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Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

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Surgical Science 2014年第1期5卷 28-31页

作者： Ramasamy Govindarajan Christopher Chang Wesam Khalil Noemi Balogh Elizabeth Cole England Saiganesh ravikumar Department of Anesthesia Bronx Lebanon Hospital New York USA Emory University Atlanta USA

Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the “call for help” was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope? assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of

关键词： Unanticipated Difficult Airway Emergency C Section Glidescope Assisted Fiberoptic Intubation Difficult Airway Algorithm

Inferior dislocation of the hip： a case series and litera- ture review

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Chinese Journal of Traumatology 2012年第5期15卷 317-320页

作者： Sameer Aggarwal Vishal Kumar Kishan Ramachandra Bhagwat Vokkaleri Shankaranarayana Shashikanth Holalu Shankaralingegowda ravikumar Department of Orthopaedic Surgery Post Graduate Institute of Medical Education and Research(PGIMER)Chandigarh 160012India

Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile （range 10 to 56 years, mean 33.8 years）. Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel toan angle almost 90° away from the axis. In our series, closed reduction was successful in all patients, either under seda tion or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and followup revealed painfree, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that pro duce inferior hip dislocation.

关键词： Hip dislocation Therapeutics Traction Weight-bearing

Cardiac Surgery in Octogenarians and Beyond: Single Center Experience

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Open Journal of Thoracic Surgery 2013年第2期3卷 51-56页

作者： Reda E. Al-Refaie Hashem Aliter Ricardo Gallo Ali Youssef Mushabab Al-Murayeh Edwin ravikumar Department of Cardiac Surgery and Car- diology Armed Forces Hospitals Southern Region Khamis Mushayt KSA Department of Cardiothoracic Surgery Mansoura University Hospitals Mansoura Egypt

Background: Increasing numbers of octogenarians and improvements in surgical techniques and postoperative care have resulted in increasing cardiac operations in this age. The aim is to analyze our experience of cardiac surgery on octogenarians and beyond concerning postoperative morbidities and mortality. Methods: 67 octogenarians and nonagenarians underwent open heart surgery in our hospital between 2001 to 2009 were retrospectively reviewed. Data included baseline preoperative status, intraoperative and perioperative course, and immediate outcomes. Results: The mean age was 86.22 ± 6.1 years. 86.6% patients were males. Symptoms were dyspnea;Class II in 13.4%, Class III in 55.2%, Class IV in 31.4% patients;angina in 82.1%, and CHF in 25.4% patients. The mean EF was 37.8% ± 10. Risk factors include smoking in 52.2%, DM in 37.3%, hypertension in 28.4%, obesity in 25.4%, previous MI in 22.4%, COPD in 17.9%, renal insufficiency in 11.9%, pulmonary hypertension in 7.5%, PVD in 6%, and cerebrovascular disease in 3% patients. The procedures were isolated CABG in 73%, AVR in 9%, MVR in 6%, CABG/valve in 9%, and MVR and AVR in 3% patients. Complications were 18%. It included renal impairment in 18%, arrhythmias in 14.9%, bleeding in 6%, prolonged ventilation in 13.4%, CHF in 4.5%, gastrointestinal bleeding in 4.5%, wound infection in 7.5%, and cerebrovascular accident in 3%. Hospital mortality was 9% patients. Conclusions: Cardiac surgery can be performed safely with acceptable hospital morbidity and mortality in octogenarians and beyond. Early referral and proper selection of patients are mandatory to improve immediate postoperative survival.

关键词： Coronary Artery Bypass Graft Valve Octogenarians Nonagenarian

Machining characteristics of fine grained AZ91 Mg alloy processed by friction stir processing

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Transactions of Nonferrous Metals Society of China 2017年第4期27卷 804-811页

作者： G.V.V.SURYA KIRAN K.HARI KRISHNA Sk.SAMEER M.BHARGAVI B.SANTOSH KUMAR G.MOHANA RAO Y.NAIDUBABU ravikumar DUMPALA B.RATNA SUNIL Department of Mechanical Engineering Rajiv Gandhi University of Knowledge Technologies (AP-IIIT) Nuzvid 521202 India Department of Mechanical Engineering Visvesvaraya National Institute of Technology Nagpur 440010 India

AZ91Mg alloy was considered and friction stir processing(FSP)was adopted to achieve grain refinement to investigatethe effect of grain size and secondary phase on machining characteristics during drilling at various speeds and *** saturatedAZ91Mg alloy was obtained after FSP and the grain refinement was achieved from(166.5±8.7)μm to(21.7±13.5)μ***,hardness reduced for FSP AZ91Mg alloy(88.95±6.1)compared with AZ91alloy(108.2±15.6),which was attributed to the reducedsecondary ***,the mean cutting force for FSP-treated(FSPed)AZ91Mg alloy was marginally *** edgedamage of the drilled holes was lower for FSPed AZ91Mg alloy compared with unprocessed AZ91Mg ***,it can beunderstood that the grain refinement may slightly increase the cutting forces during drilling but better edge finishing can be achievedin machining of AZ91Mg alloy.

