Progressive Wound Necrosis Associated With Postoperative Thrombocytosis in Mastectomy and Immediate Breast Reconstruction Surgery: Report of a Case

A 37-year-old who underwent splenectomy for motor vehicle accident-related injuries was diagnosed with stage IIA carcinoma of left breast 12 years later. She underwent bilateral mastectomy and bilateral immediate unipedicle TRAM flap reconstruction. Her preoperative platelet counts ranged from 332 to 424 K/cmm. Intraoperative fluorescein confirmed mastectomy flap viability. On postoperative day 1, platelet count was 374 K/cmm and all suture lines appeared benign. The patient was discharged 3 days later with healthy appearing tram flaps and slight epidermolysis in the abdominal region. Over the next 2 weeks, both the mastectomy flaps and the abdominal region underwent progressive necrosis as the platelet count increased to 1390 K/cmm. Aspirin therapy was instituted at this time. The TRAM flaps remained completely viable. Eighteen days later, the patient required wound debridement with secondary closure of the breast wounds. Platelet count peaked at 1689 K/cmm 2 days later (postoperative day 38). The wounds deteriorated again and were managed conservatively. Two months after mastectomy, the first area of spontaneous healing was documented (platelet count 758 K/cmm). Ultimately, wounds healed as platelet count reached its preoperative baseline. We hypothesize that an abnormal secondary thrombocytosis at subdermal plexus level caused problematic healing in this patient's mastectomy and abdominal flaps

Spatial variation in the fine-structure constant -- new results from VLT/UVES

(abridged) We present a new analysis of a large sample of quasar absorption-line spectra obtained using UVES (the Ultraviolet and Visual Echelle Spectrograph) on the VLT (Very Large Telescope) in Chile. In the VLT sample (154 absorbers), we find evidence that alpha increases with increasing cosmological distance from Earth. However, as previously shown, the Keck sample (141 absorbers) provided evidence for a smaller alpha in the distant absorption clouds. Upon combining the samples an apparent variation of alpha across the sky emerges which is well represented by an angular dipole model pointing in the direction RA=(17.3 +/- 1.0) hr, dec. = (-61 +/- 10) deg, with amplitude (0.97 +0.22/-0.20) x 10^(-5). The dipole model is required at the 4.1 sigma statistical significance level over a simple monopole model where alpha is the same across the sky (but possibly different to the current laboratory value). The data sets reveal a number of remarkable consistencies: various data cuts are consistent and there is consistency in the overlap region of the Keck and VLT samples. Assuming a dipole-only (i.e. no-monopole) model whose amplitude grows proportionally with `lookback-time distance' (r=ct, where t is the lookback time), the amplitude is (1.1 +/- 0.2) x 10^(-6) GLyr^(-1) and the model is significant at the 4.2 sigma confidence level over the null model [Delta alpha]/alpha = 0). We apply robustness checks and demonstrate that the dipole effect does not originate from a small subset of the absorbers or spectra. We present an analysis of systematic effects, and are unable to identify any single systematic effect which can emulate the observed variation in alpha.Comment: 47 pages, 35 figures. Accepted for publication by Monthly Notices of the Royal Astronomical Society. Please see http://astronomy.swin.edu.au/~mmurphy/pub.html for an ASCII version of table A1 and the full set of Voigt profile fits for appendix

Progressive wound necrosis associated with postoperative thrombocytosis in mastectomy and immediate breast reconstruction surgery: report of a case.

