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BACKGROUND: The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequent benign masses and the infrequent malignant ones that require surgery. Univocal guidelines to approach this problem are unavailable. OBJECTIVE: To perform a survey of the clinical management of incidentally discovered adrenal masses (ie, adrenal incidentalomas). DESIGN: A multicentric retrospective analysis of hospital medical records of adrenal incidentalomas diagnosed during a 5-year period; the medical records were scrutinized for demographic data and clinical details by means of a specifically tailored questionnaire. SETTING: The major surgical and medical centers of Piedmont, a northern Italian region with approximately 4 million inhabitants. The recruitment pattern of these centers was unselected. PATIENTS: The definition of adrenal incidentaloma was limited to patients with a physical examination and a clinical history unindicative of adrenal disease. Exclusion criteria also included hypertension of suspected endocrine origin and a history of neoplasms known to metastasize frequently in the adrenal glands. Two hundred twenty-four medical records were collected, and 210 were analyzed (14 excluded a posteriori). RESULTS: Most patients were in their 50s and 60s, and women were predominantly affected. The frequency of adrenocortical cancer was 13% among patients operated on. The tumor diameter was highly correlated with the risk of cancer; a cutoff at 5 cm had a sensitivity of 93% with a specificity of 64% in discriminating between benign and malignant cortical lesions. CONCLUSIONS: The occurrence of adrenocortical carcinoma among adrenal incidentalomas is not rare. The evaluation of the mass size is a simple and effective method for selecting patients at risk for cancer. The indication for surgery of masses larger than 5 cm, or of masses of any diameter that have suspicious imaging characteristics, limits unnecessary operations and costs.  相似文献   
53.
The ITER magnet system consists of structurally linked sets of toroidal (TF) and poloidal (PF) field coils, central solenoid (CS), and various support structures. The coils are superconducting, force flow Helium cooled with a Kapton-Glass-Epoxy multilayer insulation system. The stored magnetic energy is about 100GJ in the TF system and 20GJ in the PF-CS. Coils and structure are maintained at 4 K by enclosing them in a vacuum cryostat. The cryostat, comprising an outer envelope to the magnets, forms most of the second radioactivity confinement barrier. The inner primary barrier is formed by the vacuum vessel, its ports and their extensions. To keep the machine size within acceptable bounds, it is essential that the magnets are in close proximity to both of the nuclear confinement barriers. The objective of the magnet design is that, although local damage to one of the barriers may occur in very exceptional circumstances, large scale magnet structural or thermal failure leading to simultaneous breaching of both barriers is not credible. Magnet accidents fall into three categories: thermal (which includes arcing arising from insulation failure and local overheating due to discharge failure in the event of a superconductor quench), structural (which includes component mechanical failure arising from material inadequacies, design errors and exceptional force patterns arising from coil shorts or control failures), and fluid (Helium release due to cooling line failure). After a preliminary survey to select initial faults conceivable within the present design, these faults are systematically analyzed to provide an assessment of the damage potential. The results of this damage assessment together with an assessment of the reliability of the monitoring and protective systems, shows that the magnets can operate with the required safety condition.  相似文献   
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We predict that, for wavelength division multiplexing optical-network applications, an asymmetrically dilated configuration of a 2×2 cross-connect is significantly better in terms of overall crosstalk when the levels of the bar-port crosstalk and the cross-port crosstalk are significantly different from each other, as is the case with optical-frequency filters which utilize grating-assisted coupling. As a verification, we present a simulation study with 2×2 polarization-diversified acousto-optic tunable filters. We present a recursive method to extend the principle of asymmetric dilation to larger-size cross-connect switches, and make a recommendation for an asymmetrically dilated 4×4 cross-connect configuration  相似文献   
56.
Impact ionization is a major limiting factor to the maximum operating voltage of InGaAs-based, high-speed transistors. In this work, data on the positive temperature dependence of the electron impact ionization coefficient αn in In0.53Ga0.47As at medium-low electric fields are reported for the first time. The increase of αn with temperature is opposite to the behavior normally observed in most semiconductors. This anomalous behavior implies the onset of a positive feedback between power dissipation and avalanche generation which may adversely affect the power handling capability of In0.53Ga 0.47As-based devices, and which should be taken into account in device thermal modeling. In the experimental procedure, based on the measurement of the multiplication factor M-1 in npn In0.53Ga 0.47As/InP Heterojunction Bipolar Transistors (HBT), particular care has been taken in order to rule out possible spurious, temperature-dependent contributions to the measured multiplication current  相似文献   
57.
The effect of high oxide field stress is studied using capacitance-time (C-t) measurements of MOS capacitors. The stress results in parallel shifts of the C-t curve along the time axis. The flatband voltage shift ΔVFB obtained from the initial deep depletion capacitance C(t=0+) follows the same trend as that from the high-frequency C-V characteristics. However, the discrepancy between the two flatband voltages becomes larger as the stress increases due to the effect of interface charges on C-t characteristics. The flatband voltage difference is converted to interface trap density, showing a steady increase of interface trap density with stress, similar to that from low-frequency C-V measurements  相似文献   
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Communication network design is becoming increasingly complex, involving making networks more usable, affordable, and reliable. To help with this, we have proposed an expert network designer (END) for configuring, modeling, simulating, and evaluating large structured computer networks, employing artificial intelligence, knowledge representation, and network simulation tools. We present a neural network/knowledge acquisition machine-learning approach to improve the END's efficiency in solving the network design problem and to extend its scope to acquire new networking technologies, learn new network design techniques, and update the specifications of existing technologies  相似文献   
60.
Single-phase voltage source power converters (VSCs) under consideration are AC-DC current-controlled boost-type power converters with bidirectional power-handling capability. Equivalence between two series-connected two-level power converters and a single three-level power converter is considered here. Further considered is the series operation of three-level power converters. Simulation results and experimental verification for both are provided. Economical configurations of three-level power converters leading to multilevel waveforms are presented thereafter  相似文献   
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