关键词： magnesium alloy friction stir processing machining grain size microstructure

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家蚕AFLP分子进化研究

西南农业学报 2004年第2期17卷 240-243页

作者：周泽扬李斌 G.ravikumar 全国兴田村俊树西南农业大学蚕丝学院农业部蚕桑学重点实验室重庆400716 日本农业生物资源研究所

为进一步探讨家蚕的起源分化和其系统发育,为家蚕遗传育种提供科学依据,利用AFLP技术和统计学分析对具有代表性的9个不同的地区家蚕品种进行了分子系统学研究。家蚕的DNA多态性分析及其聚类分析结果进一步证实家蚕可能起源于不同地方(... 详细信息

为进一步探讨家蚕的起源分化和其系统发育,为家蚕遗传育种提供科学依据,利用AFLP技术和统计学分析对具有代表性的9个不同的地区家蚕品种进行了分子系统学研究。家蚕的DNA多态性分析及其聚类分析结果进一步证实家蚕可能起源于不同地方(多起源中心)、由多种生态类型(包括一化、二化、多化)混杂的野桑蚕驯化而来,其驯化之初就已拥有一化、二化、多化的遗传背景,而且一化和二化品种间的遗传距离小,分化程度小,表明它们应该有共同的起源中心。

关键词：家蚕 AFLP 分子进化品种遗传距离生态类型

Is there a role for arterial reconstruction in surgery for pancreatic cancer?

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World Journal of Gastrointestinal Surgery 2013年第3期5卷 27-29页

作者： Reena ravikumar David Holroyd Giuseppe Fusai Department of Hepatopancreato-biliary and Liver Transplant Surgery Royal Free London Hospital NHS Foundation Trust

Surgery remains the only potentially curative treatment for patients with pancreatic cancer. Locally advanced pancreatic cancer with vascular involvement remains a surgical challenge because high perioperative risk and the uncertainty of a survival benefit. Whilst portal vein resection has started to gather momentum because the perioperative morbidity and long term survival is comparable to standard pancreatectomy, there isn't yet a consensus on arterial resections. There have been various reports and case series of arterial resections in pancreatic cancer, with mixed survival results. Mollberg et al have appraised the heterogeneous published literature available on arterial resection in pancreatic cancer in an attempt to compare this to standard pancreatectomy. In this article, we discuss the results of this systematic review and meta-analysis, and the limitations associated with analysing results from heterogenous data. We have outlined the important features in surgery for pancreatic cancer and specifically to arterial resections, and compared arterial resections to the published literature on venous resections.

关键词： Arterial resection Pancreatic cancer Vascular resection Hepatic artery Coeliac axis Pancreatectomy

碳化混凝土(CSCC)水化硅酸钙的抗冻融性和抗剥落性研究

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建筑砌块与砌块建筑 2016年第6期 14-18页

作者： HyunGu Jeong Jan Olek Jitendra Jain Deepak ravikumar Vahit Atakan 崔玉忠(译) 杜建东(整理) 美国普渡大学土木工程学院 Solidia Technologies公司不详

1项目研究背景1.1 Solidia CementTM与波特兰水泥熟料生产过程的区别Solidia CementTM硅酸钙基胶凝材料的生产工艺,与传统波特兰水泥熟料基本相同,一是所使用原材料基本相同,二是生产烧成过程相同;不过它与波特兰水泥熟料相比,也存在多... 详细信息

1项目研究背景1.1 Solidia CementTM与波特兰水泥熟料生产过程的区别Solidia CementTM硅酸钙基胶凝材料的生产工艺,与传统波特兰水泥熟料基本相同,一是所使用原材料基本相同,二是生产烧成过程相同;不过它与波特兰水泥熟料相比,也存在多个鲜明的特征。烧成回转窑内的煅烧温度相对较低,仅约1200℃,比波特兰水泥熟料烧成温度低约150℃。

关键词：水化硅酸钙碳化混凝土抗剥落性抗冻融性水泥熟料生产过程烧成过程生产工艺

MRI显示颈动脉中度狭窄斑块内出血预测无症状男性发生脑血管缺血事件危险度的研究

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国际医学放射学杂志 2009年第5期32卷 499-500页

作者： N.Singh A.R.Moody D.J.Gladstone G.Leung R.ravikumar J.Zhan 王鹤 Department of Diagnostic Imaging Sunnybrook Health Sciences CentreUniversity of Toronto

目的研究颈动脉中度狭窄无症状男性快速三维T1加权抑脂扰相梯度回波序列MRI显示颈动脉斑块内出血（IPH）与远期同侧脑血管事件间的关系。材料与方法此项回顾性研究经机构伦理委员会批准免除书面知情同意通知。所有病人在电话随访中都给... 详细信息

目的研究颈动脉中度狭窄无症状男性快速三维T1加权抑脂扰相梯度回波序列MRI显示颈动脉斑块内出血（IPH）与远期同侧脑血管事件间的关系。材料与方法此项回顾性研究经机构伦理委员会批准免除书面知情同意通知。所有病人在电话随访中都给予了口头知情同意通知。回顾性分析2003--2006年间在血管门诊就诊，发现无症状颈动脉狭“弥漫受累”）、血清参数和疾病分期，以及与伴或不伴皮质破坏之脊柱外病变检出可能性的相关性。

关键词：颈动脉斑块脑血管事件中度狭窄无症状内出血 MRI 缺血事件男性

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采用渗压剂的花粉选择对高梁耐旱性的影响

国外作物育种 2004年第3期23卷 52-52页

作者： R．L．ravikumar 向平