Bilateral obturator hernia with intestinal obstruction: repair with a cigar roll technique.

Obturator hernia is an exceedingly rare pelvic hernia that occurs primarily in multiparous, elderly thin (>70 years of age) females. Here, we report a case of bilateral obturator hernia in an elderly female with high-grade small bowel obstruction repaired with a novel "cigar roll" technique.

Age- and anatomy-related values of blood-brain barrier permeability measured by perfusion-CT in non-stroke patients.

BACKGROUND AND PURPOSE: The goal of this study was to determine blood-brain barrier permeability (BBBP) values extracted from perfusion-CT (PCT) using the Patlak model and possible variations related to age, gender, race, vascular risk factors and their treatment and anatomy in non-stroke patients. MATERIALS AND METHODS: We retrospectively identified 96 non-stroke patients who underwent a PCT study using a prolonged acquisition time up to 3 minutes. Patients' charts were reviewed for demographic data, vascular risk factors and their treatment. The Patlak model was applied to calculate BBBP values in regions of interest drawn within the basal ganglia and the gray and white matter of the different cerebral lobes. Differences in BBBP values were analyzed using a multivariate analysis considering clinical variables and anatomy. RESULTS: Mean absolute BBBP values were 1.2 ml 100 g(-1) min(-1) and relative BBBP/CBF values were 3.5%. Statistical differences between gray and white matter were not clinically relevant. BBBP values were influenced by age, history of diabetes and/or hypertension and aspirin intake. CONCLUSION: This study reports ranges of BBBP values in non-stroke patients calculated from delayed phase PCT data using the Patlak model. These ranges will be useful to detect abnormal BBBP values when assessing patients with cerebral infarction for the risk of hemorrhagic transformation.

Automatic polyp detection and measurement with computed tomographic colonography: A phantom study.

PURPOSE: The purpose of this study is to assess the performance of computer-aided detection (CAD) software in detecting and measuring polyps for CT Colonography, based on an in vitro phantom study. MATERIAL AND METHODS: A colon phantom was constructed with a PVC pipe of 3.8 cm diameter. Nine simulated polyps of various sizes (3.2mm-25.4mm) were affixed inside the phantom that was placed in a water bath. The phantom was scanned on a 64-slice CT scanner with tube voltage of 120 kV and current of 205 mAs. Two separate scans were performed, with different slice thickness and reconstruction interval. The first scan (thin) had a slice thickness of 1mm and reconstruction interval 0.5mm. The second scan (thick) had a slice thickness of 2mm and reconstruction interval of 1mm. Images from both scans were processed using CT Colonography software that automatically segments the colon phantom and applies CAD that automatically highlights and provides the size (maximum and minimum diameters, volume) of each polyp. Two readers independently measured each polyp (two orthogonal diameters) using both 2D and 3D views. Readers' manual measurements (diameters) and automatic measurements from CAD (diameters and volume) were compared to actual polyp sizes as measured by mechanical calipers. RESULTS: All polyps except the smallest (3.2mm) were detected by CAD. CAD achieved 100% sensitivity in detecting polyps ≥6mm. Mean errors in CAD automated volume measurements for thin and thick slice scans were 8.7% and 6.8%, respectively. Almost all CAD and manual readers' 3D measurements overestimated the size of polyps to variable extent. Both over- and underestimation of polyp sizes were observed in the readers' manual 2D measurements. Overall, Reader 1 (expert) had smaller mean error than Reader 2 (non-expert). CONCLUSION: CAD provided accurate size measurements for all polyps, and results were comparable to the two readers' manual measurements.

Dynamic perfusion CT assessment of the blood-brain barrier permeability: first pass versus delayed acquisition.

