Search

8th International Congress on Environmental Modelling and Software, Toulouse, FRA, 10-/07/2016 - 14/07/2016; International audience; This paper proposes a new methodology to analyze images from subsoil surveys obtained by using ground penetrating radar (GPR) as a non-destructive method. The aim is to advance towards automatic GPR image interpretations. The main idea is to promote the inclusion of these non- destructive technologies as support in technical management in large-scale systems such as water distribution systems (WDSs). The methodology proposed in this paper uses pre-processing techniques based on a multi-agent approach and analysis of the properties of the obtained groups. In addition, a first classification (via perceptron) of the selected property in the groups is performed. The work is based on GPR studies performed on controlled laboratory conditions; two kinds of test conditions are raised. The first kind pursues capturing objects in GPR images to favor feature extraction thereof, since these tests are used to develop the proposed methodology. The second kind of tests seeks to assess the feasibility of the proposed methodology implementation, while the interaction of the captured objects with other objects and with the environment is evaluated. The results of this study are promising in regard to the selection of areas in GPR images via automatic interpretation that allows the extraction of relevant features for WDS networks. In addition, with the proposed methodology, the use of GPR is promoted by non-highly skillful and expert operators in GPR image interpretation.

Introducción: Estudios recientes indican que los beneficios en la supervivencia con hemodiafiltración en línea posdilucional (HDFOL-post) se logran si el volumen de infusión (Vinf) es superior a 20 l por sesión, cifra que no es fácil lograr por los problemas que genera la hemoconcentración. Hoy día contamos con técnicas automáticas que logran un mayor rendimiento minimizando el número de alarmas como el Ultracontrol® (UltraC). Objetivo: El objetivo ha sido, en una primera parte, evaluar el UltraC para conocer qué rendimiento logra (expresado como la fracción de filtración [FF] y el Vinf) y los problemas que presenta y, en una segunda parte, estudiar su funcionamiento con cuatro dializadores diferentes. Material y métodos: Primera parte. Nueve pacientes fueron transferidos a HDFOL-post con UltraC. Se recogieron todas las sesiones correspondientes a los tres primeros meses con HDF-OL y al mes previo en HD. Segunda parte. 18 pacientes en tratamiento crónico con HDFOL-post fueron sometidos a diálisis una semana con cada uno de estos dializadores: FX1000, FX800, Polyflux210 y Elisio 210H. Resultados: Primera parte. En 3 pacientes surgieron problemas asociados a PTM y Psist inadecuadas que se resolvieron pasando a control-presión. Los valores medios obtenidos fueron: Qb máximo 441 (21) (rango 350-490) ml/min, Vinf 26,3 (3,3) l/sesión, FF 30,6% (2,5), KT 59,9 (5) l/sesión, y aumento del KT del 12% respecto al de HD. Segunda parte. Polyflux210 fue el dializador que precisó menos retiradas de UltraC. Las presiones recogidas tanto PTM como Psist fueron distintas y determinaron la necesidad de retirada del sistema. El KT fue adecuado. Conclusiones: a) El sistema UltraC alcanza FF del 30% consiguiendo Vinf adecuados con mínimas alarmas, y b) Dializadores con prestaciones depurativas adecuadas pueden no ser útiles para realizar HDF-OL con UltraC porque sus condiciones flujodinámicas generan alarmas que impiden la aplicación automatizada aunque el rendimento final sea semejante. Introduction: Recent studies indicate that the survival benefit with post-dilution on line hemodiafiltration (OL-HDF-post) are achieved if the infusion volume (Vinf) is greater than 20L per session, a goal that is not easily achieved due to hemoconcentration problems. Today we have automated techniques to achieve higher performance minimizing the number of alarms as Ultracontrol® (Ultrac). The objective in the first part of study was to evaluate the UltraC performance (expressed as the filtration fraction (FF) and Vinf) and which problems it presents, and in the second part, to study its performance with four different dialyzers. Material and methods: 1st period. Nine patients were transferred to OL-HDF-post with UltraC. The first 3 months on OL-HDF all sessions were recorded and compared with hemodialysis sessions in the previous month. 2nd part: 18 patients on chronic OL-HDF-post were dialyzed for a week with each of these dialyser: FX1000, FX800, Elisio210H and Polyflux210. Results: 1st period: In 3 patients, problems associated with inappropriate pressures emerged. In 3 patients there were problems associated with inadequate PTM and Psist that resolved changing to pressure control. Mean values were: maximum Qb 441 (21) (range 350-490) ml/min, Vinf 26.3 (3.3) l/session, FF 30.6 (2.5)%, KT 59.9 (5) l/session. KT increase of 12% compared to HD. 2nd part: Polyflux210 required less UltraC withdrawals than the others. Different PTM or Psist were found and determined the need for removal of the system. The KT was adequate. Conclusions: a) The UltraC system reaches FF of 30% with minimal alarms and Vinf higher than 20 l. b) Structural characteristics of dialysers can limit their use with UltraC although they managed to desirable KT and Vinf in a manual way.

