68 research outputs found
Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients
No full textFerdinand Frederik Som Ling Tan,1 Sjouke Schiere,1 Auke C Reidinga,2 Fennie Wit,3 Peter HJM Veldman3 1Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands; 2Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands; 3Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands Purpose: Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block. Patients and methods: Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected . The other side was anesthetized in a similar fashion. Results: Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day. Conclusion: A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient. Keywords: intraoral, regional anesthesia, percutaneous, ultrasound, mental nerve bloc
The Heineken LAB: a place to facilitate and accelerate innovation
No full textOver the past ten years Heineken measured a decrease in brand power, especially among younger consumers. Furthermore, Heineken lacks an experiential culture that fosters innovation due to daily workloads, mindset on global impact and scalability, immediate successful deliverables and business cases, and strict brand approval and brand mitigation. To increase the brand power among younger consumers and overcome the barriers this project is initiated, a project to create a place to open-mindedly explore the future of beer and beyond. The motive of this thesis was to advice Heineken in building an innovation lab. A future oriented approach is chosen to create this place, called DIVE (Design, Innovation, Vision, Exploration). This approach is combined with the Vision in Product Design method, the dynamic capabilities framework, and the Design Driven Innovation method. Since the combination is new, there will be a reflection after every step. The steps are: 1. Understanding the present, 2. Approaching the future, 3. Imagining the future, and 4. Establishing final boundary object. Understanding the present is achieved through analysing Heineken and the target group. Findings are that the world of beer is under pressure, that Heineken has not their fair share among the Gen Y and Z and that gen Z will bring disruption. For further research the domain is delimited to quality socializing among Gen Z.Approaching the future results in a list of factors and together with knowledge from the previous step form a future worldview. This worldview is used to create a narrative about the place which indicates characteristics of the Heineken LAB. The place should be in an upcoming urban area where Heineken revamps an old building, look for combining nature, facilitating outstanding experiences, and repurposing old stuff. The place will have an amazing bar at its core to explore new drinking rituals, new production techniques, new beers and drinks and use new technologies.The final boundary object, which is the result of this thesis, is a strategy including the aim, objectives, KPI’s, characteristics and a roadmap of four steps including planning, approach, allocation of resources, and accompanying themes for creating the Heineken LAB. The defined steps for developing the Heineken LAB are the brewery, the bar, the lounge, and the program. Through a workshop with both internal and external stakeholders the previous research and strategy is validated. Although the number of participants is low, the participants confirmed the research and agreed with the roadmap. After graduating, the strategy will still be in place.The created framework in the beginning of the project needs more validation before concluding whether it works as an approach to create an innovation lab. Even though it worked for this project, there are limitations. Next to the approach, the ability to envision, inspire, simplify, structure, align, translate, embrace, and educate are needed.Strategic Product Desig
Geomechanical Characterization of the Buntsandstein including a Fracture Model
No full textWith an increased demand for renewable energy sources, geothermal developments have moved into the spotlight, including sedimentary structures. In the western part of the Netherlands, cretaceous sandstone bodies are already in use for the geothermal energy production. However, these reservoirs are generally producing water at temperatures less than 100°C from depths of 1500 to 3000 m. To reach higher temperatures, deeper reservoirs need to be targeted. Being more than 130 m thick in some parts and up to 4000 m deep, the Lower Triassic Buntsandstein would provide an ideal target reservoir for geothermal exploration in the West Netherlands Basin, given the high temperatures of over 140°C at this depth. However, the Buntsandstein is relatively heterogeneous in terms of porosity, as seen in numerous rock samples, and the overall permeability that was found in the Buntsandstein in various wells was generally low. Therefore a conventional development of a Buntsandstein reservoir, with a geothermal doublet in a natural hydrothermal