BACKGROUND AND PURPOSE: The Patlak model has been applied to first-pass perfusion CT (PCT) data to extract information on blood-brain barrier permeability (BBBP) to predict hemorrhagic transformation in patients with acute stroke. However, the Patlak model was originally described for the delayed steady-state phase of contrast circulation. The goal of this study was to assess whether the first pass or the delayed phase of a contrast bolus injection better respects the assumptions of the Patlak model for the assessment of BBBP in patients with acute stroke by using PCT. MATERIALS AND METHODS: We retrospectively identified 125 consecutive patients (29 with acute hemispheric stroke and 96 without) who underwent a PCT study by using a prolonged acquisition time up to 3 minutes. The Patlak model was applied to calculate BBBP in ischemic and nonischemic brain tissue. Linear regression of the Patlak plot was performed separately for the first pass and for the delayed phase of the contrast bolus injection. Patlak linear regression models for the first pass and the delayed phase were compared in terms of their respective square root mean squared errors (square root MSE) and correlation coefficients (R) by using generalized estimating equations with robust variance estimation. RESULTS: BBBP values calculated from the first pass were significantly higher than those from the delayed phase, both in nonischemic brain tissue (2.81 mL x 100 g(-1) x min(-1) for the first pass versus 1.05 mL x 100 g(-1) x min(-1) for the delayed phase, P < .001) and in ischemic tissue (7.63 mL x 100 g(-1) x min(-1) for the first pass versus 1.31 mL x 100 g(-1) x min(-1) for the delayed phase, P < .001). Compared with regression models from the first pass, Patlak regression models obtained from the delayed data were of better quality, showing significantly lower square root MSE and higher R. CONCLUSION: Only the delayed phase of PCT acquisition respects the assumptions of linearity of the Patlak model in patients with and without stroke.

Molecular weight of hydroxyethyl starch molecules influences coagulation profile measured by thrombelastography.

BACKGROUND: The consensus about the ideal intravenous fluid in trauma patients remains open. However, hypertonic saline and hydroxyethyl starch (HES) seems to have advantages in terms of immuno-modulatory and haemodynamic effects. Nevertheless clotting abnormalities are frequently reported in association with the use of HES. We investigated the influence of light, medium and heavy molecular weight (MW) hydroxyethyl starch (HES) on coagulation in 29 healthy subjects. METHODS: Ringer's lactate (RL) served as a control solution. Thrombelastography using Haemoscope's Thrombelastograph (TEG) hemostasis system was used to assess the effect of HES polymers and RL. TEG analysis was performed using recalcified native whole blood both with and without the addition of platelet activating factor IV (PAF IV) before and immediately after infusion of one of the solutions. RESULTS: Infusion of RL or one of the three HES solutions exerts an anticoagulant effect as demonstrated by a increase in clot formation time (R) and a decrease in maximum amplitude (MA), and the angle. The addition of PAF IV reversed these changes. CONCLUSIONS: This data indicate clear evidence of platelet activity per se or platelet interaction with the plasmatic coagulation system.

Spin chains and channels with memory.

In most studies of quantum channels, it is assumed that the errors in each use of the channel are independent. However, recent investigations of the effect of memory or correlations in error have led to speculation that nonanalytic behavior may occur in the capacity. Motivated by these observations, we connect the study of channels with correlated error to the study of many-body systems. This enables us to use many-body theory to solve some interesting models of correlated error. These models can display nonanalyticities analogous to quantum phase transitions.

Length of insertion for pulmonary artery catheters to locate different cardiac chambers in patients undergoing cardiac surgery.

BACKGROUND: Although, guidelines related to length of insertion of a pulmonary artery catheter to reach a particular cardiac chamber are available, these are not backed by clinical studies. We measured the length of insertion of pulmonary artery catheters to locate the right ventricle, pulmonary artery and pulmonary capillary wedge positions in 300 adult patients undergoing elective cardiac surgery. METHODS: The pulmonary artery catheters were inserted using a standard technique through the right internal jugular vein. The right ventricle, pulmonary artery and wedge position of the catheter were confirmed by the characteristic waveforms, and the length of insertion to these points was measured. RESULTS: The right ventricle was reached at 24.6 (3) cm (95% CI 24.2-24.9 cm), pulmonary artery at 36 (4) cm (95% CI 35.6-36.5 cm) and wedge position at 42.8 (5.7) cm (95% CI 42.2-43.5 cm). The length of catheter to reach the right ventricle, pulmonary artery and wedge position was significantly more in patients undergoing valve surgery as compared with those undergoing coronary artery bypass grafting [26 (3.8) and 24 (2.5) cm; 38.5 (4.6) and 35 (3.2) cm; and 47.8 (6.9) and 41.2 (4.1) cm, respectively, P<0.001]. The length of insertion to reach pulmonary artery and pulmonary capillary wedge position was directly related to height of the patient (Pearson's correlation 0.157 and 0.15, respectively). CONCLUSIONS: We have provided the norms related to length of insertion of pulmonary artery catheter, which should be useful in accurate placement of the catheter and minimize complications related to coiling of the catheter.

