Comparison of ultrasound‐guided core biopsy versus fine‐needle aspiration biopsy in the evaluation of salivary gland lesions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100263/1/hed23193.pd

L'inhibition de l'entartrage par les eaux géothermales du sud tunisien. Étude sur site

Une nappe d'eaux fossiles à grande profondeur (800 à 2 700 mètres) a été mise en exploitation dans le Sud-Tunisien pour alimenter une usine d'osmose inverse située à Gabès ayant une production de 15 000 m3 /jour, afin de lutter contre la désertification par irrigation et d'assurer le chauffage de serres pour la production de primeurs. La grande dureté (TH de l'ordre de 100 à 140 °F) de ces eaux géothermales a pour conséquence le colmatage rapide des conduites de distribution : 40 à 50 tonnes de tartre par forage, constitué essentiellement de carbonate de calcium, précipitent chaque année. Ce tartre est constitué d'aragonite comme le montrent la microscopie électronique à balayage et la diffraction des rayons X. Une technique électrochimique, la chronoélectrogravimétrie, permet d'étudier l'inhibition de l'entartrage par des composés de la famille des phosphates inorganiques, des phosphonates organiques et des polycarboxylates. La concentration efficace de chacun de ces inhibiteurs agissant par effet de seuil a été déterminée : elle est de l'ordre de 1,1 à 1,5 mg.l-1 pour l'eau du forage de EL HAMMA. Un essai sur le site de EL MANSOURA a été effectué en privilégiant un inhibiteur produit industriellement dans le Sud-Tunisien, le triphosphate de sodium. A la concentration de 1 mg.l-1 il évite l'entartrage du système de refroidissement de type cascade - piscines et des conduites de distribution.Deep fossil waters are used in Southern Tunisia (Gabès, Kébili, Tozeur) for the Gabès reverse osmosis plant, which delivers a flow rate of 15 000 m3 /day for irrigation and for heating greenhouses used for the production of early fruits and vegetables. Drilling depths vary between 800 and 2 700 meters. Water emerges under a pressure of ca. 20 bars and has a temperature between 50 and 73 °C. Mean flow rate is 7 800 m3 /day.Intake water at the Gabès plant has a salinity of 3.3 g.l-1 ; after reverse osmosis the salinity is less than 0.1 g.l-1. Water used for irrigation has to be cooled. Geothermal waters are characterized by high concentrations of calcium, magnesium, sulphate and chloride. Bicarbonate anions are present at limited concentrations (approx. 2.10-3 mol.l-1) that are, however, sufficient for the formation of large quantities of scale - 40 to 50 tons per year for each drilling. At the outlet of the drill hole, pressure decreases strongly, liberating carbon dioxide to the atmosphere. Water pH increases and the following equilibrium is displaced to the right, with scale precipitation : Ca2+ + 2HCO3-CO2 (g) + CaCO3(s) + H2OScale precipitation has two consequences :- the plugging of distribution pipes: a 85% reduction of the pipe has been observed, after four years, for an initial diameter of 15 cm; - water cooling installations such as cooling towers or pool systems are blocked by large quantities of scale, which have to be removed regularly. Scales have been analysed through inductively coupled plasma spectroscopy and thermogravimetry: calcium carbonate may represent, depending on the origin of the drilling water, 60 to 95% by weight of the solid. Iron oxides, silica, calcium phosphate and aluminum are present. Scanning electron microscopy and X-ray diffraction show that calcium carbonate precipitates in the form of aragonite. This is due to two reasons: the temperature at the drilling outlet is greater than 60 °C and the high magnesium concentration favours aragonite formation. Scale inhibition is possible through the use of certain chemicals such as phosphates, organic phosphonates and polycarboxylates.Chronoelectrogravimetry was used as the experimental method to determine the inhibitor concentration able to suppress scale precipitation. Dissolved oxygen is electrochemically reduced on a gold electrode; hydroxide anions are produced in the vicinity of the electrode and calcium carbonate precipitates according to:4Ca2+ + 4HCO3- + O2 + 4e -> 4CaCO3(s) + 2H2OThe gold electrode is deposited on the quartz disk of a recording microbalance. The electrode is polarized at - 1 V/SCE with a three-electrode potentiostatic device and the weight of CaCO3 deposited is recorded versus time.Four inhibitors have been studied :- PERMATREAT 191, which is the sodium salt of aminotris(methylenephosphonic) acid N(CH2COONa)3; - a proprietary organic phosphonate with high resistance to chlorine oxidation (DEQUEST 6004) ; - phosphonobutanetricarboxylic acid (DEQUEST 7000, BAYHIBIT-AM) ; - a copolymer of acrylic acid and acrylamidopropanesulfonic acid (FERROPHOS 5248). Breakthrough effects are obtained in the case of EL HAMMA water for the following concentrations: PERMATREAT 191: 1.1 mg.l-1 ; DEQUEST 6004: 1.5 mg.l-1 ; DEQUEST 7000: 1.3 mg.l-1 ; FERROPHOS 5248: 1.4 mg.l-1. These concentrations are low and, as a consequence, these inhibitors can be used for antiscale action even with high water flow rates.A field experiment was carried out on the EL MANSOURA drilling where water is cooled in three pools (input water: 5 184 m3 /day, temperature: 60 °C). For economical reasons the chosen inhibitor was sodium triphosphate Na5 P3 O10, which is produced industrially in Southern Tunisia. By chronoelectrogravimetry it has been shown that, with EL MANSOURA water, a breakthrough effect is obtained with a sodium triphosphate concentration of 0.75 mg.l-1.A dosing pump was used to inject sodium triphosphate in such a way that the inhibitor concentration would be 1 mg.l-1 in one of three pools, the two others not being treated. After four months a scale deposit of 23 cm was obtained in the untreated pools and the pipe diameter was reduced by 39%. In the treated pool scale deposit was not observed and the pipe diameter remained unchanged. In the untreated basins, examination of scale with electron scanning microscopy revealed that it was aragonite; in the treated basin, the precipitate was amorphous and an X-ray diffraction pattern with no characteristic bands was obtained.Some algal development was observed in the pool due to phosphate addition but this development was not a nuisance after the four month period. However, it could be suppressed by the use of an organic phosphonate or polycarboxylate as scale inhibitor