reservoir, might not be applicable. To enhance the permeability and achieve economic flow rates, hydraulic stimulation can be performed. This technique has proven to be effective in many other reservoirs. To assess such effects on the Buntsandstein, this thesis focusses on the effect of fractures on the fluid flow in the Buntsandstein. Geomechanical characteristics and physical properties of the Buntsandstein at relevant pressure and temperature (PT) conditions are investigated in core experiments in uniaxial compression tests and triaxial tests. The laboratory experiments on cores provide reliable intrinsic information of permeability at relevant PT conditions and give a realistic estimation of fluid flow parameters. Triaxial deformation tests were conducted on different sandstones varying in porosity, clay content, degree of oxidization and initial permeability. Changes in permeability before and after deformation are compared. Moreover, the effect of increasing confining pressure on the permeability is measured on intact sandstones. Two principal modes of brittle fracture (extension fracture and shear fracture) were tested on samples under confining pressure. Experiments revealed that the permeability decreases by a factor of 17 in porous sandstones, from 85 mD to 5 mD, when inducing shear fractures at 30 MPa effective pressure. Buntsandstein samples with a low initial permeability (~1 mD) show a slight increase to 2 mD. For tensile fractures the permeability increased exponentially with the increase in apparent fracture aperture. Up to apertures of around 1000 µm, the permeability increased by factor of 2 for increments of 100 µm. Ultimately, effects of fractures and resulting changes in flow properties are analyzed for the impact on the production life of a geothermal injector-producer pair. Results from lab experiments are implemented in a field scale thermo-hydro-mechanical model, making it possible to predict the PT distribution in the reservoir in regard to a change in permeability. The laboratory experiments and the numerical modeling procedure indicate that the in-situ permeability is too low for a geothermal reservoir production and would require some sort of stimulation to enhance the permeability
Effects of Thermal Shock on the Creation of Microfractures and Mechanical Properties of Various Volcanic Rock Types, including Samples from the Indonesian Geothermal Field (Tangkuban Perahu)
No full textThis thesis aims at investigating the effect of a thermal shock of a couple of hundred degrees on the creation of the thermal microfractures and in what way the mechanical properties of volcanic rocks change. In the geothermal field, thermal microfractures can contribute to increase the permeability and produce more steam to the surface. We exposed basaltic andesite and andesite rocks from Tangkuban Perahu (Indonesia), a granite from Benin (West Africa), a basalt from the Eifel (Germany) and a basalt rock from Reynifsjara (Iceland) to temperatures of 200, 300, 400 and 500°C before cooling them rapidly by placing them in cold 20°C water. Initially, most of the sample rocks show less than 1% of porosity, excluding andesite Tangkuban Perahu (~6%) and basalt Reynisfjara (~14%), and permeability for all rocks is below detectable value (2.6 mD by Ruska gas permeameter for specified core geometry). In the geothermal field scenario, it indicates the pores were not connected and the steam may not easily flow through the rock. After the heating stage and thermal cooling, significantly increased values of porosity are observed in most of the rocks. However, only the two high porosity rocks gained permeability; the andesite Tangkuban Perahu (7-11 mD) and basalt Reynisfjara (4.45 mD). The changes in Young’s modulus, Poisson’s ratio and ultimate compressive strength of the various samples were also determined by using an unconfined Uniaxial Compressive Strength (UCS) apparatus in which both heat treated and non-heat treated samples were placed. The results show the rock strength decreases with increasing thermal shock. Similarly, we see a decrease in both Young’s modulus and Poisson’s ratio with increasing thermal shock. To recognize the thermal shock effect visually, the samples were imaged using a micro-CT scan before and after heating treatment. The resolution of the CT scanner was 30 μm at best when the whole sample is scanned. It is noticed that the porosity increases after the heating experiment. Additional mini-cores (~10 mm x 8 mm) from the whole core are also scanned at 14 μm resolution. The scans showed the porosity on the outside part of the cores is up to 10 times higher than the inner part. In Indonesia, the geothermal reservoir temperature varies from 200-300oC. By injecting cold water from the surface at a high rate, the water temperature remains low and can thus create the thermal shock that opens up existing fractures and forms new ones. In that way, it can increase fluid path ways around the well bore and along existing natural fractures.Applied Earth Science
