Search results for: HIDA

Authors: Ibrahim M Hassan, Lorna Que, Michael Rutland

Abstract:

Type I SOD is usually diagnosed by anatomical imaging such as ultrasound, CT and MRCP. However, the types II and III SOD yield negative results despite the presence of significant symptoms. In particular, the type III is difficult to diagnose due to the absence of significant biochemical or anatomical abnormalities. Nuclear Medicine can aid in this diagnostic dilemma by demonstrating functional changes in the bile flow. Low dose Morphine (0.04mg/Kg) stimulates the tone of the sphincter of Oddi (SO) and its usefulness has been shown in diagnosing SOD by causing a delay in bile flow when compared to a non morphine provoked - baseline scan. This work expands on that process by using sublingual GTN at 60 minutes post tracer and morphine injection to relax the SO and induce an improvement in bile outflow, and in some cases show immediate relief of morphine induced abdominal pain. The criteria for positive SOD are as follows: if during the first hour of the morphine provocation showed (1) delayed intrahepatic biliary ducts tracer accumulation; plus (2) delayed appearance but persistent retention of activity in the common bile duct, and (3) delayed bile flow into the duodenum. In addition, patients who required GTN within the first hour to relieve abdominal pain were regarded as highly supportive of the diagnosis. Retrospective analysis of 85 patients (pts) (78F and 6M) referred for suspected SOD (type III) who had been intensively investigated because of recurrent right upper quadrant or abdominal pain post cholecystectomy. 99mTc-HIDA scan with morphine-provocation is performed followed by GTN at 60 minutes post tracer injection and a further thirty minutes of dynamic imaging are acquired. 30 pts were negative. 55 pts were regarded as positive for SOD and 38/55 (60%) of these patients with an abnormal result were further evaluated with a baseline 99mTc-HIDA. As expected, all 38 pts showed better bile flow characteristics than during the morphine provocation. 20/55 (36%) patients were treated by ERCP sphincterotomy and the rest were managed conservatively by medical therapy. In all cases regarded as positive for SOD, the sublingual GTN at 60 minutes showed immediate improvement in bile flow. 11/55(20%) who developed severe post-morphine abdominal pain were relieved by GTN almost instantaneously. We propose that GTN is a useful agent in the diagnosis of SOD when performing 99mTc-HIDA scan and that the satisfactory response to the sublingual GTN could offer additional information in patients who have severe pain at the time the procedure or when presenting to the emergency unit because of biliary pain. And also in determining whether a trial of medical therapy may be used before considering surgery.

Keywords: GTN, HIDA, MORPHINE, SOD

Procedia PDF Downloads 304

Authors: Kenichiro Hida, Shin-Ichi Kuribayashi

Abstract:

NFV-based network implements a variety of network functions with software on general-purpose servers, and this allows the network operator to select any capabilities and locations of network functions without any physical constraints. In this paper, we evaluate the influence of the maximum tolerable network delay on the virtual routing function deployment guidelines which the authors proposed previously. Our evaluation results have revealed the following: (1) the more the maximum tolerable network delay condition becomes severe, the more the number of areas where the route selection function is installed increases and the total network cost increases, (2) the higher the routing function cost relative to the circuit bandwidth cost, the increase ratio of total network cost becomes larger according to the maximum tolerable network delay condition.

Keywords: NFV (Network Functions Virtualization), resource allocation, virtual routing function, minimum total network cost

Procedia PDF Downloads 247

Authors: Kenichiro Hida, Shin-Ichi Kuribayashi

Abstract:

In a conventional network, most network devices, such as routers, are dedicated devices that do not have much variation in capacity. In recent years, a new concept of network functions virtualisation (NFV) has come into use. The intention is to implement a variety of network functions with software on general-purpose servers and this allows the network operator to select their capacities and locations without any constraints. This paper focuses on the allocation of NFV-based routing functions which are one of critical network functions, and presents the virtual routing function allocation algorithm that minimizes the total power consumption. In addition, this study presents the useful allocation policy of virtual routing functions, based on an evaluation with a ladder-shaped network model. This policy takes the ratio of the power consumption of a routing function to that of a circuit and traffic distribution between areas into consideration. Furthermore, the present paper shows that there are cases where the use of NFV-based routing functions makes it possible to reduce the total power consumption dramatically, in comparison to a conventional network, in which it is not economically viable to distribute small-capacity routing functions.

Keywords: NFV, resource allocation, virtual routing function, minimum power consumption

Procedia PDF Downloads 341