Low molecular weight heparins. Implications in anesthesia and resuscitation

Low molecular weight heparins are a group of drugs that have only recently been introduced in clinical practice. The are widely used for prophylaxis in thromboembolic disease and are being employed increasingly to treat established venous thrombosis. One way in which these drugs are often used is for prophylaxis in the perioperative period for patients at high risk of developing venous thromboembolism, and the anesthesiologist must therefore be familiar with the main aspects of this application. We review pharmacological characteristics of these drugs as well as the literature on low molecular weight heparins, stressing points of main interest to the anesthesiologist and intensive care recovery unit specialist, namely adverse effects (mainly bleeding) and the implications that use of low molecular weight heparin will have on choice of anesthetic (in particular the dilemma of whether to use local/regional anesthesia).     

Simultaneous bilateral fractures of the hip following a grand mal seizure. An unusual complication

Pathological fractures as a consequence of convulsive seizures without direct trauma occur in 0.3% of cases. Some lesions such as bilateral posterior dislocation of the shoulder, fracture-dislocation of the shoulder or fracture and/or dislocation of the hip strongly suggest a seizure as the aetiology. We report on a patient with simultaneous central dislocation of one hip with fracture of the contralateral femoral neck provoked by spontaneous seizures. Unrecognized associated injuries following a convulsion may result in long-term functional disability and legal consequences.     

Peripheral nerve stimulation by time-varying magnetic fields

PURPOSE: A study was performed to assess the stimulation threshold for healthy adults using sinusoidally oscillating gradients. METHOD: One hundred thirteen healthy adults were examined in the study. ECG and physiological parameters were measured. All measurements were performed of both the head and the abdomen. The subjects were measured in the supine position with the region of interest positioned in the center of the gradient coils. The measurement was performed for three orthogonal, four oblique, and double oblique orientations. RESULTS: No volunteer reported painful, severe stimulation. The mean thresholds for peripheral stimulation in head and body measurement were similar: 85.5% of stimulation during examination of the head and 87.6% during measurements of the abdomen were reported when the y-gradient was used. CONCLUSION: The greatest frequency of reported stimulations occurs when the y-gradient is used. This was confirmed by the results and supports the hypothesis that orthogonal to the y-axis the body has its largest conductive loop, resulting in the strongest peripheral stimulation.     

A novel method for elimination of line-current harmonics insingle-stage PFC switching regulators

This paper studies a particular single-stage power-factor-correction (PFC) switching regulator employing a discontinuous-conduction-mode (DCM) boost-input cell and a continuous-current-mode (CCM) forward output cell. Although this single-stage PFC regulator can provide a reasonably high power factor when its PFC stage is operating in discontinuous mode, substantial reduction in line-current harmonics is possible by applying a suitable frequency-modulation scheme. This paper derives a frequency-modulation scheme and proposes a practical implementation using a simple translinear analog circuit. A quantitative analysis on the total harmonic distortion (THD) of the line current when the circuit is subject to a limited range of frequency variations is presented along with some considerations for practical design. Experimental data obtained from a prototype confirms the effectiveness of the proposed frequency-modulation scheme. The proposed analog translinear circuit allows custom integrated circuit implementation, making it a viable low-cost solution to the elimination of line-current harmonics in switching regulators     

Regional chemotherapy of liver tumors

In the absence of adequate autogenous vein for tibial artery bypass in limb salvage surgery, the use of prosthetic grafts with a distal anastomotic vein cuff or patch has shown promising results. Here, we describe how the Florester Internal Vessel Occluder (Meadox UK, Bedfordshire, UK) can facilitate the construction of a distal anastomotic vein cuff.     

Acquiring rule sets as a product of learning in a logical neuralarchitecture

Envisioning neural networks as systems that learn rules calls forth the verification issues already being studied in knowledge-based systems engineering, and complicates these with neural-network concepts such as nonlinear dynamics and distributed memories. We show that the issues can be clarified and the learned rules visualized symbolically by formalizing the semantics of rule-learning in the mathematical language of two-valued predicate logic. We further show that this can, at least in some cases, be done with a fairly simple logical model. We illustrate this with a combination of two example neural-network architectures, LAPART, designed to learn rules as logical inferences from binary data patterns, and the stack interval network, which converts real-valued data into binary patterns that preserve the semantics of the ordering of real values. We discuss the significance of the formal model in facilitating the analysis of the underlying logic of rule-learning and numerical data representation. We provide examples to illustrate the formal model, with the combined stack interval/LAPART networks extracting rules from numerical data.