Portosystemic shunt in Budd-Chiari syndrome: long-term survival and factors affecting shunt patency in 25 patients in Western countries

BACKGROUND: In Budd-Chiari syndrome (BCS) treated by portosystemic shunt, postoperative shunt thrombosis is associated with high morbidity and mortality rates. The aim of this study was to determine factors associated with shunt thrombosis. METHODS: From 1985 to 1991, 25 patients underwent portosystemic shunt for BCS. According to the patency of the shunt during the postoperative period and follow-up, patients were divided into two groups including 17 patients with patent shunt and 8 (32%) with shunt thrombosis. RESULTS: In patients with patent shunt, actuarial survival rate at 5 years was 87% versus 38% in patients with shunt thrombosis (p < 0.05). Duration of symptoms before operation was higher in patients with shunt thrombosis than in patients with patent shunt (315 +/- 483 vs 109 +/- 168 days, p < 0.05). In patients with patent shunt, extensive fibrosis or cirrhosis was observed in 3 of 17 (18%) versus in 5 of 8 (63%) of patients with shunt thrombosis (p < 0.05). Shunt thrombosis was observed in 3 of 3 patients (100%) with the combination of myeloproliferative disorder, duration of symptoms more than 100 days, and cirrhosis versus 0 of 6 (0%) patients without this combination (p < 0.05). CONCLUSIONS: In acute form of BCS (with short history of the disease and absence of extensive fibrosis or cirrhosis), early portal decompression is mandatory, with low risk of shunt thrombosis and good long-term results. In chronic form of BCS, the risk of shunt thrombosis is high and long-term results are bad; in these patients, orthotopic liver transplantation must be considered.     

Detection of human papillomavirus gene sequences in laryngeal tumors and premalignant changes by polymerase chain reaction

Human papillomavirus gene sequences have been detected in a number of malignant and benign tumours. Non-oncogenic types 6 and 11 are etiological factors of benign mucosal tumours. Types 16 and 18 can be detected in malignancies most often but their role in the etiopathogenesis of cancers is still unclear. In our study we examined formalin-fixed and paraffin-embedded archive laryngeal tissues containing squamous cell carcinoma, papilloma and precancerous lesions for the presence of human papillomavirus genes. As a control we also examined tissues harbouring laryngeal nodules which represented the normal larynx in our study. After DNA preparation from the paraffin blocks we performed polymerase chain reaction to detect the DNA of human papillomavirus types 6, 11, 16 and 18. In the squamous cell carcinomas, papillomas and precancerous lesions the presence of human papillomavirus gene sequences was significantly higher than in the control group. To verify the integrity of DNA we also amplified a sequence deriving from the cellular beta-globin gene. Based on the 100% positivity for this gene we declare that the combination of our DNA preparation and polymerase chain reaction is a reliable method for detecting DNA sequences from formalin-fixed and paraffin-embedded tissues.     

Reactive energy measurement using frequency controlled analog-to-pulse-rate converter

Contents This paper analyzes a problem of phase shifting and deseribes a novel method for electronic reactive energy measurement. The proposed measurement structure, composed of an integrator as a phase shifting circuit and a frequency controlled analog-to-pulse-rate converter, provides for the measurement completely in accordance with IEC definition of reactive energy, which is performed with simple but high performance metering device.

---

Die Blindverbrauchsmessung anhand eines netzsynchronisierten Analog-Frequenz-Wandlers

Übersicht In diesem Artikel wird das Problem der Phasenverschiebung analysiert und eine neue Meßmethode für elektronische Blindverbrauschsmessung aufgezeigt. Die vorgeschlagene Strucktur, bestehend aus einem Integrator als Phasenschieber und netzkontrolliertem Analog-Frequenz-Wandler, ermöglicht die Verwirklichung eines einfachen aber präzisen Elektrizitätszählers zur Messung der Blindenergie, dessen Arbeitsprinzip mit den IEC Empfehlungen vollkommen übereinstimmt.

     

A General Reliable Quadratic Form: An Extension of Affine Arithmetic

In this article, a new extension of affine arithmetic is introduced. This technique is based on a quadratic form named general quadratic form. We focus here on the computation of reliable bounds of a function over a hypercube by using this new tool. Some properties of first quadratic functions and then polynomial ones are reported. In order to show the efficiency of such a method, ten polynomial global optimization problems are presented and solved by using an interval branch-and-bound based algorithm. The work of the first author was also supported by the Laboratoire de Mathématiques Appliquées CNRS–FRE 2570, Université de Pau et des Pays de l'Adour, France, and by the Laboratoire d'Electrotechnique et d'Electronique Industrielle CNRS–UMR5828, Group EM³, INPT–ENSEEIHT.     

High-Pressure (up to 140 MPa) Dynamic Viscosity of the Methane and Toluene System: Measurements and Comparative Study of Some Representative Models

The dynamic viscosity of toluene and methane mixtures containing 25.03, 37.19, 49.95, 64.11, and 95.00 mol% methane has been measured using a falling-body viscometer. The measurements (280 data points) have been performed in the temperature range 293.15 to 373.15 K and at pressures up to 140 MPa. The data have been discussed in the framework of recent representative models (hard-sphere scheme, friction theory, and free-volume model) as well as with simple mixing laws and empirical models (particularly the LBC model and the self-referencing model) used in the literature. This comparative study shows that the average absolute deviation of the models is between 4.9 and 26.8%, and the maximum deviation is between 11.6 and 49.5%.     

Heat transfer and pressure drop in a new type of corrugated channels

An experimental investigation of heat transfer and pressure drop from a new type of corrugated channels is presented. The investigation has been carried out for Reynolds numbers in the range of $\text{800 <}\text{Re}\text{< 5000}$ for one corrugated and one smooth channel. It is found that the heat transfer from the corrugated channel is up to 3.5 times higher than for the smooth one. The pressure drop is however large (5 – 6 times the value of a smooth channel) and it is suggested that the corrugation height and length should be altered in order to balance the increases in heat transfer and pressure drop.     

The role of government in health insurance markets with adverse selection

This paper analyzes the welfare economics of three arrangements for purchasing health insurance: competitive markets in which consumers are free to choose among options with different levels of coverage and prices; systems with compulsory partial pooling which permit private firms to sell supplementary coverage; and government-run pools that purchase comprehensive coverage at a single price for all consumers. Competitive insurance markets are assumed to face the problem of 'adverse selection'. This refers to a situation in which the insurer cannot observe characteristics of individuals that affect the cost of insurance and that are known to the individuals. Competitive markets with adverse selection are not efficient because low risks cannot purchase comprehensive insurance coverage. However, government-run pools with comprehensive coverage are an inefficient solution to the problem of adverse selection. Compulsory partial coverage may represent an attractive alternative to both competitive markets and comprehensive pools. We discover two situations when government intervention of this type will succeed: when there are not many high risks in the population, and when the risk types are similar. We discuss the implications of these results for health insurance programs in several countries. Our results also have implications for the allocation of public funds for disease-prevention projects. A project targeted at high risks will produce external benefits for low risks, even though they are not directly affected by the program. However, a successful project might eliminate the market for private insurance; in this case the government should consider mandating partial insurance coverage.