Successful resection of lymphangioma of the neck and mediastinum presenting as stridor in a 12 year old child

Lymphangiomas are congenital malformations of lymphatic tissue. This benign condition is generally found in the neck region and is discovered by 2 years of age. Here we report the case of a 12 year old child who presented with a cervical and mediastinal cystic hygroma that had progressed to such a space occupying nature as to cause the shifting of the trachea. The entire mass was successfully resected with a lower neck incision. Our case suggests the necessity of considering cystic lymphangioma in the differential diagnosis of lateral neck masses and use of adequate imaging to substantiate the preoperative diagnosis

Successful management of a stab wound to the left ventricle

A 24 year old male presented to the emergency room with a 2 hour history of knife stab wound. He was haemodynamically stable with good bilateral air entry. However on X-ray an enlarged cardiac silhouette was seen. The patient suddenly became hypotensive and on suspicion of cardiac tamponade a catheter was introduced in pericardial space, but the measure was unsuccessful and he was rushed to the Operating Room. During the surgery a 2 cm long laceration was identified in the mid-left ventricular (LV) wall less than 1mm away from the Left Anterior Descending (LAD) Artery. The Left Anterior Descending Vein was damaged which was then repaired along with the ventricular wall by the interrupted pledgeted 3-0 prolene suture, whilst a cardiopulmonary bypass was kept on the stand by. The patient was checked for a ventricular septal defect via an intraoperative echocardiography. Subsequently, he had an uneventful recovery and was discharged

Detection of non-melanoma skin cancer by in vivo fluorescence imaging with fluorocoxib A.

Non-melanoma skin cancer (NMSC) is the most common form of cancer in the US and its incidence is increasing. The current standard of care is visual inspection by physicians and/or dermatologists, followed by skin biopsy and pathologic confirmation. We have investigated the use of in vivo fluorescence imaging using fluorocoxib A as a molecular probe for early detection and assessment of skin tumors in mouse models of NMSC. Fluorocoxib A targets the cyclooxygenase-2 (COX-2) enzyme that is preferentially expressed by inflamed and tumor tissue, and therefore has potential to be an effective broadly active molecular biomarker for cancer detection. We tested the sensitivity of fluorocoxib A in a BCC allograft SCID hairless mouse model using a wide-field fluorescence imaging system. Subcutaneous allografts comprised of 1000 BCC cells were detectable above background. These BCC allograft mice were imaged over time and a linear correlation (R(2) = 0.8) between tumor volume and fluorocoxib A signal levels was observed. We also tested fluorocoxib A in a genetically engineered spontaneous BCC mouse model (Ptch1(+/-) K14-Cre-ER2 p53(fl/fl)), where sequential imaging of the same animals over time demonstrated that early, microscopic lesions (100 μm size) developed into visible macroscopic tumor masses over 11 to 17 days. Overall, for macroscopic tumors, the sensitivity was 88% and the specificity was 100%. For microscopic tumors, the sensitivity was 85% and specificity was 56%. These results demonstrate the potential of fluorocoxib A as an in vivo imaging agent for early detection, margin delineation and guided biopsies of NMSCs

Retrograde bullet migration from inferior vena cava into right common iliac vein following gunshot: a case report

Abstract Bullet embolization cases are rare and even rarer are its retrograde migration in the veins. We report the case of a 14 year old male with a gunshot wound to the left side of his chest. CT scan revealed bilateral haemothorax and foreign body in the right common iliac vein. The patient was immediately taken to the operating theatre and median sternotomy performed. Bullet entry tear was found in the inferior vena cava however, the bullet was found lodged in the right common iliac vein and slipped down against the flow of blood. The bullet was left in situ and after the necessary repair the chest was closed and the patient shifted to the CICU and discharged after 4 days in stable condition. Patient was followed after 1 week and reassured and advised for one year follow-up

Regular Topologies for Gigabit Wide-Area Networks

In general terms, this project aimed at the analysis and design of techniques for very high-speed networking. The formal objectives of the project were to: (1) Identify switch and network technologies for wide-area networks that interconnect a large number of users and can provide individual data paths at gigabit/s rates; (2) Quantitatively evaluate and compare existing and proposed architectures and protocols, identify their strength and growth potentials, and ascertain the compatibility of competing technologies; and (3) Propose new approaches to existing architectures and protocols, and identify opportunities for research to overcome deficiencies and enhance performance. The project was organized into two parts: 1. The design, analysis, and specification of techniques and protocols for very-high-speed network environments. In this part, SRI has focused on several key high-speed networking areas, including Forward Error Control (FEC) for high-speed networks in which data distortion is the result of packet loss, and the distribution of broadband, real-time traffic in multiple user sessions. 2. Congestion Avoidance Testbed Experiment (CATE). This part of the project was done within the framework of the DARTnet experimental T1 national network. The aim of the work was to advance the state of the art in benchmarking DARTnet's performance and traffic control by developing support tools for network experimentation, by designing benchmarks that allow various algorithms to be meaningfully compared, and by investigating new queueing techniques that better satisfy the needs of best-effort and reserved-resource traffic. This document is the final technical report describing the results obtained by SRI under this project. The report consists of three volumes: Volume 1 contains a technical description of the network techniques developed by SRI in the areas of FEC and multicast of real-time traffic. Volume 2 describes the work performed under CATE. Volume 3 contains the source code of all software developed under CATE

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK

Background: People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. Methods: We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. Results: The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation. Conclusion: We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial

Institutions, macroeconomic policy and foreign direct investment: South Asian countries case

Recent economic literature suggests that institutional quality factors exerted positive effect on foreign direct investment (FDI) inflows. The main focus of this study is to examine the role of institutional factors and macro economic policy factors on FDI inflows in a panel data of seven South Asian countries over the period of 12 years since 1996-2007. This study implies that a good institutional quality plays a key role in attractiveness of FDI inflows. A poor macroeconomic policy situation produces negative impact on FDI. Good Institutional quality and macroeconomic policy generate negative in a combined form on FDI. This study further implies that poor economic policy deteriorates institutional quality and creates negative effect on FDI inflows. Incredibility in trade liberalization policy may be a part of poor macro economic policy

Improving the vibration suppression capabilities of a magneto-rheological damper using hybrid active and semi-active control

This paper presents a new hybrid active & semi-active control method for vibration suppression in flexible structures. The method uses a combination of a semi-active device and an active control actuator situated elsewhere in the structure to suppress vibrations. The key novelty is to use the hybrid controller to enable the magneto-rheological damper to achieve a performance as close to a fully active device as possible. This is achieved by ensuring that the active actuator can assist the magneto-rheological damper in the regions where energy is required. In addition, the hybrid active & semi-active controller is designed to minimize the switching of the semi-active controller. The control framework used is the immersion and invariance control technique in combination with sliding mode control. A two degree-of-freedom system with lightly damped resonances is used as an example system. Both numerical and experimental results are generated for this system, and then compared as part of a validation study. The experimental system uses hardware-in-the-loop to simulate the effect of both the degrees-of-freedom. The results show that the concept is viable both numerically and experimentally, and improved vibration suppression results can be obtained for the magneto-rheological damper that approach the performance of an active device