Leiomyosarcoma of the esophagus: results of surgical treatment

BACKGROUND: This study examined the results of surgical treatment of leiomyosarcoma of the esophagus. METHODS: Between January 1920 and December 1996, 17 patients (9 men and 8 women) with leiomyosarcoma of the esophagus were treated surgically at the Mayo Clinic. Median age was 58 years and ranged from 26 to 76 years. Symptoms included dysphagia in 11 patients (64.7%) and odynophagia in 6 (35.3%). The tumor was located in the middle third of the esophagus in 10 patients (58.8%) and in the cervical esophagus in 7 (41.2%). Procedures performed included esophagogastrectomy in 9 patients (Ivor Lewis in 5, left thoracoabdominal in 3, and transhiatal in 1), enucleation in 3, transgastric excision in 1, and exploration without resection in 4. RESULTS: The procedure was considered curative in 11 patients (64.7%). There was one operative death (mortality, 5.9%). Complications occurred in 3 patients (17.6%) and included anastomotic leak in 2 and bleeding requiring reoperation in 1. Growth pattern was infiltrating in 7, polypoid in 5, and intramural in 5. Histologically, the tumor was grade 1 in 6 patients, grade 2 in 2, grade 3 in 7, and grade 4 in 2. The tumor was postsurgically classified as stage I in 2 patients, stage IIA in 7, stage IIB in 1, stage IIIA in 5, stage IV in 1, and unknown in 1. Six patients (35.3%) received adjuvant treatment. Follow-up was complete in 16 patients (94.1%) and ranged from 1 to 182 months (median, 48 months). Five- and 10-year actuarial survivals were 47.0% and 31.0%, respectively. Seven patients (41.2%) are currently alive (median survival, 72 months); all underwent curative resection. Factors affecting survival included completeness of resection, growth pattern, postsurgical stage, tumor grade, and tumor location (p < 0.05). CONCLUSIONS: We conclude that leiomyosarcoma of the esophagus is rare. Complete resection provides long-term survival.     

Severe fetomaternal alloimmune thrombocytopenia presenting with fetal hydrocephalus

We report two patients where the finding of isolated fetal hydrocephalus led to the detection of severe fetal thrombocytopenia, using fetal blood sampling. Serological investigation led to the diagnosis of fetomaternal alloimmune thrombocytopenia (FMAIT) due to anti-HPA-1a. Both women had had previous unsuccessful pregnancies probably due to FMAIT; one had had four miscarriages at 17-18 weeks' gestation. The other had had one previous pregnancy complicated by severe fetal anaemia, and eventually hydrocephalus developed and the fetus died without the diagnosis of FMAIT being considered. Subsequent pregnancies in the two women were also affected by FMAIT, but prenatal treatment, predominantly with serial fetal platelet transfusions, resulted in a successful outcome in both cases. These observations suggest that FMAIT should be suspected if there is isolated fetal hydrocephalus, unexplained fetal anaemia, or recurrent miscarriages. The accurate diagnosis of FMAIT is important because recent advances in prenatal management can improve the outcome of subsequently affected pregnancies.     

Timing and causality in process algebra

 There has been considerable controversy in concurrency theory between the ‘interleaving’ and ‘true concurrency’ schools. The former school advocates associating a transition system with a process which captures concurrent execution via the interleaving of occurrences; the latter adopts more complex semantic structures to avoid reducing concurrency to interleaving. In this paper we show that the two approaches are not irreconcilable. We define a timed process algebra where occurrences are associated with intervals of time, and give it a transition system semantics. This semantics has many of the advantages of the interleaving approach; the algebra admits an expansion theorem, and bisimulation semantics can be used as usual. Our transition systems, however, incorporate timing information, and this enables us to express concurrency: merely adding timing appropriately generalises transition systems to asynchronous transition systems, showing that time gives a link between true concurrency and interleaving. Moreover, we can provide a complete axiomatisation of bisimulation for our algebra; a result that is often problematic in a timed setting. Another advantage of incorporating timing information into the calculus is that it allows a particularly simple definition of action refinement; this we present. The paper concludes with a comparison of the equivalence we present with those in the literature, and an example system specification in our formalism. Received December 20, 1993/February 23, 1995     

Deoxyribonucleic acid flow cytometry of squamous cell carcinoma of the penis

This article reports 10 cases of cranial base tumors resected by pre-or retro-auricular intratemporal approach. Among them four were neuronomas, two meningiomas, one malignant giant cell tumor of bone, one osteochondnoma, one parotid mixed neoplasm and one poorly-differentiated squamors cell carcinoma. Total resection in 9 cases and one subtotal resection were performed without operative mortality and serious surgical complications. The surgical management of cranial base tumor and indications for selecting operative approaches were discussed.     

