Safety and short term outcomes of a new truly minimally-invasive mesh-less and dissection-less anchoring system for pelvic organ prolapse apical repair

Objective To evaluate the safety and short term outcomes of a new, truly minimally-invasive, mesh-less and dissection-less anchoring system for pelvic floor apical repair. Methods A prospective study was conducted using the NeuGuide™ device system for pelvic floor apical repair. The primary effectiveness outcome was centro-apical pelvic floor prolapse by POP-Q after six months. The primary safety outcome was intra-operative, immediate (first 48 h) post-operative complications and adverse effects after six months. A standardized questionnaire (UDI-6) to assess quality of life at entry and during follow-up visits was used. Patients’ six months-follow-up and evaluation are reported. Results The mean age of the study population (n=10) was 63.8±12.0 years. All patients had a previous prolapse surgery. Five had a previous hysterectomy and two had stress urinary incontinence symptoms. During surgery six patients had a concurrent colporrhaphy. There was no injury to the bladder, rectum, pudendal nerves, or major pelvic vessels and no febrile morbidity was recorded. At six months, no cases of centro-apical recurrence were noted. Patients were satisfied with the procedure and had favorable quality of life scores. Using the UDI-6 questionnaire an improvement, in all domains was seen. Moreover, although the sample size was small, the improvement in urge and overflow incontinence related domains were demonstrated to be statistically significant. Conclusions This new NeuGuide™ device allows rapid and safe introduction of a suspending suture through the sacrospinous ligament and makes sacrospinous ligament fixation easy to perform, while avoiding dissection and mesh complications

Water waves generated by a moving bottom

Tsunamis are often generated by a moving sea bottom. This paper deals with the case where the tsunami source is an earthquake. The linearized water-wave equations are solved analytically for various sea bottom motions. Numerical results based on the analytical solutions are shown for the free-surface profiles, the horizontal and vertical velocities as well as the bottom pressure.Comment: 41 pages, 13 figures. Accepted for publication in a book: "Tsunami and Nonlinear Waves", Kundu, Anjan (Editor), Springer 2007, Approx. 325 p., 170 illus., Hardcover, ISBN: 978-3-540-71255-8, available: May 200

Comparison between three-dimensional linear and nonlinear tsunami generation models

The modeling of tsunami generation is an essential phase in understanding tsunamis. For tsunamis generated by underwater earthquakes, it involves the modeling of the sea bottom motion as well as the resulting motion of the water above it. A comparison between various models for three-dimensional water motion, ranging from linear theory to fully nonlinear theory, is performed. It is found that for most events the linear theory is sufficient. However, in some cases, more sophisticated theories are needed. Moreover, it is shown that the passive approach in which the seafloor deformation is simply translated to the ocean surface is not always equivalent to the active approach in which the bottom motion is taken into account, even if the deformation is supposed to be instantaneous.Comment: 39 pages, 16 figures; Accepted to Theoretical and Computational Fluid Dynamics. Several references have been adde

Composite defect extends cosmology - 3He analogy

Spin-mass vortices have been observed to form in rotating superfluid 3He-B following the absorption of a thermal neutron and a rapid transition from the normal to superfluid state. The spin-mass vortex is a composite defect which consists of a planar soliton (wall) which terminates on a linear core (string). This observation fits well within the framework of a cosmological scenario for defect formation, known as the Kibble-Zurek mechanism. It suggests that in the early Universe analogous cosmological defects might have formed.Comment: RevTeX file, 5 pages, 2 figures, submitted to Phys. Rev. Lett., modified according to referee repor

Can Light Signals Travel Faster than c in Nontrivial Vacuua in Flat space-time? Relativistic Causality II

In this paper we show that the Scharnhorst effect (Vacuum with boundaries or a Casimir type vacuum) cannot be used to generate signals showing measurable faster-than-c speeds. Furthermore, we aim to show that the Scharnhorst effect would violate special relativity, by allowing for a variable speed of light in vacuum, unless one can specify a small invariant length scale. This invariant length scale would be agreed upon by all inertial observers. We hypothesize the approximate scale of the invariant length.Comment: 12 pages no figure