Cyclocephala ovulum H. W. Bates 1888
No full text<i>Cyclocephala ovulum</i> H. W. Bates, 1888 <p> <i>Cyclocephala ovulum</i> H. W. Bates 1888: 306 (Amazon Basin, Guatemala, Nicaragua, Panama)</p> <p> <b>Distribution. Guyana:</b> Bodkin 1919: 215; Moore et al. 2018b: 225. <b>Suriname:</b> MHCN - <b>NEW COUN- TRY RECORD</b> (Suriname, Para, 1 km W of Zanderij, (5°27′37″N, 55°13′21″W). 5-I-2011. A. J. Hielkema. On UV/HPL in savanna forest.); NZCS. <b>French Guiana:</b> Moore et al. 2018b: 225. <b>“Guianas”:</b> Arrow 1937b: 14; Blackwelder 1944: 252. <b>Brazil:</b> Arrow 1937b: 14; Blackwelder 1944: 252; Moore et al. 2018b: 225. <b>Venezuela (EO):</b> Kirmse and Ratcliffe 2019: 153 (EO). <b>“Amazon Basin”:</b> H. W. Bates 1888: 306. <b>Other:</b> H. W. Bates 1888: 306 (Guatemala, Nicaragua, Panama); Arrow 1937b: 14 (Guatemala, Paraguay); Blackwelder 1944: 252 (Guatemala, Nicaragua, Panama, Paraguay); Endrödi 1966a: 318 (treated as an aberration of <i>C. testacea</i>), 1985a: 108, 146 (treated as an aberration of <i>C. testacea</i>); Ponchel 2011 (not mentioned); Dupuis 2016b (not mentioned); Moore et al. 2018b: 225 (Argentina, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay).</p> <p> <b>Note.</b> In Endrödi (1966a: 318, 1985a: 108, 146) <i>Cyclocephala ovulum</i> is regarded as an aberration of <i>C. testacea</i>. It is reinstated as a species in Ratcliffe (2003: 180). It is noteworthy that, despite several collectors and authors being active in French Guiana, no reliable records of <i>C. ovulum</i> from the Guianas have been published after Blackwelder (1944: 252), even though Ratcliffe has identified Surinamese specimens from multiple locations in the first author’s collection as belonging to this species. However, <i>C. testacea</i> has recently been reported multiple times for French Guiana (see under that species). This likely means that either the Marowijne River between Suriname and French Guiana acts as a border for this species, or that either Surinamese or French Guianese specimens are consistently being misidentified, or that the validity of <i>C. ovulum</i> as a separate species is not (yet) accepted by French taxonomists. The only record for French Guiana that we are aware of is in Gruner (1971: 845), as <i>C. testacea</i> ab. <i>ovulum</i>, and in Moore et al. (2018b: 225), with the former being copied by the latter (M. Moore, pers. comm. 2018). Given the apparent overall untrustworthiness of Gruner (1971), we consider this record unreliable.</p>Published as part of <i>Hielkema, Auke J. & Hielkema, Meindert A., 2019, An annotated checklist of the Scarabaeoidea (Insecta: Coleoptera) of the Guianas, pp. 1-306 in Insecta Mundi 732 (732)</i> on page 177, DOI: <a href="http://zenodo.org/record/3678492">10.5281/zenodo.3678492</a>
Cyclocephala amazona
No full textCyclocephala amazona (Linnaeus, 1767) Scarabaeus amazonus Linnaeus 1767: 551 Note. Two presently recognized subspecies of Cyclocephala amazona have been described, one of which occurs in the research area. The other one is C. amazona boliviensis Höhne, 1923 (recorded from Brazil, Bolivia) Subspecies Cyclocephala amazona amazona (Linnaeus, 1767) Scarabaeus amazonus Linnaeus 1767: 551 (Suriname) = Melolontha signata Fabricius 1781: 39 (Jamaica) = Melolontha pallens Fabricius 1798: 132 (French Guiana) = Cyclocephala detecta H. W. Bates 1888: 300 (Mexico, Nicaragua) Distribution. Guyana: Endrödi 1966a: 147, 1985a: 66, 132 (as C. amazonica amazonica); Dechambre 1979c: 160; Moore et al. 2018b: 142. Suriname: Linnaeus 1767: 551 (as Scarabaeus amazonus); Uyttenboogaart 1902: 116 (as C. signata Drury); Endrödi 1966a: 147 (designation NEOTYPE Scarabaeus amazonus), 1985a: 66, 132 (as C. amazonica amazonica); Dechambre 1979c: 160; Moore et al. 2018b: 142; MHCN; NZCS; RMNH. French Guiana: Fabricius 1798: 132 (as Melolontha pallens); Endrödi 1966a: 147, 1985a: 66, 132 (as C. amazonica amazonica); Dechambre 1979c: 160; Duranton 2011: 11 (as C. amazonica); Ponchel 2011: 60; Dupuis 2016b: 109; Moore et al. 2018b: 142; MHCN; NZCS. “Guianas”: Arrow 1937b: 8, 14 (as C. amazona; as C. pallens); Blackwelder 1944: 251, 252 (as C. amazona; as C. pallens). Brazil (NA): Endrödi 1966a: 147 (NA), 1985a: 66, 132 (as C. amazonica amazonica); Dechambre 1979c: 160; Moore et al. 2018b: 142. Venezuela: Arrow 1937b: 16 (as C. signata); Blackwelder 1944: 252 (as C. pallens; as C. signata); Endrödi 1966a: 147, 1985a: 66, 132 (as C. amazonica amazonica); Dechambre 1979c: 160; Moore et al. 2018b: 142. Other: Fabricius 1781: 39 (Jamaica - as Melolontha signata); H. W. Bates 1888: 300 (Mexico, Nicaragua - as C. detecta); Arrow 1937b: 10, 16 (Honduras, Mexico, Panama - as C. detecta; Colombia, Grenada, Nicaragua, Panama, Peru, Trinidad and Tobago - as C. signata); Blackwelder 1944: 251, 252 (Honduras, Mexico, Nicaragua, Panama - as C. detecta; Belize, Colombia, Cuba, Grenada, Jamaica, Nicaragua, Panama, Peru, Trinidad and Tobago - as C. signata); Endrödi 1966a: 147 (Chile, Costa