Symptomatic subclavian steal syndrome four decades after operation for dysphagia lusoria

Congenital abnormalities of the aortic arch may lead to signs and symptoms of tracheal and esophageal obstruction secondary to a restrictive vascular ring. There are many case reports and monographs concerning the surgical management of dysphagia lusoria. This case provides the first example of long-term follow-up of surgical intervention for relief of dysphagia lusoria. A 45-year-old laborer presented with a several year history of episodic bilateral blindness and a more recent onset of "drop attacks." Notably this patient had presented at the age of 18 months with difficulty breathing and eating since birth. The patient also had frequent upper respiratory infections and episodes of pneumonia. Workup revealed a right-sided aortic arch with a left ligamentum arteriosum. When he was first seen in our clinic, history and physical examination revealed claudication and diminished pulses in the left upper extremity. Arteriography and duplex studies confirmed reversal of flow in the patient's left vertebral artery. The arteriogram demonstrated the presence of a right-sided aortic arch and descending aorta along with the proximal stump of the previously ligated left subclavian artery. He underwent left carotid to left axillary artery bypass for the treatment of symptomatic subclavian steal syndrome. His symptoms have resolved with return of antegrade vertebral flow and the presence of normal pulses in the left arm. Congenital aortic abnormalities that lead to tracheal and esophageal compromise are numerous and varied. Surgical management requires a thorough understanding of the person's anatomy and preoperative planning. The life expectancy of patients with dysphagia lusoria necessitates consideration of the long-term consequences of surgical intervention.     

Evaluating medication response in ADHD: cognitive, behavioral, and single-subject methodology

We introduce a novel application for linkage analysis: using bone marrow donor-recipient sib pairs to search for genes influential in graft-versus-host disease (GVHD), a major cause of morbidity and mortality following allogeneic bone marrow transplantation. In particular, we show that transplant sib pairs in which the recipient developed severe GVHD can be used to map genes in the same way as traditional discordant (affected/unaffected) sib pairs (DSPs). For a plausible GVHD model, we demonstrate that the transplant/discordant sib pair analog of the "possible triangle test" [Holmans (1993) Am J Hum Genet 52:362-374] has similar power to that of the simpler "restricted test" proposed by Risch [(1990b) Am J Hum Genet 46:229-241; (1992) Am J Hum Genet 51:673-675]. Moreover, we show that the restricted test has superior power in much of the DSP possible triangle and significantly inferior power in only a small region. Thus, we conclude that the restricted test is preferable for localizing genes with transplant/discordant sib pairs. Finally, we examine the effects of heterogeneity on the power to detect GVHD loci and demonstrate the gain in efficiency by dividing the sample into genetically more homogeneous subgroups.     

Work-arounds and Boundary Crossing in a High Tech Optronics Company: The Role of Co-operative Workflow Technologies

This study examines how some employeescoped with the exceptions that they encountered withtheir on-going use of a co-operative workflowtechnology in an optronics company. By drawing on thecase material, this paper will indicate thatapproaches which view work as being capable of beingplanned and managed through the formal authority ofthe hierarchy are insufficient. Instead, this paperwill suggest that exception handling, work-arounds andimprovisation are more characteristic of humanactivity. Computer supported co-operative work will beconceptualised as being embedded in a dynamicrelationship between the context it is situatedwithin, and the actors that engage in it. Theprinciples underlying ethnography have informed theresearch approach.     

Diagnosis and treatment of aortic valve stenosis

The present review has attempted to summarize the classic symptoms and signs of aortic valve stenosis, especially in an adult. It is emphasized that all the classic signs rarely are present and their absence may mislead an unwary clinician. The diagnostic help provided by noninvasive tests, including echocardiography and phonocardiography, has been emphasized. A need for cardiac catheterization and angiography in most patients prior to corrective surgery is stressed. The natural history of the disease without operative intervention is dim and a significant risk of sudden death exists. The current surgical approach with immediate and long-term results is summarized. Finally, attention has been drawn to the special clinical circumstances when the aortic valve stenosis provides a strinkingly different clinical picture. We cannot find a better way to end this review than by quoting a warning note given by Thomas Lewis in 1920: "It is the faint cry of an anguished and fast failing muscle, which, when it comes, all should strain to hear, for it is not long repeated. A few months, a few years at most, and the end comes."     

Low-temperature X-ray microanalysis of the differentiating vascular tissue in root tips of Lemna minor L

The fracture faces of bulk-frozen tissue offer a number of advantages for the analysis of diffusible elements. They are easy to prepare, remain uncontaminated, and, unlike most frozen-hydrated sections, can be shown to exist in a fully hydrated state throughout examination and analysis. Root tips of Lemna minor briefly treated with a polymeric cryoprotectant are quench frozen in melting nitrogen. Fractures are prepared using the AMRAY Biochamber, lightly etched if necessary to reveal surface detail and carbon coated while maintaining the specimen at 110 K. The frozen-hydrated fracture faces are analysed at 110 K using the P/B ratio method which is less sensitive to changes in surface geometry and variations in beam current. The method has been used to investigate the distribution of seven elements (Na+, Mg⁺⁺, P, S, Cl^?, K+ and Ca⁺⁺) in the developing vascular tissue of the root tip. The microprobe can measure relative elemental ratios at the cellular level and the results from this present study reveal important variations in different parts of the root. The younger, more actively dividing cells, appear to have a slightly higher concentration of diffusible ions in comparison to the somewhat older tissues which have begun to differentiate into what are presumed to be functional vascular elements.     

