Additional femoral catheter in combination with popliteal catheter for analgesia after major ankle surgery

Background The contribution of the saphenous nerve in pain after major ankle surgery is unknown. The aim of this study was to evaluate its contribution in this context. Methods Fifty patients were included in this prospective, randomized, controlled study. In all patients [Group P (popliteal) and Group F (popliteal+femoral)], a popliteal catheter was placed before operation and ropivacaine 0.5% (30 ml) administered via this catheter; major ankle surgery was then performed under spinal anaesthesia. In Group PF patients, an additional femoral catheter was sited before operation and ropivacaine 0.5% (10 ml) administered. Six hours after spinal anaesthesia (defined as T0), a continuous infusion of ropivacaine 0.3% (14 ml h−1) was started through the popliteal catheter until T24. Then, the concentration was reduced to 0.2% until T48. Patients in Group PF received continuous ropivacaine 0.2% (5 ml h−1) through the femoral catheter from T0 to T48. I.V. morphine patient-controlled analgesia was used as a rescue analgesia. Pain at rest, pain with movement, adverse effects, and i.v. morphine consumption were assessed. Pain at rest and on movement was evaluated 6 months after operation. Results Pain at rest was comparable in the two groups. In Group PF, patients had significantly reduced pain during movement in the postoperative period (P=0.01) and 6 months after operation (P=0.03). Morphine consumption was significantly reduced in Group PF at T0-T24 and T24-T48 (P=0.01). Adverse effects were comparable in both groups. Conclusions The addition of continuous femoral catheter infusion of ropivacaine to a continuous popliteal catheter infusion improved postoperative analgesia during movement after major ankle surgery. This effect was still present 6 months after surger

The Role of a Hot Gas Environment on the Evolution of Galaxies

Most spiral galaxies are found in galaxy groups with low velocity dispersions; most E/S0 galaxies are found in galaxy groups with relatively high velocity dispersions. The mass of the hot gas we can observe in the E/S0 groups via their thermal X-ray emission is, on average, as much as the baryonic mass of the galaxies in these groups. By comparison, galaxy clusters have as much or more hot gas than stellar mass. Hot gas in S-rich groups, however, is of low enough temperature for its X-ray emission to suffer heavy absorption due to Galactic HI and related observational effects, and hence is hard to detect. We postulate that such lower temperature hot gas does exist in low velocity dispersion, S-rich groups, and explore the consequences of this assumption. For a wide range of metallicity and density, hot gas in S-rich groups can cool in far less than a Hubble time. If such gas exists and can cool, especially when interacting with HI in existing galaxies, then it can help link together a number of disparate observations, both Galactic and extragalactic, that are otherwise difficult to understand.Comment: 16 pages with one figure. ApJ Letters, in pres

Self-consistent computation of gamma-ray spectra due to proton-proton interactions in black hole systems

In the inner regions of an accretion disk around a black hole, relativistic protons can interact with ambient matter to produce electrons, positrons and $\gamma$-rays. The resultant steady state electron and positron particle distributions are self-consistently computed taking into account Coulomb and Compton cooling, $e^-e^+$ pair production (due to $\gamma-\gamma$ annihilation) and pair annihilation. While earlier works used the diffusion approximation to obtain the particle distributions, here we solve a more general integro-differential equation that correctly takes into account the large change in particle energy that occur when the leptons Compton scatter off hard X-rays. Thus this formalism can also be applied to the hard state of black hole systems, where the dominant ambient photons are hard X-rays. The corresponding photon energy spectrum is calculated and compared with broadband data of black hole binaries in different spectral states. The results indicate that the $\gamma$-ray spectra ($E > 0.8$ MeV) of both the soft and hard spectral states and the entire hard X-ray/$\gamma$-ray spectrum of the ultra-soft state, could be due to $p-p$ interactions. These results are consistent with the hypothesis that there always exists in these systems a $\gamma$-ray spectral component due to $p-p$ interactions which can contribute between 0.5 to 10% of the total bolometric luminosty. The model predicts that {\it GLAST} would be able to detect black hole binaries and provide evidence for the presence of non-thermal protons which in turn would give insight into the energy dissipation process and jet formation in these systems.Comment: Accepted for publication in MNRA