Introducción: Estudios recientes indican que los beneficios en la supervivencia con hemodiafiltración en línea posdilucional (HDFOL-post) se logran si el volumen de infusión (Vinf) es superior a 20 l por sesión, cifra que no es fácil lograr por los problemas que genera la hemoconcentración. Hoy día contamos con técnicas automáticas que logran un mayor rendimiento minimizando el número de alarmas como el Ultracontrol® (UltraC). Objetivo: El objetivo ha sido, en una primera parte, evaluar el UltraC para conocer qué rendimiento logra (expresado como la fracción de filtración [FF] y el Vinf) y los problemas que presenta y, en una segunda parte, estudiar su funcionamiento con cuatro dializadores diferentes. Material y métodos: Primera parte. Nueve pacientes fueron transferidos a HDFOL-post con UltraC. Se recogieron todas las sesiones correspondientes a los tres primeros meses con HDF-OL y al mes previo en HD. Segunda parte. 18 pacientes en tratamiento crónico con HDFOL-post fueron sometidos a diálisis una semana con cada uno de estos dializadores: FX1000, FX800, Polyflux210 y Elisio 210H. Resultados: Primera parte. En 3 pacientes surgieron problemas asociados a PTM y Psist inadecuadas que se resolvieron pasando a control-presión. Los valores medios obtenidos fueron: Qb máximo 441 (21) (rango 350-490) ml/min, Vinf 26,3 (3,3) l/sesión, FF 30,6% (2,5), KT 59,9 (5) l/sesión, y aumento del KT del 12% respecto al de HD. Segunda parte. Polyflux210 fue el dializador que precisó menos retiradas de UltraC. Las presiones recogidas tanto PTM como Psist fueron distintas y determinaron la necesidad de retirada del sistema. El KT fue adecuado. Conclusiones: a) El sistema UltraC alcanza FF del 30% consiguiendo Vinf adecuados con mínimas alarmas, y b) Dializadores con prestaciones depurativas adecuadas pueden no ser útiles para realizar HDF-OL con UltraC porque sus condiciones flujodinámicas generan alarmas que impiden la aplicación automatizada aunque el rendimento final sea semejante.

La bacteriemia relacionada con el catéter (BRC) en pacientes en hemodiálisis (HD) es una complicación grave. Existen múltiples publicaciones que abogan por el uso de diferentes medidas farmacológicas para su prevención, pero muy pocas sobre la importancia de las medidas de precaución universal. El objetivo de este trabajo es mostrar la baja tasa de incidencia de BRC obtenida con la aplicación estricta de un protocolo de cuidados de catéter tunelizado (CT) por un personal bien entrenado en una nueva unidad de hemodiálisis. Durante 20 meses se aplicó un protocolo de manejo de CT por personal de enfermería cualificado. Se utilizaron un total de 42 CT en 32 pacientes. El tiempo total de seguimiento fue de 8.372 días en los que ocurrieron dos episodios de BRC: 0,24 eventos/1.000 días-catéter. El trabajo muestra cómo sólo con medidas de precaución universal pueden lograrse tasas de BRC dentro de la excelencia. Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB), ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with a strict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0,24 CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended.

