Insurance Law—Deduction of Settlements From Insurance Company’s Liability on Automobile Policy Allowable

Duprey v. Security Mutual Casualty Company, 22 App. Div. 544, 256 N.Y.S.2d 987 (1965)

ORIGAMIX, a CdTe-based spectro-imager development for nuclear applications

The Astrophysics Division of CEA Saclay has a long history in the development of CdTe based pixelated detection planes for X and gamma-ray astronomy, with time-resolved imaging and spectrometric capabilities. The last generation, named Caliste HD, is an all-in-one modular instrument that fulfills requirements for space applications. Its full-custom front-end electronics is designed to work over a large energy range from 2 keV to 1 MeV with excellent spectroscopic performances, in particular between 10 and 100 keV (0.56 keV FWHM and 0.67 keV FWHM at 13.9 and 59.5 keV). In the frame of the ORIGAMIX project, a consortium based on research laboratories and industrials has been settled in order to develop a new generation of gamma camera. The aim is to develop a system based on the Caliste architecture for post-accidental interventions or homeland security, but integrating new properties (advanced spectrometry, hybrid working mode) and suitable for industry. A first prototype was designed and tested to acquire feedback for further developments. In this study, we particularly focused on spectrometric performances with high energies and high fluxes. Therefore, our device was exposed to energies up to 700 keV (133Ba, 137Cs) and we measured the evolution of energy resolution (0.96 keV at 80 keV, 2.18 keV at 356 keV, 3.33 keV at 662 keV). Detection efficiency decreases after 150 keV, as Compton effect becomes dominant. However, CALISTE is also designed to handle multiple events, enabling Compton scattering reconstruction, which can drastically improve detection efficiencies and dynamic range for higher energies up to 1408 keV (22Na, 60Co, 152Eu) within a 1-mm thick detector. In particular, such spectrometric performances obtained with 152Eu and 60Co were never measured before with this kind of detector.Comment: Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment. Available online 9 January 2015, ISSN 0168-9002 (http://www.sciencedirect.com/science/article/pii/S0168900215000133). Keywords: CdTe; X-ray; Gamma-ray; Spectrometry; Charge-sharing; Astrophysics Instrumentation; Nuclear Instrumentation; Gamma-ray camera

Constrictive tuberculous pericarditis in a HIV-positive patient

Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an HIV-positive patient with constrictive calcified pericarditis due to an infection with Mycobacterium tuberculosis. Pericardectomie was performed. The therapeutical approach is discussed and the literature is reviewe

Transplantation of a Human Mammary Carcinoma Cell Line (BT 20) Into Nude Mice

Cell suspensions of a human mammary carcinoma cell line (BT 20), when injected subcutaneously into nude athymic mice (BALB/c Nu/Nu), produced tumor nodules at the injection site. Subsequent serial transplantations also gave rise to neoplastic nodules after latency periods averaging 3 weeks. The nodules displayed morphologic and functional characteristics comparable to those of the original tumor cells. Metastases, however, were not observed in any of the tumor-bearing mic

Temporary neurological dysfunction after surgery of the thoracic aorta: a predictor of poor outcome and impaired quality of life

Background: Transient neurological dysfunction (TND) consists of postoperative confusion, delirium and agitation. It is underestimated after surgery on the thoracic aorta and its influence on long-term quality of life (QoL) has not yet been studied. This study aimed to assess the influence of TND on short- and long-term outcome following surgery of the ascending aorta and proximal arch. Methods: Nine hundred and seven patients undergoing surgery of the ascending aorta and the proximal aortic arch at our institution were included. Two hundred and ninety patients (31.9%) underwent surgery because of acute aortic dissection type A (AADA) and 617 patients because of aortic aneurysm. In 547 patients (60.3%) the distal anastomosis was performed using deep hypothermic circulatory arrest (DHCA). TND was defined as a Glasgow coma scale (GCS) value <13. All surviving patients had a clinical follow up and QoL was assessed with an SF-36 questionnaire. Results: Overall in-hospital mortality was 8.3%. TND occurred in 89 patients (9.8%). As compared to patients without TND, those who suffered from TND were older (66.4 vs 59.9 years, p<0.01) underwent more frequently emergent procedures (53% vs 32%, p<0.05) and surgery under DHCA (84.3% vs 57.7%, p<0.05). However, duration of DHCA and extent of surgery did not influence the incidence of TND. In-hospital mortality in the group of patients with TND compared to the group without TND was similar (12.0% vs 11.4%; p=ns). Patients with TND suffered more frequently from coronary artery disease (28% vs 20.8%, p=ns) and were more frequently admitted in a compromised haemodynamic condition (23.6% vs 9.9%, p<0.05). Postoperative course revealed more pulmonary complications such as prolonged mechanical ventilation. Additional to their transient neurological dysfunction, significantly more patients had strokes with permanent neurological loss of function (14.6% vs 4.8%, p<0.05) compared to the patients without TND. ICU and hospital stay were significantly prolonged in TND patients (18±13 days vs 12±7 days, p<0.05). Over a mean follow-up interval of 27±14 months, patients with TND showed a significantly impaired QoL. Conclusion: The neurological outcome following surgery of the ascending aorta and proximal aortic arch is of paramount importance. The impact of TND on short- and long-term outcome is underestimated and negatively affects the short- and long-term outcom