The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings

BACKGROUND: Recent data confirmed the importance of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the selection of patients with colorectal hepatic metastases for surgery. Neoadjuvant chemotherapy before hepatic resection in selected cases may improve outcome. The influence of chemotherapy on the sensitivity of FDG-PET and CT in detecting liver metastases is not known. METHODS: Patients were assigned to either neoadjuvant treatment or immediate hepatic resection according to resectability, risk of recurrence, extrahepatic disease, and patient preference. Two-thirds of them underwent FDG-PET/CT before chemotherapy; all underwent preoperative contrast-enhanced CT and FDG-PET/CT. Those without extensive extrahepatic disease underwent open exploration and resection of all the metastases according to original imaging findings. Operative and pathological findings were compared to imaging results. RESULTS: Twenty-seven patients (33 lesions) underwent immediate hepatic resection (group 1), and 48 patients (122 lesions) received preoperative neoadjuvant chemotherapy (group 2). Sensitivity of FDG-PET and CT in detecting colorectal (CR) metastases was significantly higher in group 1 than in group 2 (FDG-PET: 93.3 vs 49%, P < 0.0001; CT: 87.5 vs 65.3, P = 0.038). CT had a higher sensitivity than FDG-PET in detecting CR metastases following neoadjuvant therapy (65.3 vs 49%, P < 0.0001). Sensitivity of FDG-PET, but not of CT, was lower in group 2 patients whose chemotherapy included bevacizumab compared to patients who did not receive bevacizumab (39 vs 59%, P = 0.068). CONCLUSIONS: FDG-PET/CT sensitivity is lowered by neoadjuvant chemotherapy. CT is more sensitive than FDG-PET in detecting CR metastases following neoadjuvant therapy. Surgical decision-making requires information from multiple imaging modalities and pretreatment findings. Baseline FDG-PET and CT before neoadjuvant therapy are mandatory

Pancreatic cancer: Surgery is a feasible therapeutic option for elderly patients

<p>Abstract</p> <p>Background</p> <p>Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery.</p> <p>Methods</p> <p>The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ≥ 70 years were compared to a younger cohort (<70y).</p> <p>Results</p> <p>Of 460 patients who had surgery for pancreatic neoplasm, 166 (36%) aged ≥ 70y. Compared to patients < 70y (n = 294), elderly patients had more associated comorbidities; 72% vs. 43% (p = 0.01) and a higher rate of malignant pathologies; 73% vs. 59% (p = 0.002). Operative time and blood products consumption were comparable; however, elderly patients had more post-operative complications (41% vs. 29%; p = 0.01), longer hospital stay (26.2 vs. 19.7 days; p < 0.0001), and a higher incidence of peri-operative mortality (5.4% vs. 1.4%; p = 0.01). Multivariable analysis identified age ≥ 70y as an independent predictor of shorter disease-specific survival (DSS) among patients who had surgery for pancreatic adenocarcinoma (n = 224). Median DSS for patients aged ≥ 70y vs. < 70y were 15 months (SE: 1.6) vs. 20 months (SE: 3.4), respectively (p = 0.05). One, two, and 5-Y DSS rates for the cohort of elderly patients were 58%, 36% and 23%, respectively.</p> <p>Conclusions</p> <p>Properly selected elderly patients can undergo pancreatic resection with acceptable post-operative morbidity and mortality rates. Long term survival is achievable even in the presence of adenocarcinoma and therefore surgery should be seriously considered in these patients.</p

Language, Truth, and Logic and the Anglophone reception of the Vienna Circle

A. J. Ayer’s Language, Truth, and Logic had been responsible for introducing the Vienna Circle’s ideas, developed within a Germanophone framework, to an Anglophone readership. Inevitably, this migration from one context to another resulted in the alteration of some of the concepts being transmitted. Such alterations have served to facilitate a number of false impressions of Logical Empiricism from which recent scholarship still tries to recover. In this paper, I will attempt to point to the ways in which LTL has helped to foster the various mistaken stereotypes about Logical Empiricism which were combined into the received view. I will begin by examining Ayer’s all too brief presentation of an Anglocentric lineage for his ideas. This lineage, as we shall see, simply omits the major 19th century Germanophone influences on the rise of analytic philosophy. The Germanophone ideas he presents are selectively introduced into an Anglophone context, and directed towards various concerns that arose within that context. I will focus on the differences between Carnap’s version of the overcoming of metaphysics, and Ayer’s reconfiguration into what he calls the elimination of metaphysics. Having discussed the above, I will very briefly outline the consequences that Ayer’s radicalisation of the Vienna Circle’s doctrines had on the subsequent Anglophone reception of Logical Empiricism