La bacteriemia relacionada con el catéter (BRC) en pacientes en hemodiálisis (HD) es una complicación grave. Existen múltiples publicaciones que abogan por el uso de diferentes medidas farmacológicas para su prevención, pero muy pocas sobre la importancia de las medidas de precaución universal. El objetivo de este trabajo es mostrar la baja tasa de incidencia de BRC obtenida con la aplicación estricta de un protocolo de cuidados de catéter tunelizado (CT) por un personal bien entrenado en una nueva unidad de hemodiálisis. Durante 20 meses se aplicó un protocolo de manejo de CT por personal de enfermería cualificado. Se utilizaron un total de 42 CT en 32 pacientes. El tiempo total de seguimiento fue de 8.372 días en los que ocurrieron dos episodios de BRC: 0,24 eventos/1.000 días-catéter. El trabajo muestra cómo sólo con medidas de precaución universal pueden lograrse tasas de BRC dentro de la excelencia.

We present the results on Anaemia Management in Fresenius Medical Care Spain dialysis centres as reported by EuCliD (European Clinical Database), evaluating a population of 4,426 patients treated in Spain during the year 2001. To analyse the erythropoietin dose and the haemoglobin levels we divided the population in two groups according to the time with dialysis treatment: patients treated less than six months and patients between six months, and four years on therapy. We compared our results with the evidence based recommendations Guidelines: the European Best Practice Guidelines (EBPG) and the US National Kidney Foundation (NKF-K/DOQI). We also compared our results with those presented by the ESAM2 on 2,618 patients on dialysis in Spain carried out in the second half of the year 2000. We observed that 70% of the population reaches an haemoglobin value higher that 11 g/dl, with a mean erythropoietin (rHu-EPO) dose of 111.9 Ul/kg weight/week (n = 3,700; SD 74.9). However, for those patients on treatment for less than six months, the mean Haemoglobin only reaches 10.65 g/dl (n = 222; SD 1.4). The rHu-EPO was administrated subcutaneously in 70.2% of the patients. About the iron therapy, 86% of the patients received iron treatment and the administration route was intravenous in 93% of the population. The ferritin levels were below 100 micrograms/dl in 10% of the patients and 26.4% showed a transferrin saturation index (TSAT) below 20%. The erythropoieting resistance index (ERI), as rHu-EPO/haemoglobin, has been used to evaluate the response to rHu-Epo, according to different variables. It was observed that the following factors lead to a higher rHu-EPO resistance: intravenous rHu-EPO as administration route, the presence of hypoalbuminemia, increase of protein C reactive, Transferrin saturation below 20% and starting dialysis during the last six months.

Objective: To study the incidence, prevalence, treatment modalities and prognosis of diabetic patients on renal replacement therapy. Material: We studied all end-stage renal failure (ESRF) diabetic patients on renal replacement therapy in "Area Sanitaria 1" in Madrid from 1978 to 1998. Results: Diabetes mellitus has become the leading cause of ESRF in our health area of Madrid, 30% of all causes of ESRF. Incidence of diabe tics beginning RRT was 33,3 per million population (pmp) in 1998, while in 1993-94 diabetes was 15 % and 21 pmp, respectively, table 1. The propor tion of diabetics on RRT has increased from 7,4 % 1986 to 12,7 % 1998. The prevalence of diabetics on RRT in 1998 was 135 pmp, with an overall prevalence of 1054 pmp. At the mean time, the proportion between incident diabetics type 2/ diabetics on RRT has increased from 15 % in 1987-88, to 54 % in 1993-94 and to 81% in 1997-98, consequently, mean age of diabe tic patients at beginning RRT has increased from 47 years before 1988, 58 in 1989-90, 61 in 1993-94, 62 in 1995-96 and 63 in 1997-98 (Table I). We studied 182 diabetics admitted for renal replacement therapy, 106 males and 76 females, 105 were diabetics type 1 and 77 type 2. Their mean age at RRT beginning was 57 12 years (SD). Hemodialysis (HD) was the first modality of treatment for 128 (70%) diabetics and CAPD for 54. Seventy out of 128 patients on HD were dialyzed in the Hospital Unit, 40% on AFB (acetate free biofiltration) and 58 in two Satellite Units, that means a higher proportion of diabetics on CAPD and on HD in Hospital Unit. Diabetics allocated to CAPD were 5 years, as mean, younger than patients allocated to HD (p

