更多
Percutaneous catheter drainage （PCD） is a minimally invasive intervation for severe acute pancreatitis （SAP）. This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment ...Percutaneous catheter drainage （PCD） is a minimally invasive intervation for severe acute pancreatitis （SAP）. This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment of 32 patients with SAP, and to direct clinicians to the most optimal approach for SAP. In the 32 patients, 19 were proved to have deteriorated clinical signs or symptoms, extensive fluid exudation, and necrosis confirmed by computed tomography （CT） and they underwent operative debridement and drainage. For extensive fluid exudation or necrosis, complete liquefaction and safe catheter implantation, the other 13 patients were given PCD. The mortality rate of the surgery group was 26.3%, much higher than that of the PCD group （0%）. There was a significant difference between the two groups （P=0.044）. The mean time for recovery of the serum C-reactive protein （CRP） level was 43.8 days in the surgery group, which was significantly longer than that of the PCD group （23.8 days） （P=0.034）. Early PCD guided by ultrasound could decrease the mortality of patients with severe acute pancreatitis, alleviate life-threatening inflammatory complications, and avoid unnecessary emergency operation.展开更多
AIM： To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome （SMAS）. METHODS： Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Cl...AIM： To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome （SMAS）. METHODS： Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Clinical data were analyzed retrospectively. RESULTS： In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum （two cases）, duodenojejunostomy （five cases）, subtotal gastrectomy and billroth I gastrojejunostomy （one case）, but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients. CONCLUSION： In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently, the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.展开更多
Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the differe...Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods:Between January 2009 and December 2019,123 patients who undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with the extracardiac conduit-TCPC(EC-TCPC)method,24 cases used the intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.Forty cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results:There were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg emerged as a predictor for early re-operation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions:TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:The distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexisting.However,the technique should be altered when the postoperative mPAP was greater than 15 mmHg.展开更多
AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection management.METHODS Data were obtained retrospectively from January 2012 to December 2016.Pa...AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection management.METHODS Data were obtained retrospectively from January 2012 to December 2016.Patients with pancreatic fluid collection were performed EUS-guided or surgical procedure.Main outcome measures including clinical efficiency,complication,duration of procedures,hospital stay and cost were analyzed.RESULTS Thirty-six patients were enrolled into the study,including 14 in endoscopic group while 22 in the surgical group.Twelve (86%) patients were treated successfully by endoscopic approach while 21 (95%) patients benefited through surgical procedure.Endoscopic treatment had higher recurrence and complication rates than surgery,resulting in more re-interventions.Meanwhile,duration of procedure,hospital stay and cost were significantly lower in endoscopic group.CONCLUSION Both approaches were effective and safe.EUS-guided approach should be the first-line treatment in mild and simple cases,while surgical approach should be considered as priority in severe and complex cases.展开更多
文摘Semarang urban coastal areas are experiencing tidal flood. In addition, land subsidence of 5 to 10 centimetres per year is taking place. The climate change phenomenon provokes land areas that are lower than sea water level from time to time. This makes the situation with respect to flooding increasingly risky. Semarang Old City （heritage） as part of principal Semarang area is suffering also from regular flooding and pollution that hamper the revitalisation of the old city. These areas used to be productive lands, but flooding make the existing public infrastructure does no longer function, and residential areas have changed into unhealthy slams. To overcome these problems, the Government of Semarang chooses a polder drainage system to address the flooding in Semarang. In the framework of the cooperation between Indonesia and the Netherlands, these activities consist of research and workshops on Urban Heritage. The scope consists basically of five components： experiences with urban drainage and flood protection in Semarang with a focus on Semarang Old City, field visit to relevant places with respect to urban drainage and flood protection of Semarang Old City, lectures on the relevant aspects of urban drainage and flood protection, exercises to get an insight in the processes that can take place under normal and extreme conditions, formulation of a preliminary plan to improve the situation with respect to urban drainage and flood protection of Semarang Old City. In this paper, the various relevant points are described, such as scenarios analysis as well as the findings and recommendations for improvement of the urban drainage system and flood protection of Semarang Heritage City.
文摘Objective To assess the clinical value of duodenal circular drainage operation to treat superior mesenterie artery syndrome（SMAS）. Methods Forty two cases of SMAS were treated with duodenal circular drainage operation from 1959 to 2001. Clinical data were analyzed retrospectively. Results In this group, 37 cases were treated with duodenal circular drainage operation,and had good effect after follow- up of 1-15 years, the other 5 cases were first treated with anterior repositioning of the duodenum （ 1 case）, gastroieiunostomy （ 1 case）, duodeojejunostomy （2 cases）, subtotal gastrectomy and Billroth 11 gastrojejunostomy（1 case） ,but vomiting was not relieved until duodenal circular drainage operation was performed again. Follow - up of 9- 10 years revealed good effect. Conclusion In SMAS, if the reversed peristalsis is stronger and continuous, and vomiting appears frequently, the symptom can not be relieved even if the obstruction of duodenum is removed by operation. The key treatment is the relief of reversed peristalsis. Only the duodenal circular drainage operation could resolve the drainage direction of duodenal content and relieve the symptom of vomiting.
文摘AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.