Future changes in tropical cyclone activity in the North Indian Ocean projected by high-resolution MRI-AGCMs

Open Access at publisher's web site: http://www.springerlink.com/content/b682734237171631

Sternal reentry in a patient with previous deep sternal wound infection managed with horizontal titanium plate fixation

Redo open-heart surgery and sternal reentry in patients with previous deep sternal wound infection (DSWI) and absence of sternal integrity can be a delicate and morbid task due the lack of a dissection plane between the heart and the surrounding soft tissues. Delayed sternal reconstruction and osteosynthesis with horizontal titanium plating fixation (Synthes) following vacuum assisted therapy (KCI) has recently been proposed and adopted for the treatment of DSWI. We present such a case of a patient who was successfully reoperated for valve replacement three years after coronary artery bypass grafting complicated by DSWI and initially treated with titanium plate fixation

Water Cycle Changes

This chapter assesses multiple lines of evidence to evaluate past, present and future changes in the global water cycle. It complements material in Chapters 2, 3 and 4 on observed and projected changes in the water cycle, and Chapters 10 and 11 on regional climate change and extreme events. The assessment includes the physical basis for water cycle changes, observed changes in the water cycle and attribution of their causes, future projections and related key uncertainties, and the potential for abrupt change. Paleoclimate evidence, observations, reanalyses and global and regional model simulations are considered. The assessment shows widespread, nonuniform human-caused alterations of the water cycle, which have been obscured by a competition between different drivers across the 20th century and that will be increasingly dominated by greenhouse gas forcing at the global scale

Computational modelling of cancerous mutations in the EGFR/ERK signalling pathway

