Outcome of cardiac valve ring abscesses after medical treatment: attempt to identify criteria of favorable prognosis

OBJECTIVES: Identify factors predicting favorable outcome after medical management of valve ring abscesses in order to propose a surveillance schedule for conservative treatment. METHODS: A multicentric study conducted from July 1989 to February 1996 included 28 patients (mean age 64 +/- 16 years, range 26-83) hospitalized for active endocarditis and valve ring abscesses diagnosed at transthoracic or transesophageal echography. Conservative medical therapy was given because of a decision of the medico-surgical team (n = 9), high surgical risk (n = 12), or patient refusal of surgery (n = 7). Outcome was favourable in 18 patients (Group I) and unfavorable in 10 (Group II) due to death (n = 9) or subsequent surgery (n = 1). Univariate and multivariate analysis were used to determine differences between the groups in terms of clinical and laboratory data. RESULTS: Mean follow-up in Group I was 33 +/- 18 months and 15 +/- 10 months in Group II. Univariate analysis showed significant differences between Group I and II respectively for age (59 +/- 18 yr vs 72 +/- 10, p = 0.04), delay to apyrexia after antibiotics (4.3 +/- 2.8 vs 8.3 +/- 2.4 days, p < 0.0008), heart failure (5% vs 70%, p = 0.003), grade III or IV valvular regurgitation (5% vs 60%, p < 0.04), and mean surface area of the abscess (1.5 +/- 1.2 vs 5.4 +/- 6.4 cm2, p < 0.03). Independent factors at multivariate analysis were by decreasing order: lack of heart failure at admission, delay to apyrexia, abscess surface area, and age. Outcome was favorable (mean follow-up 33 +/- 10 months) in all patients with an abscess surface area < 1.5 cm2, no signs of heart failure, no grade III or IV valvular regurgitation, apyrexia after less than 8 days on antibiotics and no staphylococcus positive blood culture. CONCLUSION: Medical management of valve ring abscesses may be indicated in selected patients in care units with rigorous surveillance facilities. Further studies are needed to precisely identify surveillance and treatment criteria.     

Maintenance strategy based on a multicriterion classification of equipments

In an industrial plant, the level of maintenance provided to individual equipment is directly related to the availability that is expected from it. Thus, it is hoped that the most critical equipments will not fail or, at least, that any failure will be rapidly detected and corrected in the minimum time possible. Since resources are limited, it is necessary to determine how they should be distributed, so that no important equipment remains neglected while more resources are concentrated on the most critical items. Therefore, it is necessary to classify equipment in an objective way according to its importance. The method of multicriterion classification of critical equipments (MCCE)², which is described in the present work, allows systematic and detailed quantification of the criticality of all equipment, that is to say, it provides an evaluation of the importance that its correct operation has for the plant. To provide this information, the consequences for a company of any failure in the equipment concerned are analysed. Finally, a real case example of an urban wastewater treatment plant is described, in which the MCCE method is applied.     

Kinetics of chlorination of tantalum pentoxide in mixture with sucrose carbon by chlorine gas

The mechanism and kinetics of β-Ta₂O₅ chlorination, mixed with sucrose carbon, have been studied by a thermogravimetric technique. The investigated temperature range was 500 °C to 850 °C. The reactants and reaction residues were analyzed by scanning electronic microscopy (SEM), X-ray diffraction (XRD), and Brunauer-Emmett-Teller method for surface area (BET). The effect of various experimental parameters was studied, such as carbon percentage, temperature, chlorine partial pressure, and flow, use of the multiple sample method, and carbon previous oxidation. The carbon percentage and previous treatment have an effect on the system reactivity. The temperature has a marked effect on the reaction rate. In the 500 °C to 600 °C temperature interval, the apparent activation energy is 144 kJ/mol of oxide, while at higher temperatures, the activation energy decreases. With high chorine partial pressures, the order of reaction is near zero. The kinetic contractile plate model, X=kt, considering carbon oxidation as the controlling stage, is the one with the best fit to the experimental data. A probable mechanism for the carbochlorination of β-Ta₂O₅ is proposed: (1) activation of chlorine on the carbon surface, (2) chlorination of Ta₂O₅, (3) oxidation of carbon, and (4) recrystallization of β-Ta₂O₅.     

Optical properties of Nd-doped Ca3(VO4)2 single crystal fiber

Optical absorption and photoluminescence of Ca₃(VO₄)₂ single crystal grown by a floating-zone technique and containing Nd³⁺ ions were investigated. High absorption coefficients and broadening of most absorption bands are present at 300 K, while substructures in some of the same bands can be evidenced at 12 K. Most features of measured spectra are characteristic of random occupation of more than a single Ca²⁺ site by the Nd³⁺ ion and of distortions provoked by different charge compensation mechanisms involving oxygen vacancies promotion in the crystal lattice. Nd³⁺ optical properties were studied by using the Judd-Ofelt theory to calculate the spectral parameters relevant for laser applications.