基金supported by the National Natural Science Foundation of China (Grant No. U1934211)the Open Foundation of National Engineering Research Center of High-speed Railway Construction Technology (Grant No. HSR202005)Scientific Research Project of Hunan Education Department (Grant No.20B596)。
文摘In recent years, the invert anomalies of operating railway tunnels in water-rich areas occur frequently,which greatly affect the transportation capacity of the railway lines. Tunnel drainage system is a crucial factor to ensure the invert stability by regulating the external water pressure(EWP). By means of a threedimensional(3D) printing model, this paper experimentally investigates the deformation behavior of the invert for the tunnels with the traditional drainage system(TDS) widely used in China and its optimized drainage system(ODS) with bottom drainage function. Six test groups with a total of 110 test conditions were designed to consider the design factors and environmental factors in engineering practice,including layout of the drainage system, blockage of the drainage system and groundwater level fluctuation. It was found that there are significant differences in the water discharge, EWP and invert stability for the tunnels with the two drainage systems. Even with a dense arrangement of the external blind tubes, TDS was still difficult to eliminate the excessive EWP below the invert, which is the main cause for the invert instability. Blockage of drainage system further increased the invert uplift and aggravated the track irregularity, especially when the blockage degree is more than 50%. However, ODS can prevent these invert anomalies by reasonably controlling the EWP at tunnel bottom. Even when the groundwater level reached 60 m and the blind tubes were fully blocked, the invert stability can still be maintained and the railway track experienced a settlement of only 1.8 mm. Meanwhile, the on-site monitoring under several rainstorms further showed that the average EWP of the invert was controlled within 84 k Pa, while the maximum settlement of the track slab was only 0.92 mm, which also was in good agreement with the results of model test.
文摘AIM To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter(SPC) vs those drained by 2-way urethral catheter only.METHODS A total of 84 participants undergoing Freyer's simple prostatectomy over an 18-mo period were randomized into 2 groups(n=42). Subjects in group 1 were managed with 2-way urethral catheter and in situ 2-way SPC while subjects in group 2 had a 2-way urethral catheter drainage only. In group 1 subjects, the SPC was spigotted and only used for drainage if there was clot retention. The primary outcomes were number of clot retention episodes, and number of clot retention episodes requiring bladder syringe evacuation. Other secondary outcomes evaluated were blood loss, requirement of extra analgesics, duration of surgery, hospital stay and presence or absence of post-op complications. RESULTS The mean age in the groups was 65.7(± 7.6) in group 1 vs 64.8(±6.8) in group 2.The groups were similar with respect to age, prostate specific antigen, prostate volume, blood loss, duration of surgery, blood transfusion and overall complication rate. However statistically significant differences were observed in clot retention episodes between group 1 and 2:0.8(±1.5)vs3.5(±4.4), P<0.000, clot retention episodes requiring evacuation with bladder syringe 0.4(± 0.9) vs 2.6(± 3.8), P = 0.001, requirement of extra analgesics 0.4(±0.5)vs4.0(±1.5), P<0.000 and duration of admission 8.6d(± 1.2) vs 7.3 CONCLUSION Subjects drained with a combination of urethral and SPCs have fewer clot retention episodes and reduced requirement of extra analgesics but slightly longer hospital stay.
文摘Percutaneous catheter drainage （PCD） is a minimally invasive intervation for severe acute pancreatitis （SAP）. This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment of 32 patients with SAP, and to direct clinicians to the most optimal approach for SAP. In the 32 patients, 19 were proved to have deteriorated clinical signs or symptoms, extensive fluid exudation, and necrosis confirmed by computed tomography （CT） and they underwent operative debridement and drainage. For extensive fluid exudation or necrosis, complete liquefaction and safe catheter implantation, the other 13 patients were given PCD. The mortality rate of the surgery group was 26.3%, much higher than that of the PCD group （0%）. There was a significant difference between the two groups （P=0.044）. The mean time for recovery of the serum C-reactive protein （CRP） level was 43.8 days in the surgery group, which was significantly longer than that of the PCD group （23.8 days） （P=0.034）. Early PCD guided by ultrasound could decrease the mortality of patients with severe acute pancreatitis, alleviate life-threatening inflammatory complications, and avoid unnecessary emergency operation.
文摘AIM： To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome （SMAS）. METHODS： Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Clinical data were analyzed retrospectively. RESULTS： In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum （two cases）, duodenojejunostomy （five cases）, subtotal gastrectomy and billroth I gastrojejunostomy （one case）, but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients. CONCLUSION： In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently, the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.
文摘Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods:Between January 2009 and December 2019,123 patients who undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with the extracardiac conduit-TCPC(EC-TCPC)method,24 cases used the intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.Forty cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results:There were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg emerged as a predictor for early re-operation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions:TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:The distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexisting.However,the technique should be altered when the postoperative mPAP was greater than 15 mmHg.
文摘AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection management.METHODS Data were obtained retrospectively from January 2012 to December 2016.Patients with pancreatic fluid collection were performed EUS-guided or surgical procedure.Main outcome measures including clinical efficiency,complication,duration of procedures,hospital stay and cost were analyzed.RESULTS Thirty-six patients were enrolled into the study,including 14 in endoscopic group while 22 in the surgical group.Twelve (86%) patients were treated successfully by endoscopic approach while 21 (95%) patients benefited through surgical procedure.Endoscopic treatment had higher recurrence and complication rates than surgery,resulting in more re-interventions.Meanwhile,duration of procedure,hospital stay and cost were significantly lower in endoscopic group.CONCLUSION Both approaches were effective and safe.EUS-guided approach should be the first-line treatment in mild and simple cases,while surgical approach should be considered as priority in severe and complex cases.
