An Unusual Case Presentation of the May-Thurner Syndrome

Summary: A 56-year-old woman underwent abdominoplasty with no immediate complications. She had no known bleeding history nor any relevant past surgical history. Adequate preventive measures for venous thromboembolism were performed, including sequential compression devices, good hydration, and early ambulation. At 17 days post operation, the patient presented to the emergency room complaining of left leg swelling and sharp, shooting pain radiating down her left leg. Workup in the Emergency Room revealed significant venous thrombosis involving complete occlusion of the major veins of the left leg. There were no indications of cardiopulmonary compromise. Angiography revealed an anatomical variant consistent with May-Thurner Syndrome (MTS). This variant first described in 1957 may present in up to one-quarter of patients, more commonly in young women. This case appears to the first reported of MTS occurring in association with a postoperative complication of abdominoplasty. Diagnosis and management considerations are discussed

Fate of the lower extremity in patients with VA-ECMO via femoral cannulation

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Femoral cannulation is associated with limb complications including ischemia, limb loss, arterial infections and wound infections. This study aims to evaluate these complications and management related to successful outcomes. Methods: A retrospective review was conducted in 17 patients requiring VA- ECMO support via femoral cannulation from 1/ 2010 till 4/2012. After cannulation, all patients had near infared spectroscopy (NIRS) monitoring after cannula placement and most had placement of distal arterial perfusion catheters (DPC). At decannulation, all patients had femoral cutdown with closure of arteriotomies by primary repair or patch angioplasty with bovine pericardium. Primary study endpoints included ischemia, limb loss, arterial infection; secondary endpoints were wound infection and post-discharge symptoms. Results: Seventeen patients were supported with VA-ECMO during the study period with arterial cannula size of 16-20 French. All patients had NIRS monitoring after cannula placement and 13/17 patients had DPC placement, with no subsequent ischemia. Two of 4 patients without DPC developed ischemia; one was decannulated and the other resolved spontaneously. At decannulation, open arterial repair was performed as described. In this study population, simple wound infection occurred in 3/17with Vacuum Assisted Closure (VAC) devices were placed at the timed if appropriate. There were no arterial infections and no instances of limb ischemia requiring amputation. There were no complaints of rest pain during outpatient follow-up. Conclusions: Limb complications related to femoral cannulation for VA-ECMO can lead to prolonged morbidity and limb loss. NIRS and placement of DPC, primary repair of arteriotomy or patch angioplasty, along with aggressive wound care, can dramatically decrease rates of limb ischemia, limb loss and infection

Instruction set extensions for software defined radio on a multithreaded processor

Software dened radios, which provide a programmable solu-tion for implementing the physical layer processing of multi-ple communication standards, are widely recognized as one of the most important new technologies for wireless com-munication systems. Emerging communication standards, however, require tremendous processing capabilities to per-form high-bandwidth physical-layer processing in real time. In this paper, we present instruction set extensions for sev-eral important communication algorithms including convo-lutional encoding, Viterbi decoding, turbo decoding, and Reed-Solomon encoding and decoding. The performance bene ts of these extensions are evaluated using a supercom-puter class vectorizing compiler and the Sandblaster low-power multithreaded processor for software dened radio. The proposed instruction set extensions provide signicant performance improvements, while maintaining a high degree of programmability. Categories and Subject Descriptors C.3 [Computer Systems Organization]: Special-purpose and Application-based Systems|Real-time and embedded sys

Power Analysis and Optimization Techniques for Energy Efficient Computer Systems

Reducing power consumption has become a major challenge in the design and operation of to-day’s computer systems. This chapter describes different techniques addressing this challenge at different levels of system hardware, such as CPU, memory, and internal interconnection network, as well as at different levels of software components, such as compiler, operating system and user applications. These techniques can be broadly categorized into two types: Design time power analysis versus run-time dynamic power management. Mechanisms in the first category use ana-lytical energy models that are integrated into existing simulators to measure the system’s power consumption and thus help engineers to test power-conscious hardware and software during de-sign time. On the other hand, dynamic power management techniques are applied during run-time, and are used to monitor system workload and adapt the system’s behavior dynamically to save energy

Long range corporate planning

The thesis is in two distinct parts. The first part deals with the theoretical aspect of long-range corporate planning. Specifically it: 1. Traces the history of development of long-range planning; giving evidence of maturing of the discipline, its efficacy, and its acceptance in the business world. 2. Introduces the concepts of long-range corporate planning and develops them into a comprehensive theory. 3. Outlines and analyses the advantages of long-range planning, distinguishing between 'defensive' and 'creative' advantages. 4. Suggests broad outlines on 'how to plan'. Includes some interesting (to the author) models developed by others as an aid to the planning exercise. The second part contains details of a real-life application of long-range planning. A heuristic approach is utilized to develop a 4-year plan for two associated firms, a metal-stamping organization and a distributing-cum-sales organization. The exercise involves: 1. Setting up objectives. 2. Examination of the existing resources of the two firms. Locating sources of present and potential strengths and weaknesses. 3. A study of the market. 4. Establishing a time horizon. 5. Developing a product-market policy. 6. Integrating all the above into a comprehensive long-range plan. The principles developed in the first part find normative application in the above plan. The plan therefore serves a dual purpose: a vehicle for integration of various planning principles, as also for guiding the corporate destiny of the two firms.Business, Sauder School ofGraduat