Thoracic epidural anesthesia as the last option for treating angina in a patient before coronary artery bypass surgery

Robertsonian translocations, although relatively common as a constitutional genetic aberration, are rarely encountered in leukaemia. We report a case of acute myeloid leukaemia which showed an acquired Robertsonian translocation in the form of der(14;21) by cytogenetic analysis of leukaemic cells. This was confirmed by the PHA-stimulated culture of peripheral blood lymphocytes. A review of the literature identifies only eight reported cases of acquired Robertsonian translocations in leukaemia. In the majority of cases the Robertsonian translocation occurs as a secondary change in a complex abnormal clone, whereas in two out of nine patients reported, including ours, it is found as a sole karyotypic abnormality.     

The ultrasound appearances of neonatal renal vein thrombosis

Renal vein thrombosis (RVT) is the most frequently occurring vascular condition in the new-born kidney. The predisposing factors include dehydration, sepsis, birth asphyxia, maternal diabetes, polycythaemia and the presence of an indwelling umbilical venous catheter. (RVT) may present clinically with a flank mass, haematuria, hypertension or renal failure. Many imaging modalities have been employed, but ultrasound is the technique most commonly used in the evaluation of neonates with suspected RVT. Thrombosis commences in the small renal veins and subsequently propagates via larger interlobar veins to the main renal vein and inferior vena cava (IVC). The ultrasound appearances depend upon the stage at which the examination is performed and extent of the thrombus. Initially, the interlobular and interlobar thrombus appears as highly echogenic streaks. These streaks commence in a peripheral, focal segment of the involved kidney and only persist for a few days. In the first week the affected kidney swells and becomes echogenic with prominent echopoor medullary pyramids. Later, the swelling increases and the kidney becomes heterogenous with loss of corticomedullary differentiation. Grey scale ultrasound readily demonstrates thrombus within the renal vein and IVC. Adrenal haemorrhage is a recognized association and may be identified ultrasonically. Colour Doppler scanning provides additional information. In the early stages of RVT, colour Doppler may demonstrate absent intrarenal and renal venous flow. Ultimately, the kidney may recover, show focal scarring or become atrophic. Thus, ultrasound provides an accessible and reliable tool in the assessment of suspected neonatal RVT.     

Partial congenital defect of the left pericardium: angiographic diagnosis and treatment by thoracoscopic pericardiectomy: case report

Twenty-six patients with an intracardiac myxoma underwent surgical resection at our institution from 1977 through 1992. Left atrial myxoma was diagnosed in 22 patients, left ventricular in 1, right atrial in 2, and right ventricular in 1. Six patients were asymptomatic; preoperative symptoms included dyspnea, arrhythmias, embolic episodes, and syncope. The diagnosis was established with transthoracic echocardiography in all cases but one. Surgery was performed in all cases with the aid of cardiopulmonary bypass with moderate hypothermia and cold crystalloid cardioplegia. One patient with a left ventricular myxoma died in a comatose state during the immediate postoperative period. Long-term clinical and echocardiographic evaluation was performed in 19 patients; results were excellent (all the patients were in New York Heart Association functional class I or II), and no recurrences were documented. The clinical characteristics, diagnostic methods, and surgical approach are presented and discussed.     

Reliability prediction models to support conceptual design

During the early stages of conceptual design, the ability to predict reliability is very limited. Without a prototype to test in a lab environment or without field data, component failure rates and system reliability performance are usually unknown. A popular method for early reliability prediction is to develop a computer model for the system. However, most of these models are extremely specific to an individual system or industry. This paper presents three general procedures (using both simulation and analytic solution techniques) for predicting system reliability and average mission cost. The procedures consider both known and unknown failure rates and component-level and subsystem-level analyzes. The estimates are based on the number of series subsystems and redundant (active or stand-by) components for each subsystem. The result is a set of approaches that engineers can use to predict system reliability early in the system-design process. Software was developed (and is discussed in this paper) that facilitates the application of the simulation-based techniques. For the specific type of system and mission addressed in this paper, the analytic approach is superior to the simulation-based prediction models. However, all three approaches are presented for two reasons: (1) to convey the development process involved with building these prediction tools; and (2) the simulation-based approaches are of greater value as the research is extended to consider more complex systems and scenarios     

Technology transfer projects in developing countries—furthering the Project Management perspectives

This paper attempts to broaden the analysis of the technology transfer phenomenon by refocusing research attention on the level of performance assessment of technology transfer projects. An holistic evaluation framework based on the considerations of an extended Project Life Cycle model is proposed to overcome some of the shortcomings of conventional approaches to project evaluation. This also reinforces the need for open systems thinking in assessing and managing risk of technology transfer projects. The discussion is based on two case studies which articulate the experiences with two integrated mechanisms of technology transfer used in Algeria from 1965 to 1990: turnkey and “product-in-hand”. The aim is to gain a better understanding of the processes of technology transfer and to contribute to the improvement of associated managerial practices in developing economies.     

The contact of elastic regular wavy surfaces

A complete solution in closed form to the elastic contact of a one-dimensional sinusoidal surface with a flat surface was presented by Westergaard in 1939. This paper is concerned with the elastic contact of a two-dimensional sinusoidal surface with a flat. In this case the stress distribution within the elastic solids is three-dimensional. As the load is increased the contact areas change in shape from being circular to square and finally leave a circular region of no contact when the waves are almost squashed flat. The problem is solved in general using a numerical method due to Kalker, but asymptotic solutions in closed form have been found for light loads and also for heavy loads at which contact is almost complete. The variation of the mean separation with load, which determines the volume of the space trapped between the two surfaces, is also found.     

High affinity presentation of an autoantigenic peptide in type I diabetes by an HLA class II protein encoded in a haplotype protecting from disease

Tissue composition and the distribution of body mass are described for four genera of East African Bovidae (Madoqua, Gazella, Damaliscus, Hippotragus) with supporting data from four others (Neotragus, Oryx, Tragelaphus, Connochaetes). These species are high in muscle mass, an adaptation convergent with other high-speed terrestrial cursors, bounders, and saltators. The segments below the elbow/cubitus and knee/stifle/genu joints in small bovids are both lighter in percent of total body mass (8.6% TBM) and less heavily muscled (10-15% of total limb musculature) than those segments in macaques (13.6% TBM, 20-25% of the limb musculature). Bovid species differ from one another in the regional distribution of muscle mass. Madoqua kirkii (4-5 kg) concentrates muscle in the lumbar extensors and hindlimbs; large species such as Damaliscus doreas (50-60 kg) and Hippotragus niger (160-220 kg) distribute it more evenly between the lumbar and cervical regions and between the hindlimbs and forelimbs. Gazella dorcas (10-20 kg) is quantitatively intermediate in those characteristics. The redistribution of muscle mass with increasing size correlates with the loss of axial bending of the vertebral column: in small, hindlimb dominant, 'dorsomobile' species such as Madoqua sagittal mobility increases stride length through 'extended' suspension; in large 'dorsostable' species such as Damaliscus and Hippotragus the vertebral column resists bending, consequently abbreviating or omitting this non-contact phase of the gait cycle. Locomotor adaptation as it is reflected in size, shape, and musculoskeletal structure is the key to habitat choice, dietary specialization, social structure, and male agonistic behavior and, therefore, central to the fabric of behavioral ecology.