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.     

Charge sharing in multi-electrode devices for deterministic doping studied by IBIC

Following a single ion strike in a semiconductor device the induced charge distribution changes rapidly with time and space. This phenomenon has important applications to the sensing of ionizing radiation with applications as diverse as deterministic doping in semiconductor devices to radiation dosimetry. We have developed a new method for the investigation of this phenomenon by using a nuclear microprobe and the technique of Ion Beam Induced Charge (IBIC) applied to a specially configured sub-100 μm scale silicon device fitted with two independent surface electrodes coupled to independent data acquisition systems. The separation between the electrodes is comparable to the range of the 2 MeV He ions used in our experiments. This system allows us to integrate the total charge induced in the device by summing the signals from the independent electrodes and to measure the sharing of charge between the electrodes as a function of the ion strike location as a nuclear microprobe beam is scanned over the sensitive region of the device. It was found that for a given ion strike location the charge sharing between the electrodes allowed the beam-strike location to be determined to higher precision than the probe resolution. This result has potential application to the development of a deterministic doping technique where counted ion implantation is used to fabricate devices that exploit the quantum mechanical attributes of the implanted ions.     

The Davidson method as an alternative to power iterations for criticality calculations

The Davidson method is implemented within the neutron transport core solver parafish to solve k-eigenvalue criticality transport problems. The parafish solver is based on domain decomposition. It uses spherical harmonics (P_N method) for angular discretization, and non-conforming finite elements for spatial discretization. The Davidson method is compared to the traditional power iteration method in this context.     

Evaluation of the AnaeroPack system for growth of anaerobic bacteria

Growth of anaerobic bacteria in the AnaeroPack (Mitsubishi Gas Chemical America, Inc., New York, N.Y.) anaerobic atmosphere generation systems, both the AnaeroPack jar and pouch and the AnaeroPack in a GasPak jar were considered equivalent to or better than growth obtained in the corresponding GasPak jar or pouch system (Becton Dickinson Microbiology Systems, Cockeysville, Md.) for 89 (86%) of the 103 anaerobes tested. There were a total of 26 discrepancies after 48 h of incubation, with 16 discrepancies unresolved after 96 h of incubation. The AnaeroPack jar and pouch never failed to reduce the anaerobic indicator. The AnaeroPack systems are easy to use and performed at least as well as or better than the BBL GasPak systems for growth of anaerobic bacteria.     

The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation

OBJECTIVE: The authors present their experience with patients having undergone orthotopic heart transplantation (OHT) in whom surgical conditions subsequently developed that required operative intervention. The incidence, morbidity, and mortality of these procedures are reported. SUMMARY BACKGROUND DATA: Several studies have evaluated the management options of biliary tract disease after OHT. Multiple reports of patients having undergone OHT who subsequently underwent peripheral vascular reconstructions, plastic reconstructive, and thoracic procedures also have been published. METHODS: A chart review of 349 patients who underwent OHT between 1985 and 1996 was conducted to identify surgical procedures that were required in the post-transplant period. Their outcomes are reported. RESULTS: Of 349 patients who underwent OHT, conditions requiring 94 surgical procedures developed in 54 patients (15%). Biliary tract disease developed in 17 patients (5%) who required cholecystectomy, 2 of the 5 patients with acute cholecystitis died. Eight patients (2%) underwent orthopedic procedures with no operative mortality. Flap advancements for sternal wound infections were performed in five patients and four deaths occurred. Seventeen thoracic procedures were performed in 11 patients with an overall mortality of 45%. Twenty-one vascular procedures were performed on 17 patients with 1 delayed death due to a malignancy. Seven patients underwent procedures of the colon and rectum with no mortality. Seven patients underwent repair of inguinal or incisional hernias with no mortality. Various infections occurred with one resultant death after operative intervention. Six procedures were performed for diseases of the small intestine with no resultant mortalities. CONCLUSIONS: Patients having undergone OHT and chronic immunosuppression are at increased risk of having complications develop from infection. Acute cholecystitis and sternal wound infection caused an inordinate risk of complications and death. Malignancies developed in four patients who required surgical intervention. A heightened awareness of coexisting peripheral vascular disease in patients transplanted for ischemic cardiomyopathy should exist. Close screening before surgery and surveillance after surgery to identify risk factors for infection and vascular disease and to screen for malignancies are essential.     

Plasma and antenna coupling characterization in ICRF-wall conditioning experiments

Ion Cyclotron Wall Conditioning (ICWC) discharges, in pulsed-mode operation, were carried out in the divertor tokamaks ASDEX Upgrade (AUG) and JET to simulate the scenario of ITER wall conditioning at half-field (AUG) and full-field (JET). ICWC-plasma and antenna coupling characterization results obtained during the Ion Cyclotron Resonance Frequency (ICRF)-Wall Conditioning experiments performed in helium-hydrogen mixture in AUG and helium-deuterium mixtures in JET are presented here. Safe operational regimes for optimum ICWC in ITER could be explored for different magnetic fields. Satisfactory antenna coupling in the Mode Conversion scenario along with reproducible generation of ICRF plasmas and reliable wall conditioning were achieved by coupling RF power from one or two ICRF antennas at two (AUG, JET) different resonant frequencies. These results are in qualitative agreement with the predictions of 1-D TOMCAT code. Present study of ICWC indicates towards the beneficial effect of application of an additional (along with toroidal magnetic field) stationary vertical (B_V ? B_T) magnetic field on antenna coupling and plasma parameters. The results obtained from JET and AUG tokamaks, presented in this paper, emphasizes the proposed phenomenological schemes for further development of ICWC in superconducting tokamaks.     

The null mutant of the U(L)31 gene of herpes simplex virus 1: construction and phenotype in infected cells

Earlier studies have shown that the U(L)31 protein is homogeneously distributed throughout the nucleus and cofractionates with nuclear matrix. We report the construction from an appropriate cosmid library a deletion mutant which replicates in rabbit skin cells carrying the U(L)31 gene under a late (gamma1) viral promoter. The mutant virus exhibits cytopathic effects and yields 0.01 to 0.1% of the yield of wild-type parent virus in noncomplementing cells but amounts of virus 10- to 1,000-fold higher than those recovered from the same cells 3 h after infection. Electron microscopic studies indicate the presence of small numbers of full capsids but a lack of enveloped virions. Viral DNA extracted from the cytoplasm of infected cells exhibits free termini indicating cleavage/packaging of viral DNA from concatemers for packaging into virions, but analyses of viral DNAs by pulsed-field electrophoresis indicate that at 16 h after infection, both the yields of viral DNA and cleavage of viral DNA for packaging are decreased. The repaired virus cannot be differentiated from the wild-type parent. These results suggest the possibility that U(L)31 protein forms a network to enable the anchorage of viral products for the synthesis and/or packaging of viral DNA into virions.