Psychosomatic disease and the problem of causation

Despite its impressive rate of growth in the past decades, an increasing amount if dissatisfaction with the area of psychosomatic medicine is reflected in recent literature. The discipline's failures relate to concepts of pathogenesis and therapeutic application of research findings. These failures are explained as a necessary consequence of the philosophical tenet of mind-body dualism which underlies medical theory. It is urged that advocates of psychosomatic medicine give the concept of "holism" meaning at the most fundamental level by establishing a rational basis for theory, or else forsake this line of research for others which yield causal relationships conductive to effective therapy.     

35-GHz static and 48-GHz dynamic frequency divider ICs using0.2-μm AlGaAs/GaAs-HEMTs

Two static and two dynamic frequency dividers based on enhancement and depletion 0.2-μm gate length AlGaAs/GaAs-high electron mobility transistor (HEMT) (f_T=60 and 55 GHz) technology were designed and fabricated. High-speed operations up to 35 GHz for the static frequency dividers and 48 GHz for the dynamic dividers, respectively, have been achieved. The single-ended input and differential outputs to ground simplify many applications. The power consumption is 250 mW for the divide-by-two dividers and 350 mW for the divide-by-four dividers using two supply voltages of 4 and -2.5 V     

Lithographic and pattern transfer of a novel deep-UV photoresist: ARCH2

We have developed a novel chemically amplified deep-UV photoresist called ARCH2. ARCH2 displays a resolution of<0.23μm with a DOF of 1.0μm at 0.25μm. This material also displays superior time delay stability (>8 hours). The post exposure bake (PEB) temperature was varied from 100°C to 120°C and the PEB time was varied from 60s to 180s. This had very little effect on the CD of the resist profiles. Preliminary etching experiments in a conventional reactive ion etcher were then carried out using CF₄ to etch TiN. In these experiments the ARCH2 etched at a similar rate as conventional Novolac.     

A 4-Mb low-temperature DRAM

The authors present the characterization of the first dynamic RAM (DRAM) fabricated in a technology specifically optimized for cryogenic operation. With the power supply adjusted to assure hot-electron reliability, the 25-ns 4-Mb low-temperature (LT) chips operated 3 times faster than conventional chips. The LT-optimized chips functioned properly with cycle times as fast as 45 ns, and with a toggle-mode data rate of 667 Mb/s. Wide operating margins and a very large process window for data retention were demonstrated. At a temperature of 85 K the storage retention time of the trench-capacitor memory cells exceeded 8 h. This study shows that the performance leverage offered by low temperature applies equally well to DRAM and to logic. There is no limitation inherent to memory     

Continuous-wave operation of GaInAs-AlGaAsSb quantum cascade lasers

We report on the demonstration of continuous-wave (CW) operation of GaInAs-AlGaAsSb quantum cascade (QC) lasers. By placing a 2.5-/spl mu/m-thick gold layer on both sides of the laser ridge to extract heat from the active region in the lateral direction, together with mounting the device epilayer down, we have achieved CW operation of GaInAs-AlGaAsSb QC lasers composed of 25 stages of active/injection regions. The maximum CW operating temperature of the lasers is 94 K, and the emission wavelength is around /spl lambda//spl sim/4.65 /spl mu/m. For a device with the size of 10/spl times/2000 /spl mu/m/sup 2/, the CW optical output power per facet is 13 mW at 42 K and 4 mW at 94 K. The CW threshold current density is 1.99 kA/cm/sup 2/ at 42 K, and 2.08 kA/cm/sup 2/ at 94 K, respectively.     

Continuous-wave operation of 5 /spl mu/m quantum cascade lasers with high-reflection coated facets

A report is presented on the continuous-wave operation of /spl lambda//spl sime/5 /spl mu/m GaInAs/AlInAs/InP-based quantum cascade lasers up to a heatsink temperature of 222 K (-51/spl deg/C). The devices are mounted epi-side down with high-reflection coated facets. The dissipated electrical power at threshold amounts to only 2.3 W at 222 K.     

