Effects of magnetic shear on toroidal rotation in tokamak plasmas with lower hybrid current drive.

Application of lower hybrid (LH) current drive in tokamak plasmas can induce both co- and countercurrent directed changes in toroidal rotation, depending on the core q profile. For discharges with q(0) <1, rotation increments in the countercurrent direction are observed. If the LH-driven current is sufficient to suppress sawteeth and increase q(0) above unity, the core toroidal rotation change is in the cocurrent direction. This change in sign of the rotation increment is consistent with a change in sign of the residual stress (the divergence of which constitutes an intrinsic torque that drives the flow) through its dependence on magnetic shear.

Influence of magnetic field ripple on the intrinsic rotation of tokamak plasmas.

Using the unique capability of JET to monotonically change the amplitude of the magnetic field ripple, without modifying other relevant equilibrium conditions, the effect of the ripple on the angular rotation frequency of the plasma column was investigated under the conditions of no external momentum input. The ripple amplitude was varied from 0.08% to 1.5% in Ohmic and ion-cyclotron radio-frequency (ICRF) heated plasmas. In both cases the ripple causes counterrotation, indicating a strong torque due to nonambipolar transport of thermal ions and in the case of ICRF also fast ions.

Stenting of the superior mesenteric vein in midgut carcinoid disease with large mesenteric masses.

BACKGROUND: Midgut carcinoid (MGC) tumors generally develop in the small intestine and in >50% of cases also present with lymph node metastases in the mesentery. The majority of these tumors are surgically resectable, but a fraction are inoperable and may cause obstruction of the superior mesenteric vein (SMV), often associated with stasis of the intestinal wall and severe symptoms. These symptoms include severe abdominal pain, attacks of diarrhea, and malnutrition. METHODS: Seven patients with severe MGC including a large fibrotic inoperable mesenteric mass and severe symptoms were studied. After an obstructed SMV and signs of venous stasis in the small intestine were demonstrated, an expandable stent was inserted after puncturing an intrahepatic portal venous branch. The associated venography, patient symptoms, and radiological signs on computed tomography (CT) scans were evaluated. RESULTS: Four patients demonstrated resolution of their symptoms. In one patient who had intra-abdominal lymph leakage/chyloperitoneum, a complete normalization of the circulation followed and the intra-abdominal lymph leakage stalled. The venographies demonstrated normalization of the venous blood flow through the SMV, and CT scans demonstrated reduction in the thickness of the intestinal wall. In two cases there were no changes in the symptoms, and in one case a slight worsening of the symptoms ensued. In general, reductions of symptoms were associated with the degree of normalization of venous blood flow. CONCLUSIONS: We conclude that in selected patients with MGC stenting of the SMV may improve symptoms.

Fractures of self-expanding metallic stents in periampullary malignant biliary obstruction.

BACKGROUND: Self-expanding metallic stents are widely used for relieving biliary duct obstruction in patients with unresectable periampullary malignancies. However, only a few studies have assessed the occurrence of fractures in these stents. PURPOSE: To determine the prevalence and significance of stent fracture after placement of self-expanding metallic stents for periampullary malignant biliary obstruction. MATERIAL AND METHODS: Over a 5-year period, 48 patients underwent placement of self-expanding metallic stents for periampullary malignant biliary obstructions. Stents were introduced 2-6 weeks after a percutaneous transhepatic biliary decompression. The medical records and relevant images were reviewed for stent patency, stent fracture, type of stent, and stent-related complications. RESULTS: Stent fracture was detected in four of the 48 patients (8%): in one patient at 1 month and in three patients between 10 and 21 months after stenting. All four fractures involved one type of nitinol stent used in 38 patients. In one of the patients, fracture was complicated by life-threatening gastrointestinal bleeding. The mean survival time for all patients was 251 days (standard deviation [SD]+/-275 days) and the mean overall patency time for all stents was 187 days (SD+/-205 days). CONCLUSION: Stent fracture occurs after placement of self-expanding nitinol stents for periampullary malignant biliary obstruction. The low reported incidence of this complication may be due to a lack of awareness of and difficulty in detecting stent fracture. Fracture should be considered as a possible contributing factor in recurrent biliary obstruction after self-expanding metallic stent insertion.

Demonstration of effective control of fast-ion-stabilized sawteeth by electron-cyclotron current drive.