Bounds on multipartite entangled orthogonal state discrimination using local operations and classical communication.

We show that entanglement guarantees difficulty in the discrimination of orthogonal multipartite states locally. The number of pure states that can be discriminated by local operations and classical communication is bounded by the total dimension over the average entanglement. A similar, general condition is also shown for pure and mixed states. These results offer a rare operational interpretation for three abstractly defined distancelike measures of multipartite entanglement.

Molecular diversity and multilocus organization of the parental lines used in the International Rice Molecular Breeding Program.

One hundred and ninety three parental lines obtained from 26 countries for an international rice molecular breeding program were evaluated using 101 well-distributed simple sequence repeat (SSR) markers. An overall genetic diversity of 0.68 and an average of 6.3 alleles per locus were revealed, indicating a high level of genetic variation in these lines. Cluster analysis of the 193 accessions showed three major groups and nine subgroups. Group I corresponded to the classical indica subspecies, whereas groups II and III belong to the japonica subspecies. Indica and japonica differentiation accounted for only 6.5% of the total variation in the entire sample and 93.5% was due to within-subspecies diversity. Differentiation among eco-geographic regions accounted for 24% of the diversity within the subspecies. Larger amounts of the eco-geographical differentiation were resolved within japonica than within indica. The largest indica-japonica differentiation based on the single locus level was detected by markers on chromosomes 9 and 12, while the smallest differentiation was detected by markers on chromosomes 4 and 8. Furthermore, genetic differences at the single-locus and two-locus levels, as well as components due to allelic and gametic differentiation, were revealed between indica and japonica and among the main geographic regions. The multilocus analysis in genetic diversity showed a higher proportion of variation caused by predominant non-random associations of different loci within and among the classified subspecies and geographic subdivisions. The results suggest that selection for eco-geographical adaptation on multilocus associations was largely responsible for the maintenance of the extensive variation in the primary gene pool of rice.

Asymptotic relative entropy of entanglement.

We present an analytical formula for the asymptotic relative entropy of entanglement with respect to positive partial transpose states for Werner states of arbitrary dimension. We then demonstrate its validity using methods from convex optimization. This is the first case in which the asymptotic value of a subadditive entanglement measure has been calculated.

Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery.

OBJECTIVE: To compare 2 important techniques of blood conservation, use of a cell saver and low-dose aprotinin, in terms of blood loss and homologous blood usage in patients undergoing cardiac valve surgery. DESIGN: Prospective, randomized. SETTING: Tertiary care hospital. PARTICIPANTS: Sixty adult patients undergoing elective valve surgery. INTERVENTIONS: The patients were divided into 3 groups of 20 each. In group 1, aprotinin in the dose of 30,000 KIU/kg was added to the pump prime, with a further dose of 15,000 KIU/kg added at the end of each hour of cardiopulmonary bypass. In group 2, a cell-saver system was used to collect all blood at the operation site for processing in preparation for subsequent reinfusion. Group 3 patients acted as a control group and underwent routine management, which included collection of autologous blood during the pre-cardiopulmonary bypass period. A hemoglobin of <8 g/dL was considered as an indication for bank blood transfusion in the postoperative period. MEASUREMENTS AND MAIN RESULTS: The chest tube drainage was significantly less in group 1 compared with groups 2 and 3, with total drainage (median [interquartile range]) amounting to 250 mL [105 to 325 mL] vs. 700 mL [525 to 910 mL] in group 2 and 800 mL [650 to 880 mL] in group 3 (p < 0.001). The patients in groups 1 and 2 required significantly less bank blood (median [interquartile range]) as compared with group 3 (350 mL [0 to 525 mL], 350 mL [0 to 350 mL], and 1050 mL [875 to 1050 mL]; p < 0.001), respectively. Cell saver provided 410 +/- 130 mL of hemoconcentrated blood in group 2. The average preoperative hemoglobin concentration was 11.3 g/dL, and it was around 9 g/dL on the 7th postoperative day. The hemoglobin concentration at various stages during hospitalization in all 3 groups was similar. CONCLUSIONS: Low-dose aprotinin and a cell saver are effective and comparable methods of blood conservation. Aprotinin helps by decreasing the postoperative drainage, and a cell saver helps by making the patient's own blood available for transfusion.