A 37-year-old who underwent splenectomy for motor vehicle accident-related injuries was diagnosed with stage IIA carcinoma of left breast 12 years later. She underwent bilateral mastectomy and bilateral immediate unipedicle TRAM flap reconstruction. Her preoperative platelet counts ranged from 332 to 424 K/cmm. Intraoperative fluorescein confirmed mastectomy flap viability. On postoperative day 1, platelet count was 374 K/cmm and all suture lines appeared benign. The patient was discharged 3 days later with healthy appearing tram flaps and slight epidermolysis in the abdominal region. Over the next 2 weeks, both the mastectomy flaps and the abdominal region underwent progressive necrosis as the platelet count increased to 1390 K/cmm. Aspirin therapy was instituted at this time. The TRAM flaps remained completely viable. Eighteen days later, the patient required wound debridement with secondary closure of the breast wounds. Platelet count peaked at 1689 K/cmm 2 days later (postoperative day 38). The wounds deteriorated again and were managed conservatively. Two months after mastectomy, the first area of spontaneous healing was documented (platelet count 758 K/cmm). Ultimately, wounds healed as platelet count reached its preoperative baseline. We hypothesize that an abnormal secondary thrombocytosis at subdermal plexus level caused problematic healing in this patient\u27s mastectomy and abdominal flaps

Stringent bounds to spatial variations of the electron-to-proton mass ratio in the Milky Way

The ammonia method to probe variations of the electron-to-proton mass ratio, Delta_mu/mu, is applied for the first time to dense prestellar molecular clouds in the Milky Way. Carefully selected sample of 21 NH_3/CCS pairs observed in the Perseus molecular cloud provide the offset Delta V (CCS-NH_3)= 36+/-7_{stat}+/-13.5_{sys} m/s . A similar offset of Delta V = 40.8 +/- 12.9_{stat} m/s between NH_3 (J,K) = (1,1) and N_2H+ J = 1-0 has been found in an isolated dense core L183 by Pagani et al. (2009). Overall these observations provide a safe bound of a maximum offset between ammonia and the other molecules at the level of Delta V < 100 m/s. This bound corresponds to Delta_mu/mu < 1E-7, which is an order of magnitude more sensitive than available extragalactic constraints. Taken at face value the measured Delta V shows positive shifts between the line centers of NH_3 and these two other molecules and suggest a real offset, which would imply a Delta_mu/mu about 4E-8. If Delta_mu/mu follows the gradient of the local gravitational potential, then the obtained results are in conflict with laboratory atomic clock experiments in the solar system by 5 orders of magnitude, thus requiring a chameleon-type scalar field model. New measurements involving other molecules and a wider range of objects along with verification of molecular rest frequencies are currently planned to confirm these first indications.Comment: 7 pages +2 figures. Galileo Galilei Institute Conferences on Dark Matter and Dark Energ

Searching for spatial variations of alpha^2/mu in the Milky Way

(Abridged) A procedure is suggested to explore the value of F = alpha^2/mu, where mu = m_e/m_p is the electron-to-proton mass ratio, and alpha is the fine-structure constant. The fundamental physical constants, which are measured in different physical environments of high (terrestrial) and low (interstellar) densities of baryonic matter are supposed to vary in chameleon-like scalar field models, which predict that both masses and coupling constant may depend on the local matter density. The parameter Delta F/F = (F_obs - F_lab)/F_lab can be estimated from the radial velocity offset, Delta V = V_rot-V_fs, between the low-laying rotational transitions in carbon monoxide 13CO and the fine-structure transitions in atomic carbon [CI]. A model-dependent constraint on Delta alpha/alpha can be obtained from Delta F/F using Delta mu/mu independently measured from the ammonia method. Currently available radio astronomical datasets provide an upper limit on |Delta V| < 110 m/s (1sigma). When interpreted in terms of the spatial variation of F, this gives |Delta F/F| < 3.7*10^-{7}. An order of magnitude improvement of this limit will allow us to test independently a non-zero value of Delta mu/mu = (2.2 +/- 0.4_stat +/- 0.3_sys)*10^{-8} recently found with the ammonia method. Taking into account that the ammonia method restricts the spatial variation of mu at the level of |Delta mu/mu| <= 3*10^{-8} and assuming that Delta F/F is the same in the entire interstellar medium, one obtains that the spatial variation of alpha does not exceed the value |Delta alpha/alpha| < 2*10^{-7}. Since extragalactic gas clouds have densities similar to those in the interstellar medium, the bound on Delta alpha/alpha is also expected to be less than 2*10^{-7} at high redshift if no significant temporal dependence of alpha is present.Comment: 7 pages, 1 table. Accepted for publication in Astronomy and Astrophysic

