The utility of CT angiography in planning perineal flap reconstruction following radical pelvic surgery

AbstractIntroductionClosure of the perineum following radical excision of pelvic tumours can prove to be a complex surgical problem. A number of pedicled flaps have been used for perineal reconstruction in order to reduce post-operative complications such as infection and abscess formation. The aim of this case series was to analyse the use of pre-operative computer tomography (CT) angiography to guide flap selection for perineal reconstruction following radical excision of pelvic tumours.MethodsWe conducted a retrospective review to identify all patients who underwent CT angiography prior to radical excision of pelvic tumours and planned flap reconstruction over an 18 month period. Six patients were identified and are presented in this case series. Patients' medical records, histology reports, pre-operative investigations and CT angiograms, complications and follow-up were reviewed.ResultsThe mean patient age was 58.3 years, with a male to female ratio of 1:2. Four out of six patients (66.6%) underwent pre-operative radiotherapy. The deep inferior epigastric arteries (DIEA) were visualised in all six cases (100%) and the pre-operative CT angiography helped guide flap choice in all cases (100%). In one case, narrowing of the DIEA vessels was noted precluding the use of a DIEA-based flap. One patient had a minor superficial wound dehiscence.ConclusionPre-operative CT angiography allows accurate visualisation of the DIEA system including perforator vessels. CT angiography is a useful tool, providing the surgical team with significant additional information to aid pre-operative planning and optimise reconstructive choice and outcome

The Journal of the Friends' Historical Society vol. 4 No. 1

1. Notes and Queries. 2. Our Bibliographers. 3. A New Book on George Fox. 4. American Letters of Edmund Peckover. 5. Meeting Records. 6. Friends at Newbury, Berkshire. 7. Presentations of Quakers in Episcopal Visitations, 1662-1679. 8. Friends on the Atlantic. 9. The Collection of Friends' Books in the Library of Haverford College, Pa. 10. The late Duke of Argyle's Estimate of Elizabeth Fry. 11. A so-called "Quaker Highwayman". 12. Matthew Raven, Stainesgate, Essex. 13. Brewers Yard Burial Ground. 14. Marriage Certificate - Hough-Barnes, 1676. 15. Paul Bevan's "One Little Book". 16. Land in New Jersey, 1685. 17. Minister and Merchant. 18. Friends in Current Literature. 19. Friends' Reference Library

Reflection and Ducting of Gravity Waves Inside the Sun

Internal gravity waves excited by overshoot at the bottom of the convection zone can be influenced by rotation and by the strong toroidal magnetic field that is likely to be present in the solar tachocline. Using a simple Cartesian model, we show how waves with a vertical component of propagation can be reflected when traveling through a layer containing a horizontal magnetic field with a strength that varies with depth. This interaction can prevent a portion of the downward-traveling wave energy flux from reaching the deep solar interior. If a highly reflecting magnetized layer is located some distance below the convection zone base, a duct or wave guide can be set up, wherein vertical propagation is restricted by successive reflections at the upper and lower boundaries. The presence of both upward- and downward-traveling disturbances inside the duct leads to the existence of a set of horizontally propagating modes that have significantly enhanced amplitudes. We point out that the helical structure of these waves makes them capable of generating an alpha-effect, and briefly consider the possibility that propagation in a shear of sufficient strength could lead to instability, the result of wave growth due to over-reflection.Comment: 23 pages, 5 figures. Accepted for publication in Solar Physic

MeV-mass dark matter and primordial nucleosynthesis

The annihilation of new dark matter candidates with masses $m_X$ in the MeV range may account for the galactic positrons that are required to explain the 511 keV $\gamma$-ray flux from the galactic bulge. We study the impact of MeV-mass thermal relic particles on the primordial synthesis of $^2$H, $^4$He, and $^7$Li. If the new particles are in thermal equilibrium with neutrinos during the nucleosynthesis epoch they increase the helium mass fraction for m_X\alt 10 MeV and are thus disfavored. If they couple primarily to the electromagnetic plasma they can have the opposite effect of lowering both helium and deuterium. For $m_X=4$--10 MeV they can even improve the overall agreement between the predicted and observed $^2$H and $^4$He abundances.Comment: 11 pages, 10 figures, references and two appendices added, conclusions unchanged; accepted for publication in Phys.Rev.