In a tokamak plasma, sawtooth oscillations in the central temperature, caused by a magnetohydrodynamic instability, can be partially stabilized by fast ions. The resulting less frequent sawtooth crashes can trigger unwanted magnetohydrodynamic activity. This Letter reports on experiments showing that modest electron-cyclotron current drive power, with the deposition positioned by feedback control of the injection angle, can reliably shorten the sawtooth period in the presence of ions with energies >or=0.5 MeV. Certain surprising elements of the results are evaluated qualitatively in terms of existing theory.

Sawtooth-control mechanism using toroidally propagating ion-cyclotron-resonance waves in tokamaks.

The sawtooth control mechanism in plasmas employing off-axis toroidally propagating ion cyclotron resonance waves in tokamaks is reinvestigated. The radial drift excursion of energetic passing ions distributed asymmetrically in the velocity parallel to the magnetic field determines stability when the rational q=1 surface resides within a narrow region centered about the shifted fundamental cyclotron resonance.

Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle.

BACKGROUND: Transcatheter arterial embolization (TAE) is considered a safe, life-saving procedure in postpartum hemorrhage (PPH), but its long-term effect on menstruation and fertility is unclear. PURPOSE: To investigate technical aspects and the evaluation of complications, focused on menstrual cycle and fertility, using TAE in patients with PPH. MATERIAL AND METHODS: A retrospective study including 20 patients (seven with vaginal and 13 with cesarean delivery) with severe PPH treated with bilateral TAE of the uterine artery was carried out. All patients were asked to answer a questionnaire regarding their post-embolization history. In six patients, the radiation dose was measured. RESULTS: All 20 cases underwent bilateral TAE of the uterine artery. Gelfoam was used as the embolic agent. However, after cesarean delivery in six patients who had clear contrast medium extravasation and/or pseudoaneurysm-like lesion, metallic coils had to be used in order to achieve hemostasis. No major short- or long-term complications were registered. Normal menses resumed in all patients. Four patients had a total of five full-term and two preterm pregnancies, and all delivered healthy infants by cesarean section with no recurrence of PPH. The mean radiation dose to the ovaries was 586 mGy (range 204-729 mGy). CONCLUSION: TAE in patients with PPH is safe and has no major short- or long-term side effects. A patient managed with TAE can expect return of normal menses and preservation of future fertility and successful pregnancies. PPH after cesarean section might need to be embolized with metallic coils in addition to Gelfoam in order to achieve secure hemostasis.

Liver embolization with trisacryl gelatin microspheres (embosphere) in patients with neuroendocrine tumors.

PURPOSE: To report our experience of liver embolization with trisacryl gelatin microspheres (Embospheretrade mark) in patients with metastatic neuroendocrine tumors. MATERIAL AND METHODS: Fifteen patients underwent selective embolization of the right or left hepatic artery with Embosphere. One lobe was embolized in seven patients and both lobes, on separate occasions, in eight patients. Seven patients had midgut carcinoids, two had lung carcinoids, one suffered from a thymic carcinoid, and five had endocrine pancreatic tumors. Eight patients suffered from endocrine symptoms, seven of whom had carcinoid syndrome and one WDHA (watery diarrhea, hypokalemia, achlorhydria) syndrome. RESULTS: Partial radiological response was seen after eight embolizations (in six different patients), stable disease was observed after 13 embolizations (after three of these, necroses occurred), while radiological progression was noted after only two embolizations. Only two patients experienced a biochemical response. Clinical improvement of carcinoid syndrome was observed after five embolizations. There were no major complications. Fever >38 degrees C was seen after all but four embolizations, and urinary tract infections were diagnosed after eight embolizations. CONCLUSION: Selective hepatic artery embolization with Embosphere particles is a safe treatment for patients with metastatic neuroendocrine tumors and may lead to partial radiological response as well as symptomatic improvement of disabling endocrine symptoms.

Three-dimensional rotational angiography of transplanted renal arteries: influence of an extended angle of rotation on beam-hardening artifacts.

