Is coronary angiography necessary for vascular surgery patients who have positive results of dipyridamole thallium scans?

PURPOSE: Because dipyridamole thallium (DT) scanning is a useful predictor of perioperative cardiac events, a positive results of a DT scan is frequently the basis for performing more invasive cardiac evaluation and for consideration for performing coronary revascularization procedures before performing peripheral vascular surgery. The rationale for this approach has been that the treatment of anatomically significant coronary artery disease would lower the risk of performing a subsequent vascular operation. However, the benefit of performing aggressive diagnostic and therapeutic cardiac procedures in such patients remains unproved. To examine this issue, data from patients who underwent coronary angiography because of thallium redistribution were compared with data from matched control subjects who underwent peripheral vascular operations without further cardiac evaluation. METHODS: The medical records of 70 consecutive patients who underwent coronary angiography because of the presence of two or more segments of redistribution on DT scan were reviewed and compared with 70 other patients matched with respect to age, gender, peripheral vascular operation, and number of segments of redistribution on DT scan who did not undergo additional cardiac evaluation. RESULTS: DT scans were performed on 934 preoperative peripheral vascular surgery patients to help in the assessment of operative risk. Ischemic responses, defined as two or more segments of redistribution, were observed in 297. Of these, 70 underwent cardiac catheterization and 25 underwent coronary revascularization procedures. Adverse outcomes affected 46% of the coronary angiography group and 44% of the control group (p = NS). Patients who underwent coronary angiography and were considered for myocardial revascularization had fewer cardiac events with a subsequent vascular operation than did the control subjects. However, any possible benefit from invasive cardiac evaluation was offset by the three deaths and two myocardial infarctions (MIs) that complicated the cardiac evaluation. There was no significant difference between the angiography group and the matched control subjects with respect to perioperative nonfatal MI (13% vs 9%), fatal MI (4% vs 3%), late nonfatal MI (16% vs 19%), or late cardiac death (10% vs 13%). In long-term follow-up, MIs occurred later in patients who underwent coronary angiography than the control subjects (p = 0.049), but this difference was not associated with an improvement in the overall survival rate. CONCLUSIONS: The risks of extended cardiac evaluation and treatment did not produce any improvement in either the perioperative or the long-term survival rate. For most vascular surgery patients who have a positive result of a DT scan, coronary angiography does not provide any additional useful information.     

A unified group technology implementation using the backpropagation learning rule of neural networks

Two engineering problems in implementing Group Technology are part family formation and part classification. Regardless of the approach adopted for the formation and classification, a critical problem is how to maintain consistency. The consistency problem can be addressed most effectively if the formation and classification is a single procedure rather than two separate procedures. A feedforward neural network using the Backpropagation learning rule is adopted to automatically generate part families during the part classification process. The spontaneous generalization capability of the neural network is utilized in classifying the parts into the families and creating new families if necessary. A heuristic algorithm using the neural network is described with an illustrative example.     

Kinetics of AuSn4 migration in lead-free solders

The relatively fast diffusion of Au atoms in eutectic PbSn matrix is considered one of the contributing factors to the Au embrittlement problem. In this study, we further investigated the Au embrittlement problem in high-Sn solders. Experimentally, Sn3.5Ag (wt.%) spheres with 500-μm diameter were soldered over the Au/Ni soldering pads. It was found that some of the AuSn₄ needles that formed after reflow inside the solder migrated back to the solder/pad interface during thermal aging. However, the migration kinetics in high-Sn solders was slower compared to that in eutectic PbSn. The difference in migration kinetics of AuSn₄ in eutectic PbSn and SnAg was ascribed to the difference in the magnitudes of the Au flux and the Ni flux. In eutectic PbSn, the Au flux was much greater than that of the Ni flux, and the Au and Ni flux were in the same order of magnitude in eutectic SnAg. The relative magnitude of the Au and Ni flux changed in eutectic PbSn and SnAg because the homologous temperatures of PbSn and SnAg were different.