Thermal transport properties and size effects in very dilute superfluid mixtures of3He in4He

The effective thermal conductivity _eff has been measured for 1.6 K for mixtures with 10^–6–2. Both _eff and the derived impurity mass diffusion coefficient D_iso show an unexpected dependence on the height h of the fluid layer. A scaled representation of D_iso leads to a purely phenomenological model involving an effective length scale, proportional to X^–1 and temperature independent. The relations so obtained are consistent with the observations as well as with the observed transition curve Q_C(X) to non-linear behavior.     

High resolution XPS characterization of chemical functionalised MWCNTs and SWCNTs

High resolution XPS analysis of chemical functionalised multi-wall carbon nanotubes (MWCNTs) and single wall carbon nanotubes (SWCNT) was done with ESCA300 (overall instrument resolution of 0.35 eV). Information to the degree of functionalisation was ascertained by argon ion bombardment of the samples followed by XPS analysis to detect the functional groups, the percentage atomic concentration of various elements present and whether or not the detected functional groups imposed a chemical shift on the CNT atoms. The results show that true chemical functionalisation was achieved and by argon ion bombardment these functional groups can be altered relative to the C 1s carbon atoms of the CNT. The choice of chemicals used for functionalisation, the techniques employed and the types of nanotubes treated are important factors in chemical characterisation. The carbon atom on the nanotube ring to which the functional group (atom) is bonded, the chirality of the CNT, the electronegativity of the functional group, the bond type and whether the CNT is single-wall or multi-wall, or cut (short) could play a role in determining the chemical shift on the CNTs atoms. These investigations are relevant to chemical functionalisation of carbon nanotubes for various applications for example DNA sensors and other biomedical sensors.     

Flaking and extrusion as mechanical treatments for enzyme-assisted aqueous extraction of oil from soybeans

Flaking and extruding dehulled soybeans were evaluated as a means of enhancing oil extraction efficiency during enzyme-assisted aqueous processing of soybeans. Cellulase, protease, and their combination were evaluated for effectiveness in achieving high oil extraction recovery from extruded flakes. Aqueous extraction of extruded full-fat soy flakes gave 68% recovery of the total available oil without using enzymes. A 0.5% wt/wt protease treatment after flaking and extruding dehulled soybeans increased oil extraction recovery to 88% of the total available oil. Flaking and extruding enhanced protease hydrolysis of proteins freeing more oil. Treating extruded flakes with cellulase, however, did not enhance oil extraction either alone or in combination with protease. Discrepancies in oil extraction recoveries were encountered when merely considering crude free fat because some oil became bound to denatured protein during extrusion and/or sample drying. Bound fat was unavailable for determination by using the hexane extraction method, but was accounted for by using the acid hydrolysis method for total oil determination. Oil extraction recovery from extruded soybean flakes was affected by oil determination methods, which was not the case for unextruded full-fat soy flour.     

Effect of external index of refraction on multimode fiber couplers

The dependence of the performance of fused-taper multimode fiber couplers on the refractive index of the material surrounding the taper region has been investigated both theoretically and experimentally. It has been identified that for a 2 × 2 multimode fiber coupler there is a range of output-power-coupling ratios for which the effect of the external refractive index is negligible. When the coupler is tapered beyond this region, the performance becomes dependent on the external index of refraction and lossy. To analyze the multimode coupler-loss mechanism, we develop a two-dimensional ray-optics model that incorporates trapped cladding-mode loss and core-mode loss through frustrated total internal reflection.

Computer-simulation results support the experimental observations. Related issues such as coupler fabrication and packaging are also discussed.