Dose-linearity of the pharmacokinetics of an intravenous [C-14]midazolam microdose in children

Aims Drug disposition in children may vary from adults due to age-related variation in drug metabolism. Microdose studies present an innovation to study pharmacokinetics (PK) in paediatrics; however, they should be used only when the PK is dose linear. We aimed to assess dose linearity of a [C-14]midazolam microdose, by comparing the PK of an intravenous (IV) microtracer (a microdose given simultaneously with a therapeutic midazolam dose), with the PK of a single isolated microdose. Methods Preterm to 2-year-old infants admitted to the intensive care unit received [C-14]midazolam IV as a microtracer or microdose, followed by dense blood sampling up to 36 hours. Plasma concentrations of [C-14]midazolam and [C-14]1-hydroxy-midazolam were determined by accelerator mass spectrometry. Noncompartmental PK analysis was performed and a population PK model was developed. Results Of 15 infants (median gestational age 39.4 [range 23.9-41.4] weeks, postnatal age 11.4 [0.6-49.1] weeks), 6 received a microtracer and 9 a microdose of [C-14]midazolam (111 Bq kg(-1); 37.6 ng kg(-1)). In a 2-compartment PK model, bodyweight was the most significant covariate for volume of distribution. There was no statistically significant difference in any PK parameter between the microdose and microtracer, nor in the area under curve ratio [C-14]1-OH-midazolam/[C-14]midazolam, showing the PK of midazolam to be linear within the range of the therapeutic and microdoses. Conclusion Our data support the dose linearity of the PK of an IV [C-14]midazolam microdose in children. Hence, a [C-14]midazolam microdosing approach may be used as an alternative to a therapeutic dose of midazolam to study developmental changes in hepatic CYP3A activity in young children

Dose-linearity of the pharmacokinetics of an intravenous [C-14]midazolam microdose in children

Aims Drug disposition in children may vary from adults due to age-related variation in drug metabolism. Microdose studies present an innovation to study pharmacokinetics (PK) in paediatrics; however, they should be used only when the PK is dose linear. We aimed to assess dose linearity of a [C-14]midazolam microdose, by comparing the PK of an intravenous (IV) microtracer (a microdose given simultaneously with a therapeutic midazolam dose), with the PK of a single isolated microdose. Methods Preterm to 2-year-old infants admitted to the intensive care unit received [C-14]midazolam IV as a microtracer or microdose, followed by dense blood sampling up to 36 hours. Plasma concentrations of [C-14]midazolam and [C-14]1-hydroxy-midazolam were determined by accelerator mass spectrometry. Noncompartmental PK analysis was performed and a population PK model was developed. Results Of 15 infants (median gestational age 39.4 [range 23.9-41.4] weeks, postnatal age 11.4 [0.6-49.1] weeks), 6 received a microtracer and 9 a microdose of [C-14]midazolam (111 Bq kg(-1); 37.6 ng kg(-1)). In a 2-compartment PK model, bodyweight was the most significant covariate for volume of distribution. There was no statistically significant difference in any PK parameter between the microdose and microtracer, nor in the area under curve ratio [C-14]1-OH-midazolam/[C-14]midazolam, showing the PK of midazolam to be linear within the range of the therapeutic and microdoses. Conclusion Our data support the dose linearity of the PK of an IV [C-14]midazolam microdose in children. Hence, a [C-14]midazolam microdosing approach may be used as an alternative to a therapeutic dose of midazolam to study developmental changes in hepatic CYP3A activity in young children

Limits on the gravity wave contribution to microwave anisotropies

We present limits on the fraction of large angle microwave anisotropies which could come from tensor perturbations. We use the COBE results as well as smaller scale CMB observations, measurements of galaxy correlations, abundances of galaxy clusters, and Lyman alpha absorption cloud statistics. Our aim is to provide conservative limits on the tensor-to-scalar ratio for standard inflationary models. For power-law inflation, for example, we find T/S<0.52 at 95% confidence, with a similar constraint for phi^p potentials. However, for models with tensor amplitude unrelated to the scalar spectral index it is still currently possible to have T/S>1.Comment: 23 pages, 7 figures, accepted for publication in Phys. Rev. D. Calculations extended to blue spectral index, Fig. 6 added, discussion of results expande

Constraints on diffuse neutrino background from primordial black holes

We calculated the energy spectra and the fluxes of electron neutrino emitted in the process of evaporation of primordial black holes (PBHs) in the early universe. It was assumed that PBHs are formed by a blue power-law spectrum of primordial density fluctuations. We obtained the bounds on the spectral index of density fluctuations assuming validity of the standard picture of gravitational collapse and using the available data of several experiments with atmospheric and solar neutrinos. The comparison of our results with the previous constraints (which had been obtained using diffuse photon background data) shows that such bounds are quite sensitive to an assumed form of the initial PBH mass function.Comment: 18 pages,(with 7 figures

Solar Wind Turbulence and the Role of Ion Instabilities

International audienc