155 research outputs found
Transanal endoscopic microsurgery: an indispensable component of contemporary coloproctology
No full textPetr Vavra, Petr Andel, Anton Pelikan, Lubomir Martinek, Petra Gunkova, Igor Gunka
Department of Surgery University Hospital of Ostrava,
Ostrava-Poruba, 17. listopadu 1790,
708 52 Ostrava, Czech Republic
E-mail: [email protected]
Background / objective
At many surgical and gastroenterological working places still persists the problem what to do with an adhered tumour in the rectum at an unfavourable distance from the anus. This paper presents the possibilities offered by contemporary coloproctology by means of TEM (transanal endoscopic microsurgery) applied to the lesions that are hardly accessible.
Patients and methods
At the Department of Surgery of University Hospital Ostrava, the TEM method has been used since August 2002. The technique itself was implemented by Buess in the year 1983. His working place in Tübingen, Germany serves also as a training centre for teaching TEM. In the Czech Republic, the TEM method was used for first time in 1992. In TEM methodology the advantages of mini-invasive endoscopic medical help and the advantages of surgical treatment are combined.
Results
At the Department of Surgery of University Hospital of Ostrava in the period between 01/2003 and 12/2003 we carried out 37 operations by means of TEM. Of this number, 15 patients were operated on for benign rectum affection, 18 for malign disease, other 4 operations were twice on periproctal fistula, one operation for rectum stenosis, one introduction of a self-expandible stent. In malign rectum lesions we performed CT and endosonography preoperatively and used TEM twice for carcinoma in situ, 6 times for T1NXM0 lesions, 3 times for T2NXM0 lesions and 4 times for T3NXM0 lesions. These patients were then operated on transabdominally on the basis of definite histological findings. For a palliative effect we used TEM twice in patients with metastatic liver affection T3NXMl and once for a patient with T4NXMl.
Conclusions
The TEM methodology introduced in 2002 has become an inseparable and inevitable component of coloproctological operations at our department. We think the main contribution of this method consists in a safe treatment of wide benign rectum lesions, in treatment of early rectal carcinoma stages, and last but not least, the use of TEM in palliative surgery of rectum while emphasising the quality of life preservation.
Keywords: transanal endoscopic microsurgery, TEM unfavourable distance, indication, harmonic scalpe
Tjeerd van Andel en het begin van de pollenanalyse in Groningen
No full textTjeerd van Andel and the beginnings of pollen analysis at Groningen. During the Second World War, Tjeerd Hendrik van Andel (1923-2010) was a student-assistant at the Biological-Archaeological Institute. One of his tasks was to establish a pollen laboratory. After the war he left the archaeological field and turned to Geology. He made an impressive career in the US as an earth scientist and oceanographer. In 1988 he returned to archaeology and became an ‘Honorary Professor of Earth History, Quaternary Science and Geo-archaeology’ at the University of Cambridge, UK. In 1945 the author became his successor as a student-assistant. In this paper he describes their joint botanical and pedological work during the war as members of the phytosociology study group of the Nederlandse Jeugdbond voor Natuurstudie (Netherlands Youth League for the Study of Nature). These experiences were essential for the successful application of pollen analysis to the study of prehistoric barrows
Spatial Implications of Policy Trends and Changing Concepts of Housing and Care for the Elderly, Current Trends in the Netherlands
No full textReal Estate Managemen
The Participation Triangle: Involving Generation Y in energy strategy
No full textThe liberalization of the Dutch energy market has led to a change of relation between energy companies and their customers. At the same time, the Dutch energy policy expects energy companies to contribute to an energy supply that is cleaner, smarter and more varied, and available at any time at affordable prices. The situation since the liberalization of the energy market can be summarized in the following points:- Energy companies provide a product: energy, that is of social interest and importance, which forces them to act in a socially responsible manner,- Energy as a product is a commodity- Energy consumers are free to choose the energy supplier they want, to provide in their energy need.Consequently, energy suppliers have to think and act like a commercial company, which means that energy companies in a liberalized market, next to their public responsibility, have strategic marketing issues to handle.The notion that energy companies a) need future energy consumers to help them understand changes going on at the consumer-end, and their probable implications on future energy supply, while b) they are unfamiliar with this specific group of consumers at the same time, has resulted in the following leading question of the research: How to involve the future energy consumer effectively in the strategy of an energy company?Answering this practical design question requires answering a variety of underlying knowledge questions, including definitions of key concepts such as ‘involvement’ and ‘effective’, and, more generally, ‘What factors and conditions affect the process of involvement, and what is their impact on the effectiveness of the process?’, and ‘What are the design principles following from these insights’?The theoretical basis to answer these knowledge questions lies in two research traditions; Policy Analysis and Consumer Research. Consumer Research and Policy Analysis assign three common elements to the concept of involvement. They both implicitly and explicitly consider:1) The topic: the subject the involvement is about. In this research the topic was the strategy of Eneco concerning future energy supply.2) The participant: the person or group of persons that is actively involved or being involved with the topic. In this research the future energy consumer, represented by participating member of Generation Y, was the participant.3) The initiator: the party that initiates and/or organizes the involvement of the participant in the topic. In this research Eneco, representing the energy company, was the initiator. In this research the relations between these elements are conceptualised as “The Participation Triangle”:Policy Analysi