Parametric amplification of metric fluctuations through a bouncing phase

We clarify the properties of the behavior of classical cosmological perturbations when the Universe experiences a bounce. This is done in the simplest possible case for which gravity is described by general relativity and the matter content has a single component, namely a scalar field in a closed geometry. We show in particular that the spectrum of scalar perturbations can be affected by the bounce in a way that may depend on the wave number, even in the large scale limit. This may have important implications for string motivated models of the early Universe.Comment: 17 pages, 12 figures, LaTeX-ReVTeX format, version to match Phys. Rev.

Searching for chameleon-like scalar fields with the ammonia method

(Abridged) The ammonia method, which has been proposed to explore the electron-to-proton mass ratio, mu = m_e/m_p, is applied to nearby dark clouds in the Milky Way. This ratio, which is measured in different physical environments of high (terrestrial) and low (interstellar) densities of baryonic matter is supposed to vary in chameleon-like scalar field models, which predict strong dependence of both masses and coupling constant on the local matter density. High resolution spectral observations of molecular cores in lines of NH3 (J,K) = (1,1), HC3N J = 2-1, and N2H+ J = 1-0 were performed at three radio telescopes to measure the radial velocity offsets, DeltaV = V_rot - V_inv, between the inversion transition of NH3 (1,1) and the rotational transitions of other molecules with different sensitivities to the parameter dmm = (mu_obs - mu_lab)/mu_lab. The measured values of DeltaV exhibit a statistically significant velocity offset of 23 +/- 4_stat +/- 3_sys m/s. When interpreted in terms of the electron-to-proton mass ratio variation, this infers that dmm = (2.2 +/- 0.4_stat +/- 0.3_sys)x10^{-8}. If only a conservative upper bound is considered, then the maximum offset between ammonia and the other molecules is |DeltaV| <= 30 m/s. This gives the most accurate reference point at z = 0 for dmm: |dmm| <= 3x10^{-8}.Comment: 23 pages, 11 figures, 6 tables. Accepted for publication in A&A. Title and text corrected, references update

Adiabatic and entropy perturbations propagation in a bouncing Universe

By studying some bouncing universe models dominated by a specific class of hydrodynamical fluids, we show that the primordial cosmological perturbations may propagate smoothly through a general relativistic bounce. We also find that the purely adiabatic modes, although almost always fruitfully investigated in all other contexts in cosmology, are meaningless in the bounce or null energy condition (NEC) violation cases since the entropy modes can never be neglected in these situations: the adiabatic modes exhibit a fake divergence that is compensated in the total Bardeen gravitational potential by inclusion of the entropy perturbations.Comment: 25 pages, no figure, LaTe

Space-time variation of the electron-to-proton mass ratio in a Weyl model

Seeking a possible explanation for recent data indicating a space-time variation of the electron-to-proton mass ratio within the Milky Way, we consider a phenomenological model where the effective fermion masses depend on the local value of the Weyl tensor. We contrast the required values of the model's free parameters with bounds obtained from modern tests on the violation of the Weak Equivalence Principle and we find that these quantities are incompatible. This result indicates that the variation of nucleon and electron masses through a coupling with the Weyl tensor is not a viable model.Comment: 24 page

Observable Effects of Scalar Fields and Varying Constants

We show by using the method of matched asymptotic expansions that a sufficient condition can be derived which determines when a local experiment will detect the cosmological variation of a scalar field which is driving the spacetime variation of a supposed constant of Nature. We extend our earlier analyses of this problem by including the possibility that the local region is undergoing collapse inside a virialised structure, like a galaxy or galaxy cluster. We show by direct calculation that the sufficient condition is met to high precision in our own local region and we can therefore legitimately use local observations to place constraints upon the variation of "constants" of Nature on cosmological scales.Comment: Invited Festscrift Articl