Pharmacologic support of circulation in patients undergoing cardiac surgery.

Maintenance of adequate oxygen balance to all tissues is one of the primary objectives when dealing with patients undergoing cardiac surgery. Cardiac output is one of the major components of oxygen delivery so that its maintenance is an important consideration. Due to pre-operative cardiac lesion and myocardial dysfunction secondary to the events related to cardiac surgery and cardiopulmonary by-pass, circulatory support by pharmacological or mechanical means is frequently required after surgery. Therefore, inotropes and vasodilators are used to improve the myocardial performance after cardiac surgery. Epinephrine, dopamine and dobutamine are commonly used inotropes. Dopexamine and phosphodiesterase inhibitors such as amrinone, milrinone and enoximone are some of the newer agents that have been introduced in clinical practice. Amongst the vasodilators, sodium nitroprusside and nitroglycerin are commonly used. Alpha adrenergic blockers such as phentolamine and phenoxybenzamine and calcium channel blockers such as diltiazem are some other vasodilators that can be used. Many units still regard epinephrine as an inotrope of choice and use its predominant beta agonist effect in the dose range of 0.02 to 0.04 mg/kg/minute. Some prefer dobutamine and others a combination of inotrope and vasodilator or an inodilator. Phosphodiesterase inhibitors can be useful in certain situations such as pre-existing ventricular dysfunction or when stunning of the myocardium is suspected with down regulation of beta receptors. Dopamine is useful in the renal vasodilating dose to improve renal perfusion and improve output. There is no ideal inotrope at present and each one has its own drawbacks. The clinician must learn to use the inotropes (especially the newer ones) based on his own clinical experience.

Development of PCR-based markers for thermosensitive genetic male sterility gene tms3(t) in rice (Oryza sativa L.).

Development of simple and reliable PCR-based markers is an important component of marker-aided selection (MAS) activities for agronomically important genes in rice breeding. In order to develop PCR-based markers for a rice thermosensitive genetic male sterility gene tms3(t), located on chromosome 6, the nucleotide sequences of four linked RAPD markers OPF18(2600), OPAC3(640), OPB19(750) and OPM7(550) were used to design and synthesize several pairs of specific primers for PCR amplification of the genomic DNA of both the parents IR32364TGMS (sterile) and IR68 (fertile), involved in mapping this gene. For the RAPD marker OPF 18(2600), two pairs of specific primer pair combination from different positions of the sequence resulted in generation of two codominant STS (Sequence Tagged Sites) markers. In case of markers OPAC3(640), OPB19(750) and OPAA7(550) the first two could generate dominant polymorphism, while the last one could not be successful in PCR amplification. Both the codominant STSs with primer combinations F18F/F18RM and F18FM/F18RM were found to be tightly linked to the tms3(t) gene with a genetic distance of 2.7 cM. The sizes of the different alleles in case of F18F/F18RM, F18FM/F18RM combinations were 2300 bp, 1050 bp, and 1900 bp, 1000 bp respectively. The efficiency of marker-assisted selection for this trait was estimated as 84.6%. Polymorphism survey of 12 elite rice lines, indicated that these PCR-based markers for tms3(t) can now be used in selecting TGMS plants at seeding stage in the segregating populations in environment independent of controlled temperature regime.

Molecular mapping of a thermosensitive genetic male sterility gene in rice using bulked segregant analysis.

The thermosensitive genetic male sterility (TGMS) system is considered to be a more efficient alternative to the cytoplasmic male sterility (CMS) system for hybrid rice. An F2 population from a cross between a TGMS mutant line (IR32364TGMS) and IR68 was used to map the TGMS gene tms3(t). Fertile and sterile bulks were constructed following the classification of F2 plants into true breeding sterile, fertile, and segregating fertile plants based on F3 family studies. From the survey of 389 arbitrary primers in bulked segregant analysis, four RAPD markers were identified in which three, OPF182600, OPB19750, and OPAA7550, were linked to tms3(t) in repulsion phase and one, OPAC3640, was linked to tms3(t) in coupling phase. The tms3(t) gene was flanked by OPF182600 and OPAC3640 on one side and by OPAA7550 and OPB19750 on the other side. All four markers were low-copy sequences and two of them (OPF182600 and OPAC3640) detected polymorphism when the markers were used to probe the genomic blots. Subsequently, OPAC3640 was mapped to the short arm of chromosome 6 using a mapping population available at IRRI. However, no RFLP markers from this region showed linkage to tms3(t) owing to the lack of polymorphism between the parents. All RAPD fragments were cloned and partially sequenced from both ends. Thus, PCR primers can be designed to develop PCR markers for marker-assisted breeding to facilitate the transfer of tms3(t) from one genetic background to another.

