Laparoscopic operation of a Morgagni hernia

Morgagni hernias are the least common form of diaphragmatic hernias. Although they are congenital, most of them are not diagnosed until later in life. The indication for surgery is based on the patient's symptoms or on the radiological evidence of incarcerated tissue, and until quite recently involved a laparotomy or thoracotomy. Laparoscopy not only permits the suspected diagnosis to be confirmed--which is otherwise often difficult--but also makes it possible to close the hernia site by suturing. For improved security, the hernia site is augmented by fixing in place a non-absorbable mesh. The operative technique employed is described.     

Coronary bypass in vascular patients: a relatively high-risk procedure

A premise of cardiac risk stratification is that the added risk of coronary artery bypass grafting (CABG) is offset by the improved safety of subsequent vascular reconstruction (VR). We questioned if elective CABG is patients with severe peripheral vascular disease (PVD) is a relatively high-risk procedure. A cohort study of 680 elective CABG patients from January 1993 to December 1994 was performed using three mutually exclusive outcomes of complication-free survival, morbidity, and mortality. Patient characteristic, operative, and outcome data were prospectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morbidity occurred at rates 3.6-fold higher in PVD patients (39.7%) than in disease-free patients (16.7%) after adjustment for the effects of patient and operative variables (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most likely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aortic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD patients is associated with significant major morbidity. Such morbidity may preclude or alter the timing of subsequent VR.     

Review of the Robotica software package for robotic manipulators

Robotica is a computer-aided design package for robotic nmanipulators developed at the Coordinated Science Laboratory at the University of Illinois at Urbana- Champaign. The package is a collection of function definitions for the Mathematica symbolic mathematics program. Robotica can be used either with an X- Windows graphical user interface (GUI) on a Sun Workstation or as an included function definition file within Mathematica. The primary feature of Robotica is the ability to compute, symbolically or numerically, the kinematic and dynamic equations of arbitrary robot systems utilizing the standard Denevit-Hartenburg (DH) kinematic convention. Robotica also provides the ability to visualize these arbitrary manipulators using the X- Windows graphical interface to the Mathematica graphics routines. The paper looks at the usage of Robotica at the Air Force Institute of Technology, comments on the features of Robotica, and needs for improvement and suggestions for future development     

High yield formation of carbon nanotubes using a rotating cathode in open air

Carbon nanotubes (CNTs) have been synthesized using the arc discharge method with a rotating graphite disc as the cathode. Arcing was carried out in open air and without the use of catalysts. The current density was maintained constant through out the experiment, while, the rate of rotation of the cathode and atmosphere under which arcing was carried out were changed during experimentation. Characterization of the samples produced indicates that rotation of the cathode has a significant impact on the quality and yield of the process. It is proposed that rotation of the cathode drags plasma formed between two electrodes away from high temperature region. This results in a sudden quenching of the reactive plasma. The time available for nucleation and growth phenomena is significantly reduced and thus leads to the formation of highly graphitic multi walled CNTs (yield 60%) and traces of double walled CNTs.     

Periodontal management of gingival overgrowth in the heart transplant patient: a case report

Heart transplant patients take several medications that could affect their periodontal health. Gingival overgrowth associated with cyclosporin (immunosuppressant agent) and nifedipine (calcium channel blocker) is well documented. Candidal infections often develop because of immune suppression. This report describes the clinical and histopathological changes in the gingival tissues of a heart transplant patient and their management. The gingival tissues exhibited pronounced enlargement. The gingivae were lobulated, and the surface of the lobulations was pebbly and granular. Biopsies showed lobules of fibrous connective tissue covered by stratified squamous epithelium. The outer surfaces were dotted with numerous smaller papillations. Candidal hyphae were present in the superficial layers of the epithelium. The extensive papillary lesions appear to be related to candidiasis and constitute a condition which is best designated as papillary stomatitis. Hyperplastic gingival tissues were excised, and the patient was placed on periodic maintenance. One-year postoperative follow-up showed minor gingival growth.     

Incorporating social support into a community-wide smoking-cessation contest

Exposure to foreign particles sometimes causes inflammatory reactions through production of cytokines and chemoattractants by phagocytic cells. In this study, we focused on macrophage migration inhibitory factor (MIF) to evaluate its pathophysiological role in the phagocytic process. Immunohistochemical analysis of human pseudosynovial tissues retrieved at revision of total hip arthroplasty showed that infiltrating mononuclear and multinuclear cells were positively stained by both an anti-CD68 antibody and anti-human MIF antibody. For in vitro study, MIF was released from murine macrophage-like cells (RAW 264.7) in response to phagocytosis of fluorescent-latex beads in a particle dose-dependent manner. Northern blot analysis showed marked elevation of the MIF mRNA level in the phagocytic macrophage-like cells. Moreover, pretreatment of RAW 264.7 cells with rat recombinant MIF increased the extent of phagocytosis by 1.6-fold compared with the control. Taken together, these results suggest that MIF plays an important role by activating macrophages in autocrine and paracrine fashion to phagocytose foreign particles.     

Childhood thyroid cancer. Characteristics and long-term outcome in children irradiated for benign conditions of the head and neck

OBJECTIVE: To determine the characteristics and long-term outcome of radiation-induced thyroid cancer in children. DESIGN: Retrospective review of a cohort of 4296 irradiated patients who received childhood radiation treatment to the head and neck area at the same hospital. PATIENTS: Forty-one children who were younger than 20 years when thyroid cancer developed in them and 77 adults in whom thyroid cancer developed. All 118 cases were diagnosed before 1974 and were followed up for a median of 19.4 years. RESULTS: Children presented with clinically palpable lymph nodes more often than adults (30.7% vs 15.1%, P = .05) and had more recurrences (39% vs 16%, P = .05). Despite these frequent recurrences, only one patient (an adult) died of thyroid cancer. Seventy percent of the recurrences occurred during the first 10 years of follow-up, but recurrences continued after 20 years. The adults had previously identified factors that predicted the risk of recurrences, but none could be identified in the children. CONCLUSION: The presentation and relatively good outcome of radiation-induced thyroid cancer in children is similar to that in nonirradiated children. Frequent and late recurrences call for lifelong follow-up.     

Biaxiale Ermüdung reibrührgeschweißter Strukturelemente

Biaxial fatigue of friction stir welded stiffened panels Within the framework of the European WelAir project, cruciform specimens made from stiffening FSW overlap joints were fatigued in the DLR biaxial test rig. To resemble the loading situation of pressurized fuselage structures, proportional loading without any phase shift, but with different load ratios λ between the loading components in both directions was applied.Natural crack initiation and subsequent crack growth were governed by the stiffness gradient caused by introducing the stringer. Cracks initiated and propagated at run‐in and run‐out locations in a direction perpendicular to the weld seam. The shortest fatigue life was observed for uniaxial loading in welding direction (λ = 0). An additional stress component perpendicular to the joint line (λ > 0) resulted in a higher number of cycles to failure. Similar to single stringer panels, increasing the load ratio also increased the number of cycles to failure for FSW clip‐stringer structural members, but additionally gives a different location of the fatal crack.