Proximal median and ulnar resections. Results of primary and secondary repairs

PURPOSE OF THE STUDY: Recovery after median and ulnar nerve proximal repair is widely appreciated. The place and time for secondary functional reconstruction remains controversial. MATERIAL AND METHOD: From January 1983 to January 1990, 66 patients suffering from proximal injury of the median or ulnar nerves underwent nerve repair. Forty-five patients had a postoperative follow-up of more than 24 months: 24 isolated ulnar nerve lesions, 12 isolated median nerve lesions, and 9 combined median and ulnar nerve lesions. Ten patients were given a primary microsurgical nerve suture in our department. Thirty-eight patients underwent a delayed or secondary nerve repair of one or both nerves: 8 secondary nerve sutures, and 35 nerve grafts in 31 patients. RESULTS: Muscular strength, sensitivity, motion, and pain were better after primary nerve sutures (when technically possible) or after shortly delayed secondary sutures, although 40 per cent of patients treated with nerve grafts get final "good" or "very good" results. The time between the injury and nerve repair was the most significant prognosis factor. Results of ulnar nerve repairs at the elbow were statistically better with anterior transposition as compared to in situ repairs (p < 0.005). Fourteen patients required secondary functional reconstruction. Tendon transfers were performed at least 24 months after nerve repair. DISCUSSION: Nerve repair of proximal lesion to the median or ulnar nerves depends on the type of injury, but is advised even when delayed. Residual deficit following nerve repair should require functional transfers depending on hand sensitivity and extrinsic function.     

Circadian variations in the occurrence of cardiac arrests: initial and repeat episodes

The purpose of this study was to predict diameters of lesions induced by laser-induced thermotherapy (LITT) of benign prostatic hyperplasia (BPH) from MRI signal/tissue temperature correlations during on-line monitoring with a temperature-sensitive fast low-angle shot (FLASH) sequence. Twenty LITT procedures with Nd:YAG (1,064 nm) and diode (830 nm) lasers were monitored on line with a T1-weighted FLASH sequence at 1.5 Tesla. Interstitial prostate temperature (T) was measured on line in 10 LITT procedures and laser energy deposition in 12. Slopes of linear regression curves for signal intensity (SI) over T were applied to determine SI at 60 degrees C to estimate diameters of intraprostatic LITT lesions. Diameters of unperfused LITT lesion cores in contrast-enhanced T1-weighted images served as gold standards. Linear regression curves with an average slope of -.54% SI/degrees C were obtained in 17 LITT procedures. Correlation coefficients were r = .92-.95 for SI/T and SI/energy deposition. Baseline variation of SI at body temperature was +/-3.9%, corresponding to +/-7 degrees C. Prediction of size (13 lesions) from on-line FLASH imaging was correct in 10 of 13, whereas 3 lesions were overestimated. Prediction of LITT lesion diameters from on-line MRI monitoring is possible with a temperature-sensitive FLASH sequence in the prostate. Accuracy may suffice to assign target regions of interest to tissue locations to be protected from coagulation.     

Intrathyroidal parathyroid glands can be a cause of failed cervical exploration for hyperparathyroidism

BACKGROUND: The incidence of intrathyroidal parathyroid glands remains controversial. The purpose of this study was to determine the incidence in a series of patients with hyperparathyroidism. METHODS: Three hundred nine patients underwent parathyroidectomy. Patients were divided into two groups: uniglandular disease versus hyperplasia. RESULTS: Eighteen of 309 patients (6%) had abnormal intrathyroidal parathyroid glands. The incidence was 3% (7 of 222) in patients with uniglandular disease versus 15% (11 of 73) in those with hyperplasia. With a mean follow-up of 54 months, 12 patients are eucalcemic, 5 have persistent hypocalcemia, and 1 has recurrent hypercalcemia. There were no recurrent laryngeal nerve injuries. CONCLUSIONS: These data suggest that an intrathyroidal adenoma is an uncommon cause of failure, whereas abnormal intrathyroidal parathyroid tissue may be a more common cause of failure in patients with hyperplasia.