Cuspal fracture resistance and microleakage of glass ionomer cements in primary molars.

The purpose of this study was to comparatively evaluate the fracture strength and microleakage among two new glass ionomer cements. One hundred and ten primary first and second molars were divided into two main groups, one group comprising of fifty teeth for microleakage evaluation and second group of sixty for fracture strength. Both the groups were subdivided equally into four based on the materials used, consisting of the same number of teeth respectively, in each. Two controls were used for cuspal fracture strength and an additional trial group was added for microleakage evaluation. Ideal, non retentive class II were prepared and restored with amalgam, Fuji IX, Fuji II LC and Vitremer. The statistical analysis revealed highly significant differences among all the subgroups except between subgroup 3 vs. 4 and 1 for cuspal fracture strength. Similarly microleakage values were significantly different statistically among sub groups 4 and 5 vs 1 and 2. The present study revealed that Fuji IX was the best in terms of cuspal fracture strength and Fuji IX with an additional application of light cure resin sealant gave the lowest degree of microleakage.

HIGH ALTITUDE PULMONARY OEDEMA - AN EXPERIENCE IN EASTERN HIMALAYA.

Three hundred and five cases of high altitude pulmonary oedema (HAPO) hospitalised in eastern Himalayan region have been analyzed. Incidence of HAPO was 5.5 per cent. Eighty per cent cases occurred during latter half of the year. Fifty six per cent of cases belonged to the third decade of life. HAPO cases occurred most commonly between the height of 2740 m to 5960 m. Eighty three per cent cases developed symptoms within 72 hours of induction to high altitude and 65.9 per cent suffered from the illness despite complete acclimatization. Breathlessness, headache and cough were the commonest symptoms. Tachycardia and tachypnoea was present in all cases. Twenty five per cent cases showed various ECG abnormalities. Mortality rate was 0.98 per cent.

Mapping of the Rf-3 nuclear fertility-restoring gene for WA cytoplasmic male sterility in rice using RAPD and RFLP markers.

The cytoplasmic male sterility (CMS) of wild-abortive (WA) cytoplasm has been widely used for breeding hybrid rice. Two restorer genes for the CMS have been found by traditional genetic analysis. To tag the restorer genes we used a set of near-isogenic lines (NILs) of Zhenshan 97 carrying different genotypes for fertility restoration from IR24, to perform RAPD analysis. From the survey of 720 random primers, six RAPD markers were identified to be associated with Rf-3. Three of these OPK05-800, OPU10-1100 and OPW01-350, were mapped on chromosome 1. Two F(2) populations from the crosses between Zhenshan 97 A and a near-isogenic restorer line ZSR21 and between Zhenshan 97 A and IR24 were used for mapping Rf-3. The three RAPD markers and three RFLP markers, RG532, RG140 and RG458, were found to be closely linked to Rf-3 in the two F(2) populations. The same location of Rf-3 was also found in a BC(1) population from the cross of IR58025 A//IR36/IR58025 B. At the RG532 locus, different alleles were found between two CMS lines, Zhenshan 97 A and IR58025 A, and between two restorer lines, IR24 and IR36. The use of these molecular markers closely linked to Rf-3 in facilitating the development of hybrid rice is discussed.

ELECTROCARDIOGRAPHIC CHANGES IN VIRAL HEPATITIS.

Electrocardiograms of 322 patients with viral hepatitis were examined. Abnormal electrocardiograms were found in 229 patients (71.1%). The commonest abnormalities were T wave changes in 27 per cent. Other significant abnormalities were sinus bradycardia (13.7%), ST segment changes (5.7%), ventricular premature beats (2.5%) and U waves (6.5%). All the electrocardiographic abnormalities were transient and had no correlation with the severity or duration of illness.