Presentation and treatment of spontaneous aortocaval fistula

BACKGROUND: Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare. The clinical presentation is highly variable, and the diagnosis can be difficult, often being made only at operation. The aortocaval fistula results in a large left-to-right shunt, which can cause cardiac failure. Once the diagnosis is made, treatment is by surgical closure of the fistula and repair of the aneurysm with a graft. METHODS: This is a retrospective review of a single surgeon's experience with aortocaval fistula complicating abdominal aortic aneurysms. RESULTS: Over a 15-year period, we had five patients with spontaneous aortocaval fistula who were treated operatively. Preoperative diagnosis was made in two, suspected in one, and not made in two, one of whom died (the only perioperative death in the series). CONCLUSIONS: Spontaneous aortocaval fistulas are uncommon, and their preoperative recognition is difficult. Hematuria in association with an abdominal aortic aneurysm should raise the suspicion of an aortocaval fistula. Surgical correction is possible, with survival rates comparable to those associated with rupture of aneurysms into the retroperitoneum. Early operative control of the fistula is important to optimize the preload to the heart.     

Temporal bone volumetric image deblurring in spiral computed tomography scanning

RATIONALE AND OBJECTIVES: We developed a method for volumetric image deblurring in spiral (helical) computed tomography (CT) scanning with a three-dimensional (3D) Gaussian point spread function (PSF) to improve the quality of temporal bone spiral CT images for assessing the position of cochlear implants electrodes. METHODS: A patient was scanned after cochlear implantation, and the temporal bone was reconstructed into a volume with 128 voxels per dimension, 0.1 mm per voxel side, and x 10 gray-scale expansion. The 3D PSF in spiral CT imaging was assumed to be Gaussian separable transversely and longitudinally. Standard deviations of the PSF were derived and subjectively adjusted. The image was then deconvolved using Wiener filtering and maximum-likelihood deconvolution methods. Image quality was assessed both visually and quantitatively using cross-sectional area at half of the maximum (CAHM) of the implanted array as the figure of merit. RESULTS: Substantial image deblurring was achieved via deconvolution. Subjectively, anatomic structures were more clearly shown. Deconvolution reduced the CAHM by approximately one third, on average. Three-dimensional deconvolution had better image quality than two-dimensional deconvolution. The maximum-likelihood method produced superior image quality but took longer to process relative to Wiener filtering. CONCLUSION: Volumetric image deblurring is practical with a Gaussian PSF. The maximum-likelihood method is preferred if time permits. Deconvolution facilitates the study of fine details of the temporal bone and cochlear implant.     

Ovarian neoplasms in children

OBJECTIVE: To review the clinical presentation, treatment, and outcome in a series of children with ovarian neoplasms. DESIGN: A retrospective review of the medical records in a case series of 29 girls with ovarian neoplasms. The length of follow-up ranged from 6 months to 7 1/2 years and averaged 3.0 years in the girls with malignant tumors. SETTING: The patients were treated at a large referral children's hospital. PATIENTS: Twenty-nine girls with ovarian neoplasms were treated from 1976 to 1992. The average age of the patients was 10 years and ranged from 2 to 16 years. MAIN OUTCOME MEASURES: The principal outcomes examined were mortality and surgical morbidity. RESULTS: The most common presenting symptoms for these ovarian tumors in pediatric patients included chronic abdominal pain, an abdominal mass, or distention. Three girls presented with precocious puberty or hirsutism. In 27 cases, the tumor was a primary ovarian lesion. In two patients, the ovarian mass was the presenting finding for a stage IV non-Hodgkin's lymphoma. Seventeen tumors were benign and 12 were malignant. Tumors originating from the germ-cell line predominated (n = 17). Seven of the 10 ovarian malignant neoplasms were stage I at the time of diagnosis. All but one of the girls with malignant tumors received either adjunctive radiation therapy or multiple-agent chemotherapy. Two girls with sex cord/stromal cell tumors who presented with stage I disease ultimately developed widespread metastases. Both girls with large epithelial tumors survived. All of the girls with benign tumors and seven (70%) of 10 with malignant lesions survived. CONCLUSION: Ovarian tumors are unusual lesions in the pediatric population. Unlike in adults, such neoplasms generally originate from the germ-cell line. Whereas most ovarian tumors in girls are benign, some children have malignant tumors that are very aggressive and do not respond well to adjuvant therapy. In particular, malignant sex cord/stromal cell tumors, even when they present at an early stage, may behave unpredictably.     