Description and evaluation of a ventriculo-coronary artery bypass device that provides bi-directional coronary flow

Objective: The objective of this study was to assess acute patency of a new myocardial revascularization device that connects the left ventricular cavity to a coronary artery (termed ventriculo-coronary artery bypass, VCAB) thereby providing proximal and distal blood flow from the site of the anastomosis. Methods: A device made of expanded polytetrafluoroethylene and low density polyethylene was implanted from the base of the left ventricle to the mid left anterior descending coronary artery (LAD) in 11 juvenile domestic pigs using a beating heart approach. Flow rates were measured in the distal LAD before and after implant using ultrasonic flow techniques, and patency was assessed at explant at either 2 or 4 weeks post-implantation. Myocardial perfusion using positron emission tomography (PET) was assessed in a separate set of pigs (n=2) revascularized by VCAB 2 weeks post-implant. Results: Net forward flow distal to the implanted device was 73±15% of native LAD flow. PET demonstrated that the target myocardium was perfused at 85% of that seen in the remote, control myocardium. Device patency rate was 80% (4/5) at 2 weeks in one set of pigs and 83% (5/6) at 4 weeks in a second set of pigs. Histologic analysis showed formation of neointima along the extraventricular segment of the device. Conclusions: This study demonstrates the promise of perfusing ischemic myocardium using a VCAB approach with a device that provides blood flow both proximal and distal to the anastomosis. Patency of the transmyocardial device was encouraging at 2 and 4 weeks and warrants further investigatio

Decision-making in aortic root surgery in Marfan syndrome: bleeding, thromboembolism and risk of reintervention after valve-sparing or mechanical aortic root replacement†

OBJECTIVES Valve-sparing root replacement (VSRR) is thought to reduce the rate of thromboembolic and bleeding events compared with aortic root replacement using a mechanical aortic root replacement (MRR) with a composite graft by avoiding oral anticoagulation. But as VSRR carries a certain risk for subsequent reinterventions, decision-making in the individual patient can be challenging. METHODS Of 100 Marfan syndrome (MFS) patients who underwent 169 aortic surgeries and were followed at our institution since 1995, 59 consecutive patients without a history of dissection or prior aortic surgery underwent elective VSRR or MRR and were retrospectively analysed. RESULTS VSRR was performed in 29 (David n = 24, Yacoub n = 5) and MRR in 30 patients. The mean age was 33 ± 15 years. The mean follow-up after VSRR was 6.5 ± 4 years (180 patient-years) compared with 8.8 ± 9 years (274 patient-years) after MRR. Reoperation rates after root remodelling (Yacoub) were significantly higher than after the reimplantation (David) procedure (60 vs 4.2%, P = 0.01). The need for reinterventions after the reimplantation procedure (0.8% per patient-year) was not significantly higher than after MRR (P = 0.44) but follow-up after VSRR was significantly shorter (P = 0.03). There was neither significant morbidity nor mortality associated with root reoperations. There were no neurological events after VSRR compared with four stroke/intracranial bleeding events in the MRR group (log-rank, P = 0.11), translating into an event rate of 1.46% per patient-year following MRR. CONCLUSION The calculated annual failure rate after VSRR using the reimplantation technique was lower than the annual risk for thromboembolic or bleeding events. Since the perioperative risk of reinterventions following VSRR is low, patients might benefit from VSRR even if redo surgery may become necessary during follow-u