Objetivo: Valorar la incidencia, prevalencia, tipo de tratamiento y pronóstico de pacientes diabéticos en tratamiento sustitutivo de la función renal (TSFR). Material: Se estudia a todos los pacientes diabéticos con insuficiencia renal terminal en TSFR en el Área Sanitaria 1 de Madrid desde 1978 hasta 1998. Resultados: La diabetes mellitus se ha convertido en la principal causa de insuficiencia renal terminal en nuestra área sanitaria, constituyendo en la actualidad el 30% de todas las causas de entrada en TSFR. La incidencia de diabéticos que comenzaron en 1998 TSFR fue de 33,3 pmp, claramente superior a la del periodo 1993-94, 21 pmp. La prevalencia de pacientes diabéticos en TSFR en 1998 fue de 135 pmp, con una prevalencia global de 1054 pmp. Se ha incrementado la proporción de diabéticos tipo 2 con respecto al global de pacientes diabéticos que inician tratamiento sustitutivo, pasando de ser un 15% en 1987-88 a un 81% en 1997-98. De manera simultánea, se ha incrementado la edad media de dichos pacientes, pasando de ser 47 años antes de 1988 a 63 años en 1997-98. En total se estudian 182 diabéticos, 106 hombres y 76 mujeres. 105 eran diabéticos tipo 1 y 77 tipo 2, con una edad media al comienzo del TSFR de 57 12 años. La hemodiálisis (HD) fue la primera modalidad de tratamiento en 128 pacientes y la diálisis peritoneal (DP) en 54. Los pacientes que iniciaban DP eran 5 años más jóvenes que los que iniciaban HD, p

Prospective study initiated in September of 1994 in patients with complicated glaucoma who had had the Ahmed valve implanted.12 eyes from 12 patients were studied until February of 1996, with a median follow-up of 9.3+/-5.1 months (range 3-18 months). The most common diagnostic was pseudophakic glaucoma (8 ojos). 3 eyes had aphakic glaucoma and 1 eye had traumatic glaucoma. The success is defined as intraocular pressure (IOP)/=20 mmHg. without oral carbonic anhydrase inhibitors (OCAI) treatment.The IOP was reduced (p0.01) of 26.2+/-9.96 mmHg to 15.7+/-4.48 mmHg. The success was of 83.3% but only 2 eyes (16.6%) were controlled effectively without treatment. The major complication was the Tenon's cyst (25%).From the percentage of successes (83.3%) and the absence of important complications we advise the implantation of the Ahmed glaucoma valve in those patients with complicated glaucoma after a failure of filtrating surgery with mitomycin-C.

This study investigates the results of trabeculectomy with peroperative topical application of mitomycin-C performed on eyes with previous failed glaucoma filtering surgery.The study includes 34 eyes of 26 patients operated on open angle glaucoma between March 1992 and October 1996, with a minimum of 6 months follow-up (mean 28.1 months). All the eyes had undergone prior one (27) o two (7) filtering surgeries. We evaluated intraocular pressure (IOP) and treatment reduction after surgery. Success was defined as IOP20 mmHg, without deterioration of the visual field and/or papilla and without oral carbonic anhydrase inhibitors (OCAI) treatment.Average IOP decrease (p0,001) from 21.06+/-3.70 mmHg to 13.88+/-2.42 mmHg after surgery and the number of medications dropped from 2.44+/-0.69 to 0.68+/-1.02 (p0.01). The success rate was 88.2%. The major complication was hypotony maculopathy in 3 eyes (8.8%).Trabeculectomy with mitomycin-C decreases IOP and postoperative medications in eyes with previous unsuccessful filtering surgery.