Nonsulfhydryl-reactive phenoxyacetic acids increase aqueous humor outflow facility

PURPOSE: The phenoxyacetic acid, ethacrynic acid (ECA), has potential use in glaucoma therapy because it acts to increase aqueous outflow in vivo and in vitro. In human trabecular meshwork (HTM) cell culture, ECA acts to change cell shape and attachment, effects that have been correlated with microtubule (MT) alterations and chemical sulfhydryl (SH) reactivity. To further explore these actions, we evaluated two non-SH reactive phenoxyacetic acids, inadcrinone and ticrynafen, and the MT-disrupting drug vinblastine. METHODS: Excised bovine and porcine eyes were perfused and outflow facility measured. Calf pulmonary artery endothelial and HTM cells were grown in culture and cytoskeletal effects evaluated after drug treatment. RESULTS: Indacrinone, ticrynafen, and vinblastine all caused an increase in outflow facility. In contrast with ECA, the outflow effects of indacrinone and ticrynafen were not blocked by excess cysteine. Although indacrinone and ticrynafen produced changes in cell shape in vitro, the beta-tubulin staining pattern of treated cells was not altered. Vinblastine caused cell shape change and the expected MT disruption. CONCLUSIONS: Phenoxyacetic acids can increase aqueous outflow facility and alter HTM cell shape and attachment in vitro by a non-SH, non-MT mechanism (which is probably shared also by ECA). These findings suggest the possibility of a broader class of glaucoma drugs that may be directed at the HTM. An understanding of the cellular target for these drugs has implications both for potential glaucoma therapy and for the cytoskeletal mechanisms involved in normal outflow function.     

DEVELOPMENT AND VALIDATION OF A PROCESS SIMULATOR FOR DRYING SUBBITUMINOUS COAL

Drying subbituminous coal has never been practiced commercially. The commercial dryers built to date have been designed for drying surface moisture in conjunction with upstream coal preparation facilities. This type of drying is mainly controlled by input energy and the basis of the design is an energy balance. In drying inherent moisture from subbituminous coal, the thermal conductivity of the coal and the diffusion of molecular water within coal particles impose limitations on the process conditions. Energy input and solids residence time in the dryer have to be controlled properly for simultaneously balancing the heat and mass transfer within the coal particles. Improper control of either parameter can cause fires and explosions during the key steps of the drying process—drying and cooling

In parallel to the Anaconda coal drying pilot plant program, a cross-flow, fluid-bed coal drying/cooling process simulator was developed for: (1) understanding the drying phenomena on an individual particle basis; (2) analyzing potential risks and safety limits, and (3) designing the Anaconda pilot plant program

The development of the process simulator was based on both first principles and laboratory data and can be divided into two phases:

1 Development of a semi-mechanistic drying model for Powder River Basin subbituminous coal employing an analytical solution of the diffusion equation

2.Formulation of a fluid-bed cross-bed cross-flow dryer/cooler simulator employing simultaneous heat and mass transfer

This model was validated against process variables data taken on a 4 tph pilot plant. An operable range, or process envelope, has been developed through the pilot plant experience and the process simulation study. Based on the model predictions, an uncertainly range was defined in the design recommendations of a pioneer coal drying plant in scale-up.     

Using non-ideal gates to implement universal quantum computing between uncoupled qubits

In many physical systems, when implementing quantum gate operations unavoidable global and relative phases occur as by-products due to the internal structure of the governing Hamiltonian. To correct, additional phase rotation gates are used, which increases the computational overhead. Here, we show how these phase by-products can actually be used to our advantage by using them to implement universal quantum computing between qubits not directly coupled to each other. The gate operations, CNOT, Toffoli, and swap gates, require much less computational overhead than present schemes, and are achieved with fidelity greater than 99%. We then present a linear nearest-neighbor architecture that takes full advantage of the phase by-products, and we show how to implement gates from a universal set efficiently in this layout. In this scheme gate operations are realized by only varying a single control parameter per data qubit, and the ability to tune couplings is not required.     

Charge-coupled-device detection of soft x rays for grazing-incidence spectrometers

We describe calculations of the sensitivity of CCD's to soft x rays incident at grazing angles. Soft-x-ray spectrometers based on a Rowland-circle geometry have a focal plane and hence detector surface at grazing incidence to the soft × rays. We model the penetration of the grazing-incidence soft × rays to the sensitive region of the CCD and predict the charge-collection efficiency as a function of wavelength. The results show significant advantages over microchannel plate intensified detection.