Anesthetic management for a patient with pheochromocytoma using magnesium sulfate and epidural block

A 54-year-old woman with pheochromocytoma was anesthetized using magnesium sulfate infusion. Anesthesia was induced with thiopental and fentanyl, and maintained with 0.5% sevoflurane in nitrous oxide/oxygen and 60 mg.hr-1 of epidurally infused lidocaine. Muscle relaxation was achieved with intermittent administration of vecuronium under neuromuscular monitoring. Magnesium 2 g was infused prior to the tracheal intubation and followed by continuous infusion of 2 g.hr-1. These anesthetic techniques made hemodynamic state stable, and no additional vasoactive agents were needed. However, the infusion rate of magnesium was reduced to a half because of PQ interval prolongation. Magnesium is believed to be useful for anesthetic management for patients with pheochromocytoma, but the proper dose and the way of administration should be further investigated for their safe clinical use.     

Risk factors for neurologic deterioration after revascularization surgery in patients with moyamoya disease

To investigate the risk factors for postoperative neurological deterioration in patients with moyamoya disease, we retrospectively reviewed the perioperative course of 368 cases of revascularization surgery in 216 patients with this disease. Risk factors anecdotally associated with postoperative ischemic events were analyzed by comparing groups with or without a history of such events on the operative day. Ischemic events were noted in 14 cases (3.8%), 4 of which were defined as strokes and the others as transient ischemic attack (TIA). Postoperative neurological deterioration more often developed in patients who suffered from frequent TIAs, had precipitating factors for TIA, and underwent indirect nonanastomotic revascularization. The authors conclude that the incidence of postoperative ischemic events were related more to the severity of moyamoya disease and the type of surgical procedure than to other factors, including anesthetic management. IMPLICATIONS: Although preventing stroke is the major concern for patients with moyamoya disease, risk factors for perioperative cerebral ischemia have not been clarified. We retrospectively analyzed the perioperative course in 368 cases with this disease and found that the severity of the disease and type of surgical procedure were major determinants of postoperative cerebral ischemia.     

Development of an automatic Vickers hardness testing system usingimage processing technology

The mechanical characteristics of machines or machine parts depend on the properties of the materials from which they are made. Hardness is an especially important index for machine design. The Vickers hardness number of a test material is defined by the surface area of the indentation made in the surface of a test specimen by a diamond pyramid indenter. Diagonal lines that indicate the indentation size are usually several micrometers to several hundred micrometers long, depending on the hardness of the material. Conventional automatic Vickers hardness testing systems have been applied only to specular-polished specimens. A new fully automatic Vickers hardness testing system has been developed that emulates visual Vickers hardness testing in terms of accuracy and that automatically sets the threshold level of the image processor to suit indentation image data. It can be applied not only to the testing of rough-polished specimens while meeting the measurement accuracy specified in Japanese Industrial Standard (JIS) B 7725, but can also process one indentation within 20 s, including the indenting, focusing and image processing time     

Dynamic cardiac compression improves contractile efficiency of the heart

The effect of dynamic cardiac compression on left ventricular contractile efficiency was assessed in terms of the pressure-volume relationship and myocardial oxygen consumption. In 11 excised cross-circulated dog hearts, the ventricle was directly compressed during systole (dynamic cardiac compression). Measurements for pressure-volume area (a measure of total mechanical energy), external work, and myocardial oxygen consumption were done before and during dynamic cardiac compression. Dynamic cardiac compression increased pressure-volume area by 28% +/- 17% (mean plus or minus the standard deviation) and external work by 24% +/- 20% (p = 0.0000185 and 0.0000212, respectively) at given end-diastolic and stroke volumes without affecting myocardial oxygen consumption. As a result, the oxygen cost of pressure-volume area, that is, the slope of the myocardial oxygen consumption-pressure-volume area relationship, significantly decreased by 16% +/- 13% (p = 0.0000135) whereas the pressure-volume area-independent myocardial oxygen consumption was unchanged. Then, contractile efficiency, that is, the reciprocal of the slope of the myocardial oxygen consumption-pressure-volume area relationship in joules significantly improved from 45% +/- 8% to 53% +/- 13% (p = 0.0000437). When the native myocardial oxygen consumption-pressure-volume area relationship was assessed by subtracting the dynamic cardiac compression pressure applied to the heart, the slope of the myocardial oxygen comsumption-pressure-volume area relationship returned to the control level. This indicates that the contractile efficiency of the native heart was not affected by dynamic cardiac compression. We conclude that dynamic cardiac compression enhances left ventricular pump function by improving the contractile efficiency of the overall heart leaving the energetics of the native heart unchanged.     