Immunology and adjuvant chemoimmunotherapy of breast cancer

Antibody against a breast carcinoma antigen was present in patients with breast carcinoma and other cancer more often (P less than .05) than in normal women. The incidence of antibody in women with breast carcinoma correlated with the presence or absence of gross tumor, and the titer of antibody paralleled the clinical course. These results suggest importance of a host-immune response to breast carcinoma. Fifty-seven patients with stage II carcinoma of the breast were entered into a prospective randomized adjuvant chemoimmunotherapy program of cyclophosphamide, methotrexate, and fluorouracil, and BCG vaccine +/- an irradiated allogeneic tumor cell vaccine. After 24 months of study, metastases occurred in two patients (3.5%) and a new primary carcinoma developed in the contralateral breast in two others, for an overall treatment failure rate of 7%. Adjuvant chemoimmunotherapy can delay early recurrence. Long-term follow-up is needed to assess the significance of these results.     

A hierarchical test generation methodology for digital circuits

A new hierarchical modeling and test generation technique for digital circuits is presented. First, a high-level circuit model and a bus fault model are introduced—these generalize the classical gate-level circuit model and the single-stuck-line (SSL) fault model. Faults are represented by vectors allowing many faults to be implicitly tested in parallel. This is illustrated in detail for the special case of array circuits using a new high-level representation, called the modified pseudo-sequential model, which allows simultaneous test generation for faults on individual lines of a multiline bus. A test generation algorithm called VPODEM is then developed to generate tests for bus faults in high-level models of arbitrary combinational circuits. VPODEM reduces to standard PODEM if gate-level circuit and fault models are used. This method can be used to generate tests for general circuits in a hierarchical fashion, with both high- and low-level fault types, yielding 100 percent SSL fault coverage with significantly fewer test patterns and less test generation effort than conventional one-level approaches. Experimental results are presented for representative circuits to compare VPODEM to standard PODEM and to random test generation techniques, demonstrating the advantages of the proposed hierarchical approach.     

Numerical modeling of energy balance equations in quantum well AlxGa1-xAs/GaAs p-i-n photodiodes

The energy balance equations coupled with drift diffusion transport equations in heterojunction semiconductor devices are solved modeling hot electron effects in single quantum well p-i-n photodiodes. The transports across the heterojunction boundary and through quantum wells are modeled by thermionic emission theory. The simulation and experimental current-voltage characteristics of a single p-i-n GaAs/Al _xGa_1-xAs quantum well agree over a wide range of current and voltage, The GaAs/Al_xGa_1-xAs p-i-n structures with multi quantum wells are simulated and the dark current voltage characteristics, short circuit current, and open circuit voltage results are compared with the available experimental data, In agreement with the experimental data, simulated results show that by adding GaAs quantum wells to the conventional cell made of wider bandgap Al_x Ga_1-xAs, short circuit current is improved, but there is a loss of the voltage of the host cell, In the limit of radiative recombination, the maximum power point of an Al_0.35Ga_0.65As/GaAs p-i-n photodiode with 30-quantum-well periods is higher than the maximum power point of similar conventional bulk p-i-n cells made out of either host Al_0.35Ga_0.65As or bulk GaAs material     

Logic Design Validation via Simulation and Automatic Test Pattern Generation

We investigate an automated design validation scheme for gate-level combinational and sequential circuits that borrows methods from simulation and test generation for physical faults, and verifies a circuit with respect to a modeled set of design errors. The error models used in prior research are examined and reduced to five types: gate substitution errors (GSEs), gate count errors (GCEs), input count errors (ICEs), wrong input errors (WIEs), and latch count errors (LCEs). Conditions are derived for a gate to be testable for GSEs, which lead to small, complete test sets for GSEs; near-minimal test sets are also derived for GCEs. We analyze undetectability in design errors and relate it to single stuck-line (SSL) redundancy. We show how to map all the foregoing error types into SSL faults, and describe an extensive set of experiments to evaluate the proposed method. These experiments demonstrate that high coverage of the modeled errors can be achieved with small test sets obtained with standard test generation and simulation tools for physical faults.     

Eigenface-domain super-resolution for face recognition

Face images that are captured by surveillance cameras usually have a very low resolution, which significantly limits the performance of face recognition systems. In the past, super-resolution techniques have been proposed to increase the resolution by combining information from multiple images. These techniques use super-resolution as a preprocessing step to obtain a high-resolution image that is later passed to a face recognition system. Considering that most state-of-the-art face recognition systems use an initial dimensionality reduction method, we propose to transfer the super-resolution reconstruction from pixel domain to a lower dimensional face space. Such an approach has the advantage of a significant decrease in the computational complexity of the super-resolution reconstruction. The reconstruction algorithm no longer tries to obtain a visually improved high-quality image, but instead constructs the information required by the recognition system directly in the low dimensional domain without any unnecessary overhead. In addition, we show that face-space super-resolution is more robust to registration errors and noise than pixel-domain super-resolution because of the addition of model-based constraints.