Topologically massive magnetic monopoles

We show that in the Maxwell-Chern-Simons theory of topologically massive electrodynamics the Dirac string of a monopole becomes a cone in anti-de Sitter space with the opening angle of the cone determined by the topological mass which in turn is related to the square root of the cosmological constant. This proves to be an example of a physical system, {\it a priory} completely unrelated to gravity, which nevertheless requires curved spacetime for its very existence. We extend this result to topologically massive gravity coupled to topologically massive electrodynamics in the framework of the theory of Deser, Jackiw and Templeton. These are homogeneous spaces with conical deficit. Pure Einstein gravity coupled to Maxwell-Chern-Simons field does not admit such a monopole solution

Algebras generated by two bounded holomorphic functions

We study the closure in the Hardy space or the disk algebra of algebras generated by two bounded functions, of which one is a finite Blaschke product. We give necessary and sufficient conditions for density or finite codimension of such algebras. The conditions are expressed in terms of the inner part of a function which is explicitly derived from each pair of generators. Our results are based on identifying z-invariant subspaces included in the closure of the algebra. Versions of these results for the case of the disk algebra are given.Comment: 22 pages ; a number of minor mistakes have been corrected, and some points clarified. Conditionally accepted by Journal d'Analyse Mathematiqu

A lower lipschitz condition for the stable subordinator

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47646/1/440_2004_Article_BF00538471.pd

Cosmic Voids: structure, dynamics and galaxies

In this review we discuss several aspects of Cosmic Voids. Voids are a major component of the large scale distribution of matter and galaxies in the Universe. They are of instrumental importance for understanding the emergence of the Cosmic Web. Their relatively simple shape and structure makes them into useful tools for extracting the value of a variety cosmic parameters, possibly including even that of the influence of dark energy. Perhaps most promising and challenging is the issue of the galaxies found within their realm. Not only does the pristine environment of voids provide a promising testing ground for assessing the role of environment on the formation and evolution of galaxies, the dearth of dwarf galaxies may even represent a serious challenge to the standard view of cosmic structure formation.Comment: 29 pages, 12 figures, invited review COSPA2008, Pohang, Korea. Modern Physics Letters A, accepted. For high-res version see http://www.astro.rug.nl/~weygaert/voids.cospa2008.weygaert.pd

Spectroscopy of 194^{194}Po

Prompt, in-beam $\gamma$ rays following the reaction $^{170}$Yb + 142 MeV $^{28}$Si were measured at the ATLAS facility using 10 Compton-suppressed Ge detectors and the Fragment Mass Analyzer. Transitions in $^{194}$Po were identified and placed using $\gamma$-ray singles and coincidence data gated on the mass of the evaporation residues. A level spectrum up to J$\approx$10$\hbar$ was established. The structure of $^{194}$Po is more collective than that observed in the heavier polonium isotopes and indicates that the structure has started to evolve towards the more collective nature expected for deformed nuclei.Comment: 8 pages, revtex 3.0, 4 figs. available upon reques

Evaluating the utility of inflammatory markers in the diagnosis of soft tissue abscesses of the forearm and hand

Upper extremity abscesses frequently present to the acute care setting with inconclusive physical examination and imaging findings. We sought to investigate the diagnostic accuracy of inflammatory markers including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). A retrospective cohort study was performed to identify subjects ≥18 years treated with surgical debridement of upper extremity abscesses at our institution between January 2012 and December 2015. In this study, 188 patients were screened, and 72 met the inclusion criteria. A confirmed abscess as defined by culture positivity was present in 67 (93.1 %) cases. The sensitivity of WBC, ESR, or CRP individually was 0.45, 0.71, and 0.81. The specificity of WBC, ESR, or CRP individually was 0.80, 0.80, and 0.40. In combination all three markers when positive had a sensitivity of 0.26 and specificity of 1.0. These values were similar among patients with diabetes and those with obesity. With the highest sensitivity and lowest specificity, CRP exhibited the most utility as a screening test (level IV).</p