This article has been made available through the Brunel Open Access Publishing Fund - Copyright @ 2009 Orton et al.BACKGROUND: The Epidermal Growth Factor Receptor (EGFR) activated Extracellular-signal Regulated Kinase (ERK) pathway is a critical cell signalling pathway that relays the signal for a cell to proliferate from the plasma membrane to the nucleus. Deregulation of the EGFR/ERK pathway due to alterations affecting the expression or function of a number of pathway components has long been associated with numerous forms of cancer. Under normal conditions, Epidermal Growth Factor (EGF) stimulates a rapid but transient activation of ERK as the signal is rapidly shutdown. Whereas, under cancerous mutation conditions the ERK signal cannot be shutdown and is sustained resulting in the constitutive activation of ERK and continual cell proliferation. In this study, we have used computational modelling techniques to investigate what effects various cancerous alterations have on the signalling flow through the ERK pathway. RESULTS: We have generated a new model of the EGFR activated ERK pathway, which was verified by our own experimental data. We then altered our model to represent various cancerous situations such as Ras, B-Raf and EGFR mutations, as well as EGFR overexpression. Analysis of the models showed that different cancerous situations resulted in different signalling patterns through the ERK pathway, especially when compared to the normal EGF signal pattern. Our model predicts that cancerous EGFR mutation and overexpression signals almost exclusively via the Rap1 pathway, predicting that this pathway is the best target for drugs. Furthermore, our model also highlights the importance of receptor degradation in normal and cancerous EGFR signalling, and suggests that receptor degradation is a key difference between the signalling from the EGF and Nerve Growth Factor (NGF) receptors. CONCLUSION: Our results suggest that different routes to ERK activation are being utilised in different cancerous situations which therefore has interesting implications for drug selection strategies. We also conducted a comparison of the critical differences between signalling from different growth factor receptors (namely EGFR, mutated EGFR, NGF, and Insulin) with our results suggesting the difference between the systems are large scale and can be attributed to the presence/absence of entire pathways rather than subtle difference in individual rate constants between the systems.This work was funded by the Department of Trade and Industry (DTI), under their Bioscience Beacon project programme. AG was funded by an industrial PhD studentship from Scottish Enterprise and Cyclacel

Transrenal Deployment of a Modular Stent Graft to Repair AAAs with Short Necks: Experiments in Dogs

Severely angulated (> 60°) or short (< 15mm) proximal necks remain significant anatomical limitations for endovascular stent-graft repairs for abdominal aortic aneurysms. Ensuring proper proximal fixation of the stent-graft to the host artery without the short-or long-term risks of endoleak or migration represents a particular technical challenge for these anatomical circumstances. An innovative balloon expandable stent combined with a weft-knitted prosthesis was specifically designed for these situations by modelling the stent to the neck anatomy without overdistension or potential barotrauma allowing better incorporation of the device. The Latecba stent-graft consists of a 2 parts modular design. The first one, Module A, is deployed at the transrenal level and consists of a Palmaz type stent whose first half is bare and second half is sutured to a crimped weft-knitted polyester graft whose distal end holds a constriction. The second Module B is a non-crimped weft-knitted graft attached to 2 stainless steel stents. The first stent is entirely contained in the proximal textile tube, allowing fixation to module A. The second stent, which is left uncovered over the distal third, ensures proper fixation of the stent-graft distally. Following the creation of a prosthetic aneurysm in the infrarenal aorta in 32 dogs, 29 received the Latecba stent-graft for scheduled durations of 10 days, 1 month, 3 months and 6 months. Proper deployment of the stent-grafts was achieved without difficulty. All 29 animals survived and the devices were all patent at sacrifice. No device defects or migrations were observed and the stent-grafts proved to be efficient in this setting to exclude the aneurysm. Analyses of the explanted devices (gross observations, RX, CT scan, IVUS, angioscopy) confirmed the stability of this modular stent-graft. Further on-going clinical investigations are warranted to validate this concept before this stent-graft becomes commercially available without any restriction

Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

<p>Abstract</p> <p>Background</p> <p>To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps</p> <p>Methods</p> <p>From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve.</p> <p>Results</p> <p>Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days.</p> <p>Conclusion</p> <p>Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.</p