PURPOSE: To investigate whether three-dimensional rotational angiography (3D-RA) of the transplant renal artery performed with an extended angle of rotation can reduce beam-hardening artifacts in 3D reconstructed images without image quality being lost or side effects to the transplanted kidney being increased. MATERIAL AND METHODS: 3D-RA with a C-arm rotation of 180 degrees was performed consecutively in 12 renal transplanted patients with suspicion of renal artery stenosis. A 1.7-mm balloon occlusion catheter was placed using the crossover technique and this was compared to a protocol with 160 degrees rotation and a traditional 1.4-mm catheter in 10 patients. The occurrence of beam-hardening artifacts was registered and the effects of the reduced contrast load on image quality and of arterial occlusion on renal function were assessed. RESULTS: The extended angle of rotation, from 160 degrees to 180 degrees, reduced the beam-hardening artifacts. Artifacts were observed in 4/11 patients (36%) in the study group and in all 10 (100%) of the controls. There was no statistical difference regarding image quality between the two protocols. Renal function was equally affected in both protocols. CONCLUSION: 3D-RA with an extended C-arm rotation reduced the beam-hardening artifacts. Image quality was not reduced despite the reduced contrast medium load. The different protocols had no effect on patient outcome.

Plasma rotation induced by directed waves in the ion-cyclotron range of frequencies.

Changes of the toroidal plasma rotation induced by directed waves in the ion-cyclotron range of frequencies (ICRF) have been identified experimentally for the first time on the JET tokamak. The momentum carried by the waves is initially absorbed by fast resonating ions, which subsequently transfer it to the bulk plasma. Thus, the results provide evidence for the influence of ICRF heated fast ions on plasma rotation.

Destabilization of fast-ion-induced long sawteeth by localized current drive in the JET tokamak.

In a tokamak fusion reactor the energetic alpha particles will transiently stabilize the magnetohydrodynamic activity causing sawtooth oscillations. The crash events terminating long sawtooth free periods can provide seed islands for neoclassical tearing modes [Phys. Rev. Lett. 88, 105001 (2002)]]. To shorten the sawtooth periods localized current drive near the q=1 surface is a possibility. This Letter provides the first experimental evidence for the effectiveness of this method in the different physics regime associated with fast-ion-induced long sawteeth on the JET tokamak.

Current dynamics during disruptions in large tokamaks.

Self-consistent modeling of the evolution of the plasma current during disruptions in large tokamaks is presented, taking into account both the generation of runaway electrons and their backreaction on the electric field. It is found that the current profile changes dramatically, so that the postdisruption current carried by runaway electrons is much more peaked than the thermal predisruption current. Although only a fraction of the thermal current is converted into runaway electrons, the central current density increases significantly for typical parameters in JET and ITER. It is also shown that the radial runaway profile can easily become filamented in the radial direction.

Ion acceleration during reconnection in MAST.

Spontaneous acceleration of ions to suprathermal energies is observed during magnetic reconnection in the Mega-Ampere Spherical Tokamak (MAST). A high-energy tail is observed in the ion-distribution function following each internal reconnection event in Ohmic discharges. This phenomenon is explained in terms of runaway ion acceleration in the electric field induced by the reconnection.

Controlling the profile of ion-cyclotron-resonant ions in JET with the wave-induced pinch effect.

Experiments on the JET tokamak show that the wave-induced pinch in the presence of toroidally asymmetric waves can provide a tool for controlling the profile of ion-cyclotron-resonant 3He ions. Direct evidence for the wave-induced pinch has been obtained from the measured gamma-ray emission profiles. Concurrent differences in the excitation of Alfvén eigenmodes (AEs), sawtooth stabilization, electron temperatures, and fast-ion stored energies are observed. The measured location of the AEs and gamma-ray emission profiles are consistent with the fast-ion radial gradient providing the drive for AEs.

Discharges in the JET tokamak where the safety factor profile is identified as the critical factor for triggering internal transport barriers.

Joint European Torus discharges which demonstrate the critical role the safety factor profile, q, can play in the formation of internal transport barriers (ITB) are examined. In these discharges, the target parameters, including the E x B flows, were kept virtually the same, except for the q profile. In a discharge with a nonmonotonic q, an ITB was triggered whereas a discharge with monotone q made no such transition. Thus, there is strong evidence that the q profile was the critical factor for the triggering of an ITB. Possible interpretations of this finding are discussed.

JET quasistationary internal-transport-barrier operation with active control of the pressure profile.

Quasistationary operation has been achieved on the Joint European Torus tokamak in internal-transport-barrier (ITB) scenarios, with the discharge time limited only by plant constraints. Full current drive was obtained over all the high performance phase by using lower hybrid current drive. For the first time feedback control on the total pressure and on the electron temperature profile was implemented by using, respectively, the neutral beams and the ion-cyclotron waves. Although impurity accumulation could be a problem in steady state ITBs, these experiments bring some elements to answer to it.

