Coronary bypass in vascular patients: a relatively high-risk procedure

A premise of cardiac risk stratification is that the added risk of coronary artery bypass grafting (CABG) is offset by the improved safety of subsequent vascular reconstruction (VR). We questioned if elective CABG is patients with severe peripheral vascular disease (PVD) is a relatively high-risk procedure. A cohort study of 680 elective CABG patients from January 1993 to December 1994 was performed using three mutually exclusive outcomes of complication-free survival, morbidity, and mortality. Patient characteristic, operative, and outcome data were prospectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morbidity occurred at rates 3.6-fold higher in PVD patients (39.7%) than in disease-free patients (16.7%) after adjustment for the effects of patient and operative variables (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most likely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aortic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD patients is associated with significant major morbidity. Such morbidity may preclude or alter the timing of subsequent VR.     

Comments on “Editorial: fuzzy models-what are they andwhy?”

In the editorial by J.C. Bezdek (ibid., p.1), an example is presented to demonstrate differences between fuzzy membership and probability. The authors argue that probability can be used in a way much more closely analogous to this use of fuzzy membership, weakening the argument for the latter     

The double-reversing Z-plasty in primary palatoplasty: operative experience and early results

The double-reversing Z-plasty of Furlow for closure of the soft palate was used in 34 children with various types of cleft palate. Mean age at repair was 12.8 months. Intraoperative experience was favorable, with acceptable operating time and blood loss. Length of hospitalization averaged 1.9 days. Postoperatively, two children experienced temporary stridor, which resolved within 24 to 48 hours. One child had dehiscence of the hard palate (Von Lagenbeck repair) 4 weeks postoperatively, and three children developed small oronasal fistulae. Early speech evaluation demonstrated adequate soft palate mobility in 33 of 34 patients, with observable velopharyngeal function. Twelve children had mild velar compromise, with eight exhibiting slight nasal air escape.     

The use of stokeslets to describe the arbitrary translation of a disk near a plane wall

A previously presented method is extended to describe the fully three-dimensional Stokes flow generated by the translation in any direction of an arbitrarily oriented disk in fluid bounded by a plane wall. The velocity field is represented solely in terms of stokeslet distributions on the disk, modified to take account of the bounding wall according to the century-old idea of Lorentz. Sets of integral equations of the second kind, not all disjoint, are obtained for the Abel transforms in each Fourier mode of the density functions. However, only a few modes need be considered in determining the flow field to order D ^-3, where D is the distance of the disk axis from the wall. Less detail is required to evaluate the drag force and torque experienced by the disk.     

A multi-agent decision support system for stock trading

A distributed problem solving system can be characterized as a group of individual cooperating agents running to solve common problems. As dynamic application domains continue to grow in scale and complexity, it becomes more difficult to control the purposeful behavior of agents, especially when unexpected events may occur. This article presents an information and knowledge exchange framework to support distributed problem solving. From the application viewpoint the article concentrates on the stock trading domain; however, many presented solutions can be extended to other dynamic domains. It addresses two important issues: how individual agents should be interconnected so that their resources are efficiently used and their goals accomplished effectively; and how information and knowledge transfer should take place among the agents to allow them to respond successfully to user requests and unexpected external situations. The article introduces an architecture, the MASST system architecture, which supports dynamic information and knowledge exchange among the cooperating agents. The architecture uses a dynamic blackboard as an interagent communication paradigm to facilitate factual data, business rule, and command exchange between cooperating MASST agents. The critical components of the MASST architecture have been implemented and tested in the stock trading domain, and have proven to be a viable solution for distributed problem solving based on cooperating agents     

Energy use in controlled temperature marine aquaculture

Temperature control offers benefits in land‐based marine aquaculture: stock growth rates may be enhanced by heating in winter; mortality rates in summer may be reduced by cooling. However, if the plant is not well designed, temperature control may create very large energy demands. This paper describes the application of temperature control in abalone aquaculture in New Zealand, with a focus on energy considerations in plant design. An abalone farm using a semi‐closed water conditioning system is used as a case study for which an energy model, based on a heat pump system, is developed. The model is used to determine the impact of plant design and tank conditions on the economics of the operation. Copyright © 2002 John Wiley & Sons, Ltd.     

Infections in patients with cystic fibrosis following lung transplantation

BACKGROUND: There is controversy over whether colonization with drug-resistant organisms is a contraindication to lung transplantation. METHODS: We undertook a retrospective review of the results of lung transplantation for patients with cystic fibrosis (CF) at Duke University Medical Center. RESULTS: As of May 1996, 21 patients with CF underwent bilateral lung transplantation. The first patient died within 24 h of transplantation from sepsis due to Stenotrophomonas maltophilia. Of the remaining 20 patients, 17 (85%) are alive and in stable condition. The three deaths were related primarily to bronchiolitis obliterans at 4 and 18 months in two patients and to cytomegalovirus pneumonitis at 5 months in the other patient. The 17 surviving patients have been followed up for a mean of 13 months (range, 0.5 to 34 months). Most of them were colonized and infected with multidrug-resistant organisms before transplantation. Following transplantation, 11 patients had complications from infections. One patient had bacteremia due to a panresistant Burkholderia cepacia and was treated successfully. Two patients had bacteremia and wound infection due to Burkholderia gladioli, previously thought to be pathogenic only in plants. Both patients were treated successfully. Of the six patients with Aspergillus fumigatus isolated from cultures before transplantation, only one had invasive disease following transplantation and responded to treatment. CONCLUSION: The organisms present before transplantation were not the primary cause of mortality in our patient population. Our findings suggest that lung transplantation should be considered in CF patients infected with multidrug-resistant organisms.