Perioperative Takotsubo Stress Cardiomyopathy During Endoscopic Spinal Surgery: A Case Report.

CASE: A 37-year-old man American Society of Anesthesiologists grade 1 patient with lumbar canal stenosis at the L4-L5 level underwent endoscopic decompression. Toward the end of the procedure, the patient developed sudden-onset bradycardia, followed by ventricular arrhythmia and acute pulmonary edema. The patient was successfully managed with resuscitation and supportive management and recovered uneventfully thereafter. A diagnosis of perioperative stress cardiomyopathy was subsequently made after evaluation of the patient. CONCLUSION: The possibility of takotsubo cardiomyopathy should be considered in cases of acute perioperative cardiac decompensation and pulmonary edema in patients undergoing spinal surgery.

Delayed presentation of Wilkie's syndrome after scoliotic curve correction surgery: a case report.

BACKGROUND: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare but serious complication following scoliosis correction surgery. It occurs as a result of mechanical compression of third part of duodenum between the SMA and aorta. This condition occurs most commonly in significantly underweight patients with deformities, and usually during the first week following spinal deformity corrective surgeries. The angle between the abdominal aorta and the SMA gets reduced following spinal lengthening during deformity correction surgery causing compression of third part of duodenum resulting in development of SMA syndrome. CASE PRESENTATION: We present a case of 17-year-old male with congenital scoliosis with a 70-degree scoliotic curve who underwent spinal deformity correction surgery with posterior instrumented fusion. Post-operative course was uneventful and the patient was discharged after suture removal on post-operative day 15. The patient presented after 21-days of symptom onset on post-operative-day 51, with a 3 week history of post-prandial vomiting, abdominal pain and distension which resulted in rapid weight loss of 11 kg. A CT-angiogram showed obstruction at third part of duodenum. After reviewing clinical and radiological profile of the patient, a diagnosis of SMA syndrome was made. Conservative management was tried, but due to rapid deterioration of patient condition and symptoms of complete intestinal obstruction, the patient was treated surgically by gastro-jejunostomy and side-to-side jejuno-jejunostomy, which improved his condition. CONCLUSION: SMA syndrome can occur much later than previously reported cases and with potentially life-threatening symptoms following scoliosis correction. Having a high index of suspicion, early recognition of condition and institution of appropriate treatment are essential to prevent occurrence of severe complications including risk of intestinal perforation and mortality. This case highlights management of delayed onset of SMA syndrome, with presentation further delayed after symptom onset, as is common in developing parts of the world, due to limited availability and accessibility of resources, and low socio-economic status of large segments of the population.

Subpicosecond pre-plasma dynamics of a high contrast, ultraintense laser-solid target interaction.

Using the spectral interferometry technique, we measured subpicosecond time-resolved pre-plasma scale lengths and early expansion (<12 ps) of the plasma produced by a high intensity (6 × 1018 W/cm2) pulse with high contrast (109). We measured pre-plasma scale lengths in the range of 3-20 nm, before the arrival of the peak of the femtosecond pulse. This measurement plays a crucial role in understanding the mechanism of laser coupling its energy to hot electrons and is hence important for laser-driven ion acceleration and the fast ignition approach to fusion.

Efficient second-harmonic generation of a high-energy, femtosecond laser pulse in a lithium triborate crystal.

We demonstrate the highest efficiency (∼80%) second harmonic generation of joule level, 27 fs, high-contrast pulses in a type-I lithium triborate (LBO) crystal. In comparison, potassium dihydrogen phosphate gives a maximum efficiency of 26%. LBO thus offers high-intensity (>1018-19W/cm2), ultra-high contrast femtosecond pulses, which have great potential for high energy density science and applications, particularly with nanostructured targets.

Towards Remote Lightning Manipulation by Meters-long Plasma Channels Generated by Ultra-Short-Pulse High-Intensity Lasers.

Remote manipulation (triggering and guiding) of lightning in atmospheric conditions of thunderstorms has been the subject of intense scientific research for decades. High power, ultrashort-pulse lasers are considered attractive in generating plasma channels in air that could serve as conductors/diverters for lightning. However, two fundamental obstacles, namely the limited length and lifetime of such plasma channels prevented their realization to this date. In this paper, we report decisive experimental results of our multi-element broken wire concept that extends the generated plasma channels to the required tens of meters range. We obtain 13-meter-long plasma wire, limited only by our current experimental setup, with plasma conditions that could be sufficient for the leader initiation. This advance, coupled with our demonstrated method of laser heating for long time sustenance of the plasma channel, is a major, significant step towards controlling lightning.

Recombination of Protons Accelerated by a High Intensity High Contrast Laser.

Short pulse, high contrast, intense laser pulses incident onto a solid target are not known to generate fast neutral atoms. Experiments carried out to study the recombination of accelerated protons show a 200 times higher neutralization than expected. Fast neutral atoms can contribute to 80% of the fast particles at 10 keV, falling rapidly for higher energy. Conventional charge transfer and electron-ion recombination in a high density plasma plume near the target is unable to explain the neutralization. We present a model based on the copropagation of electrons and ions wherein recombination far away from the target surface accounts for the experimental measurements. A novel experimental verification of the model is also presented. This study provides insights into the closely linked dynamics of ions and electrons by which neutral atom formation is enhanced.