Rica, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru - as C. amazona amazona; Antilles - as C. amazona signata), 1985a: 66, 132 (Central America, Ecuador, Paraguay, Peru - as C. amazonica amazonica); Dechambre 1979c: 160 (Barbados, Bolivia, Central America, Chile, Colombia, Cuba, Ecuador, Grenada, Mexico, Paraguay, Peru, Trinidad and Tobago); Lachaume 1992: 13 (Central America–Paraguay, West Indies); Ratcliffe 2003: 83 (Costa Rica–Paraguay/Chile); Moore et al. 2018b: 142 (Bolivia, Chile, Colombia, Costa Rica, Ecuador, Panama, Paraguay, Peru, Trinidad and Tobago, West Indies). Note 1. Uyttenboogaart (1902: 116) incorrectly named Drury as the author of the Cyclocephala signata he recorded for Suriname. In Uyttenboogaart’s time, two species could be called C. signata. These were Melolontha signata Fabricius, 1781 (p. 39), which is now a synonym of C. amazona, and M. signata Olivier, 1789 (p. 28), which is now a synonym of C. notata (Illiger, 1806) (p. 235). According to Uyttenboogaart (1902), the species he found was very common and flew into lighted rooms at night. This species is the present C. amazona, as confirmed by our examination of the original specimens of Uyttenboogaart in RMNH. Cyclocephala notata is a species from the Antilles and does not occur in the Guianas. Note 2. Moore et al. (2018b: 107) conclude that the neotype of Scarabaeus amazonus designated in Endrödi (1966a: 147) is invalid because it violates several requirements of Article 75 of the ICZN (1964: 81). Note 3. According to Ratcliffe (2003: 83, 165), Ratcliffe and Cave (2006: 132, 167) and Ratcliffe et al. (2013: 201, 595), the purported specimens of Cyclocephala amazona from El Salvador, Guatemala, Honduras, Mexico and Nicaragua in Endrödi (1966a: 147) and Dechambre (1979c: 160) are in fact C. multiplex Casey, 1915. Note 4. Cyclocephala multiplex is described in Casey (1915: 139) based on five specimens from Honduras. In Arrow (1937b: 10) and Blackwelder (1944: 251), this species is considered a synonym of C. detecta, which was described in H. W. Bates (1888: 300) based on two specimens from Mexico and an unspecified number of specimens from Nicaragua. Cyclocephala detecta is synonymized with C. amazona in Endrödi (1964: 466), and both C. detecta and C. multiplex are mentioned as synonyms of C. amazona amazona in Endrödi (1966a: 147) and of C. amazonica in Endrödi (1985a: 66). Ratcliffe (2003: 165) reinstates C. multiplex as a valid species and mentions that all supposed specimens of C. amazona from north of Costa Rica were in fact C. multiplex. By doing so he ignores C. detecta, which, based on its type locality, is almost certainly a senior synonym of C. multiplex rather than a junior synonym of C. amazona. This is also mentioned in Moore et al. (2018b: 217). The type series of C. detecta should be compared with those of C. multiplex to confirm this supposition.Published as part of Hielkema, Auke J. & Hielkema, Meindert A., 2019, An annotated checklist of the Scarabaeoidea (Insecta: Coleoptera) of the Guianas, pp. 1-306 in Insecta Mundi 732 (732) on page 162, DOI: 10.5281/zenodo.367849
Hoofdpijn na een laparotomie: Een chronisch subduraal hematoom na epidurale anesthesie
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie
Headache after a laparotomy:A chronic subdural hematoma after epidural anesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
Headache after a laparotomy:A chronic subdural hematoma after epidural anesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
Headache after a laparotomy:A chronic subdural hematoma after epidural anesthesia
No full textEen 63-jarige man onderging een proeflaparotomie in verband met een rectumcarcinoom. De operatie werd uitgevoerd onder algehele anesthesie gecombineerd met epidurale anesthesie. Vanaf de operatie had patiënt hoofdpijnklachten; 8 weken daarna werd hij opgenomen in verband met een toename van de hoofdpijn en tevens somnolentie. Bij lichamelijk onderzoek vonden wij een lichte valneiging naar links. Op de CT-scan van de hersenen bleek er sprake te zijn van een subduraal hematoom, dat operatief werd ontlast. Wij vermoedden dat het hematoom veroorzaakt was door een accidentele durapunctie. Wij beschrijven incidentie, oorzaken, symptomen, diagnose en behandeling van deze zeldzame complicatie.A 63-year-old man underwent an exploratory laparotomy because of rectal carcinoma. The operation was performed under general anaesthesia in combination with epidural anaesthesia. Since the operation the patient complained of a headache. Eight weeks after the operation he was hospitalized because of worsening of the headache and also drowsiness. A physical examination showed a slight tendency to incline to the left. A CT scan showed a subdural haematoma, which was relieved with surgery. We suspected that accidental puncture of the dura caused the haematoma. The incidence, causes, symptoms, diagnosis and treatment of this rare complication are discussed.</p
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