New system for linear accelerator radiosurgery with a gantry-mounted video camera

PURPOSE: We developed a positioning method that does not depend on the positioning mechanism originally annexed to the linac and investigated the positioning errors of the system. METHODS AND MATERIALS: A small video camera was placed at a location optically identical to the linac x-ray source. A target pointer comprising a convex lens and bull's eye was attached to the arc of the Leksell stereotactic system so that the lens would form a virtual image of the bull's eye (virtual target) at the position of the center of the arc. The linac gantry and target pointer were placed at the side and top to adjust the arc center to the isocenter by referring the virtual target. Coincidence of the target and the isocenter could be confirmed in any combination of the couch and gantry rotation. In order to evaluate the accuracy of the positioning, a tungsten ball was attached to the stereotactic frame as a simulated target, which was repeatedly localized and repositioned to estimate the magnitude of the error. The center of the circular field defined by the collimator was marked on the film. RESULTS: The differences between the marked centers of the circular field and the centers of the shadow of the simulated target were less than 0.3 mm.     

Structural studies of synthetic peptides dissected from the voltage-gated sodium channel

Peptides representing transmembrane regions of the alpha-subunit of the voltage-gated sodium channel were synthesised and their structures analysed, using 1H NMR and CD, in trifluoroethanol and in dodecylphosphocholine micelles. Sequence analysis suggests that the channel has six regions, S1 to S6, predicted to span the membrane in four homologous domains, designated, I, II, III and IV. Presented here are studies of representatives examples of possible single spanning segments (IS2, IS4, IVS4) and a double spanning segment, IS34, composed of segments IS3 and IS4. In addition, we investigated ISlink56, the putative linker region between segments IS5 and IS6. All of the peptides were found to have predominantly alpha-helical structures in both solvent systems. There was some evidence for bending of the longer helices but there was no discernible evidence for well-defined tertiary structure.     

Formulation of Gmax from Reconstituted Clayey Soils and its Application to Gmax Measured in the Field

The elastic shear modulus of natural sedimentary clay ground, G_max, is estimated based on laboratory tests for fifteen different reconstituted clays. Two types of tests were performed, i.e., Bender Element and Cyclic Triaxial tests. The proposed formulation is not based on void ratio, e, but consists of only three parameters: w_L (liquid limit), p′ (the current mean effective stress) and p′_max (the maximum mean consolidation pressure). To apply it to the field, this equation is modified for using σ′_v0 (the in situ effective overburden pressure) and OCR, instead of p′ and p′_max. Since existing formulae for G_max are mostly based on e, they are not able to apply to both reconstituted soil and field, without considering the correction factor for structure. This is because e in the field is much larger than that for reconstituted soil even though their consolidation pressures and OCR are the same for these clays. The applicability of the proposed formula was examined by using investigated results from the in-situ seismic surveys performed at eleven worldwide sites. It is well demonstrated that the proposed equation in this paper is capable of predicting G_max of natural sedimentary clay deposits with higher accuracy than the existing empirical formulae using a function of e.     

Semiconductor devices in photonic switching

Three types of photonic switching networks have been proposed, namely, optical space-division switching, optical wavelength-division switching. Optional function devices required for each switching network are as follows: optical switch matrix for space-division switching; optical memory and optical write/read gate for time-division switching; and tunable wavelength filter and wavelength converter for wavelength-division switching. Recent progress in semiconductor functional devices such as modulators, switching devices, bistable devices, and wavelength control devices, which would be key devices to build switching networks, is reviewed     

Reliability of Special Redundant Systems Considering Exchange Time and Repair Time

The reliability of a 2-out-of-3 parallel redundant system having a limited number of standby spare units is derived when the exchange of the failed unit for a spare unit is not instantaneous. The reliability can be represented in the form of a failure state diagram. When the number of standby spares and the repair rate are both small, the influence of the exchange rate is small. When the number of standby spares and the repair rate are both large, the influence of the exchange rate is large. The number of standby spares and the repair rate influence the probability that system failure occurs after all spare units have failed. The exchange rate strongly influences the probability of system failure during the exchange time.