Anticipatory water management: Using ensemble weather forecasts for critical events
No full textDay-to-day water management is challenged by meteorological extremes, causing floods and droughts. Often operational water managers are informed too late about these upcoming events to be able to respond and mitigate their effects, such as by taking flood control measures or even requiring evacuation of local inhabitants. Therefore, the use of weather forecast information with hydrological models can be invaluable for the operational water manager to expand the forecast horizon and to have time to take appropriate action. This is called Anticipatory Water Management. Anticipatory actions may have adverse effects, such as when flood control actions turn out to have been unnecessary, because the actual rainfall was less than predicted. Therefore the uncertainty of the forecasts and the associated risks of applying Anticipatory Water Management have to be assessed. To facilitate this assessment, meteorological institutes are providing ensemble predictions to estimate the dynamic uncertainty of weather forecasts. This dissertation presents ways of improving the end-use of ensemble predictions in Anticipatory Water Management.Hydraulic EngineeringCivil Engineering and Geoscience
Enkele aspecten van kiemkoken
No full textApplied SciencesKramers Laboratorium voor Fysische Technologi
Developing an impact-based combined drought index for monitoring crop yield anomalies in the Upper Blue Nile Basin, Ethiopia
No full textDrought is a silent and pervasive disaster that impacts a large area and propagates slowly. Unlike for other natural disasters such as floods, tornados etc., impacts of droughts do not manifest immediately. This makes it more difficult to monitor drought and mitigate adverse effects by early warning. Several drought indices exist to monitor drought. Individually, however, they are unable to provide an integral concise information to characterize and indicate the occurrence of meteorological, agricultural and hydrological droughts. A combined drought index (CDI) using several meteorological, agricultural and hydrological drought indices can indicate the occurrence of all drought types, and can provide information that facilitates the drought management decision-making process. Moreover, development of a CDI can be an impact-based, e.g. by optimizing for monitoring drought-related crop yield reduction. The economic growth in many developing countries relies on the agricultural products, hence developing crop yield monitoring and prediction methods is vital to enhance the economic growth.Dissertation submitted in fulfillment of the requirements of the Board for Doctorates of Delft University of Technology and of the Academic Board of the UNESCO-IHE Institute for Water Education.Water Resource
Integrating Multiple Sources of Information for Improving Hydrological Modelling: an Ensemble Approach
No full textThe availability of Earth observation (EO) and numerical weather prediction data for hydrological modelling and water management has increased significantly, creating a situation that today, for the same variable, estimates may be available from two or more sources of information. Precipitation data, for example, can be obtained from rain gauges, weather radar, satellites, or outputs from numerical weather models. Land use data can be obtained from land survey, satellite imagery, or a combination of the two. Each of these data sources provides an estimate of a catchment characteristic and related hydrological model parameters, or of a hydrometeorological variable. Estimates from each data source vary in magnitude or temporal and spatial variability. It is not alwayspossible to judge which data source is the most accurate. One data source may perform poorly in one situation but give an accurate estimate for another. Yet, in hydrological modelling, usually, a particular set of catchment characteristics and input data is selected, possibly ignoring other relevant data sources. One of the reasons may be that despite vast research and development efforts in integration methods for sub-sets of the available data sources, there is no comprehensive data-model integration framework assuming existence and enabling effective use of multiple data sources in hydrological modelling.The main objective of this thesis, therefore, is to develop such a data-model integration framework, and test it on a case study.Dissertation submitted in fulfillment of the requirements of the Board for Doctorates of Delft University of Technology and of the Academic Board of the UNESCO-IHE Institute for Water Education.Water Resource
Kolfe Low-Cost Housing Site
No full textThis graphic novel is the result of a micro-ethnographic research to Kolfe, a neighbourhood in Addis Ababa. Using graphic techniques borrowed from the architecture discipline, this graphic novel aims at bringing together representations of everyday life in Kolfe, that show how human life shapes its environment and vice versa. This graphic novel not only represents the architectural qualities and spatial relationships, but also reveals the hidden narratives of ordinary stories.This Graphic Novel was produced as part of the MSc3 Global Housing Research Seminar of Architecture & Dwelling from the Faculty of Architecture and the Built Environment. The course was set up as a supportive educational component in the research project ‘Addis Ababa Living Lab’ (2019-2023), jointly funded by NWO-WOTRO and TU Delft.Architecture, Urbanism and Building Sciences | Dwellin
Gerji World
No full textThis graphic novel is the result of a micro-ethnographic research to Gerji, a district of Addis Ababa. Using graphic techniques borrowed from the architecture discipline, this graphic novel aims at bringing together representations of everyday life in the Gerji neighbourhood, that show how human life shapes its environment and vice versa. This graphic novel not only represents the architectural qualities and spatial relationships, but also reveals the hidden narratives of ordinary stories.This Graphic Novel was produced as part of the MSc3 Global Housing Research Seminar of Architecture & Dwelling from the Faculty of Architecture and the Built Environment. The course was set up as a supportive educational component in the research project ‘Addis Ababa Living Lab’ (2019-2023), jointly funded by NWO-WOTRO and TU Delft.Architecture, Urbanism and Building Sciences | Dwellin
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