Alpha-tail production with ion-cyclotron-resonance heating of 4He-beam ions in JET plasmas.

Third-harmonic ion-cyclotron-resonance heating of 4He-beam ions has produced for the first time on the JET tokamak high-energy populations of 4He ions to simulate 3.5 MeV fusion-born alpha (alpha) particles. Acceleration of 4He ions to the MeV energy range is confirmed by gamma-ray emission from the nuclear reaction 9Be(alpha,ngamma) 12C and excitation of Alfvén eigenmodes. Concomitant electron heating and sawtooth stabilization are observed. The scheme could be used in next-step tokamaks to gain information on trapped alpha particles and to test alpha diagnostics in the early nonactivated phase of operation.

Determination of the relative glomerular filtration rate of each kidney in man. Comparison between iohexol CT and 99mTc-DTPA scintigraphy.

Iohexol and 99mTc-DTPA were used in 43 patients to determine the relative glomerular filtration rate (GFR), i.e., the GFR of each kidney in percent of total GFR. The amount of any GFR marker accumulating in Bowman's space, tubuli and renal pelvis within a few minutes after i.v. injection, before any marker had left the kidney via the ureter, was defined as proportional to the GFR of that kidney. The renal accumulation of iohexol was determined by CT using 10 slices of 8-mm thickness 1 to 4 minutes after injection. The renal accumulation of 99mTc-DTPA was determined with a gamma camera within 2 minutes after injection. The correlation coefficient between the two methods was 0.98. Due to the higher radiation dose from CT than from 99mTc-DTPA injection, relative GFR determination with CT should be performed when there is also a diagnostic need to reveal morphology.

Localization of quinolinic acid metabolizing enzymes in the rat brain. Immunohistochemical studies using antibodies to 3-hydroxyanthranilic acid oxygenase and quinolinic acid phosphoribosyltransferase.

Specific antibodies raised in rabbits against 3-hydroxyanthranilic acid oxygenase (EC 1.13.11.6) and quinolinic acid phosphoribosyltransferase (EC 1.13.11.6) and quinolinic acid phosphoribosyltransferase (EC 2.4.2.19) were used in immunohistochemical studies to map the cellular localization of the quinolinic acid metabolizing enzymes in the adult male rat brain. 3-Hydroxyanthranilic acid oxygenase immunoreactivity was found to be present in glial cells of presumed astroglial identity, as judged by co-localization with glial fibrillary acidic protein. 3-Hydroxyanthranilic acid oxygenase-immunoreactive glial cells were present in all brain regions and within major fiber tracts. The density of 3-hydroxyanthranilic acid oxygenase-immunoreactive glial cells as well as the intensity of staining of these cells differed among brain regions. In general, telencephalic acid diencephalic areas harbored a larger number of 3-hydroxyanthranilic acid oxygenase-positive cells than did mesencephalic regions. In the former regions the caudate nucleus, septum, nucleus accumbens, neocortex and hippocampus were particularly enriched in 3-hydroxyanthranilic acid oxygenase-immunoreactive cells. In the thalamus, regional differences were noted with regard to the intensity of staining among glial cells with high densities of 3-hydroxyanthranilic acid oxygenase cells in the anteroventral, reticular and ventromedial nuclei. In the inferior and superior colliculi, numerous 3-hydroxyanthranilic acid oxygenase-positive glial cells were found in all layers. In the hypothalamus, 3-hydroxyanthranilic acid oxygenase-immunoreactive glial cells were encountered in the zona incerta, the lateral hypothalamic area, the caudal preoptic region and in the dorsomedial nucleus. In the mesencephalon, the substantia nigra contained numerous, moderately stained cells. At caudal levels of the brain-stem, a relatively large number of cells was detected in the nucleus of the solitary tract, the pontine nucleus and in the fascial nerve nucleus, while other nuclei, such as the reticular formation and the area postrema were relatively poor in 3-hydroxyanthranilic acid oxygenase-immunoreactive cells. In addition to staining of glial cells, neuronal cell bodies containing 3-hydroxyanthranilic acid oxygenase immunoreactivity were detected in the main and in the accessory olfactory bulb, as well as in the ventromedial nucleus of the hypothalamus. Quinolinic acid phosphoribosyltransferase immunoreactivity was observed within glial cells and in association with neuronal cell bodies. Some, but not all, quinolinic acid phosphoribosyltransferase positive glial cells contained glial fibrillary acidic protein (Köhl