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We review the use of neural-network-based equalizers for mitigating the power fading effect in intensity-modulated directly detected links, and compare the different approaches reported in the literature.

Selective sensory spinal anesthesia preserves lower limb motor function and thus facilitates postanesthesia care unit (PACU) bypass and reduces ambulation recovery time.We compared the ambulation time and PACU bypass rate after using 3 low-dose, low-concentration levobupivacaine-fentanyl spinal solutions (5, 4, and 3 mg + 10 μg) in a double-blind study consisting of 90 patients (ASA physical status I and II) scheduled to undergo knee arthroscopy.The 3-mg dose was halted because of a large number of inadequate blocks (50%). Twenty-three percent and 80% of patients from groups 5 mg and 4 mg, respectively, bypassed the PACU (P = 0001). Ambulation took place after 70 minutes (30-130 minutes) (median [range]) in group 5 mg and 45 minutes (23-120 minutes) in group 4 mg (P = 0006).Four milligrams levobupivacaine plus 10 μg fentanyl produced adequate surgical anesthesia with the shortest time to ambulation and the highest PACU bypass rate.

Resumen Introduccion El objetivo de este estudio fue comparar el porcentaje de pacientes que evitaban su paso (bypass) por la unidad de recuperacion postanestesica (URPA) despues de una anestesia subaracnoidea selectiva con lidocaina-fentanilo respecto a otra de levobupivacaina-fentanilo, en cirugia anorrectal realizada en pacientes en posicion de navaja. Material y metodos Estudio aleatorizado, prospectivo y doble ciego. Se compararon dos grupos de 30 pacientes, ASA I-II. El grupo Lido recibio 18 mg de lidocaina 0,6% mas 10 µg fentanilo y el grupo Levo 3 mg de levobupivacaina 0,1% mas 10 µg fentanilo. Se monitorizaron las siguientes variables intraoperatorias: tiempo de inicio de la cirugia, nivel maximo de bloqueo sensitivo, necesidad de suplementacion analgesica, aparicion de eventos hemodinamicos. El nivel sensitivo se registro a los 5, 10 y 15 minutos y al final de la cirugia. Tras la cirugia se registro el grado de bloqueo motor, el nivel de propiocepcion, el test de Romberg y si el paciente podia puentear la Unidad de recuperacion postanestesica. Los tiempos de deambulacion y de alta a domicilio, las complicaciones y la satisfaccion postoperatoria tambien fueron registradas. Resultados No se observo diferencias significativas entre los grupos en cuanto a variables intraoperatorias. El 100% de los pacientes del estudio fue directamente a la unidad de adaptacion al medio sin pasar por la URPA. Los tiempos para la deambulacion, el alta a domicilio, asi como las complicaciones y la satisfaccion global postoperatoria fueron similares en ambos grupos. Conclusiones Ambas soluciones intratecales producen anestesia selectiva efectiva proporcionando un porcentaje de bypass de la URPA similar en cirugia anorrectal en posicion de navaja.

Resume En dehors des rares cas de pseudotumeurs et de tumeurs medicales, le traitement des tumeurs de la paroi thoracique repose sur une prise en charge chirurgicale. C'est le principal point commun d'un ensemble tres heterogene de pathologies. Longtemps associees a des pronostics tres pejoratifs, les procedures chirurgicales ont progresse. Aujourd'hui, a condition de respecter les principes fondamentaux de la chirurgie de paroi, la resection de paroi n'altere plus, en elle-meme, le pronostic. Un bilan preoperatoire detaille est indispensable avant d'envisager la moindre intervention ; il permet de prevoir une strategie operatoire. Exerese et reconstruction parietale sont, ensuite, les deux temps indissociables de toute intervention. Il s'agit de respecter a la fois les imperatifs d'une resection complete satisfaisante d'un point de vue carcinologique, et ceux d'une reconstruction stable preservant la fonction respiratoire.

Resume Les pathologies pleurales associent a divers degres epanchement pleural, epaississement pleural et calcifications. Il existe un certain chevauchement entre les aspects radiologiques des affections benignes et malignes. Cette distinction est parfois difficile et la TDM est l’examen le plus discriminant actuellement dans la pathologie pleurale. Nous verrons dans cet expose les images cles qui permettent d’orienter rapidement le diagnostic dans la pathologie pleurale liee a l’exposition a l’amiante.

Introduction La pneumatose kystique intestinale (PKI) est definie par la presence d’air libre dans la paroi intestinale. La PKI a ete decrite dans des cas d’ischemie intestinale, d’infections, de maladies systemiques, de maladies pulmonaires, parfois dans un contexte traumatique ou suite a l’introduction d’un medicament. Quelques cas de PKI ont ete decrits chez des patients atteints d’une dermatomyosite (DM). Nous presentons le premier cas de PKI chez un patient atteint de dermatomyosite associee a un anticorps anti-MDA5 et effectuons une revue des cas de PKI associes a une connectivite publies dans la litterature. Observation Un homme de 47 ans etait adresse en medecine interne pour une polyarthrite rhumatoide seronegative corticodependante. Huit mois auparavant, il avait presente un bursite du coude gauche ainsi qu’une polyarthrite des poignets, mains et genoux. Il presentait egalement des lesions cutanees sur les coudes, les avant-bras et les oreilles, un perionyxis et un ulcere digital du 3e rayon de la main droite et une alopecie diffuse. De plus, il se plaignait d’une diarrhee chronique non sanglante avec une perte de poids progressive de 7 kg. Une ileocoloscopie recente etait normale. Enfin, il presentait des douleurs musculaires diffuses. A l’examen, la force musculaire des membres superieurs etait legerement diminuee. Des crepitants etaient notes en base droite. La biologie montrait des CPK tres legerement elevees (235 U/L, N Discussion Soixante-seize cas de PKI associee a une connectivite etaient retrouves, pour la plupart des femmes (n = 65). Les connectivites representees etaient la sclerodermie (n = 28), le lupus systemique (n = 19), la DM (n = 10), la DM juvenile (n = 9), et d’autres (n = 10). Le lupus etait souvent severe. Les cas associes a une DM presentaient souvent des manifestations cutanees au diagnostic. De multiples facteurs predisposants pouvaient etre mis en evidence : une corticotherapie, un traitement immunosuppresseur, une atteinte digestive de la connectivite. Un facteur declenchant etait parfois rapporte, notamment un traumatisme (une surpression abdominale, une chirurgie, une endoscopie digestive), ou un medicament (un inhibiteur de l’α-glucosidase). La PKI etait generalement symptomatique et evoluait sur quelques semaines ou quelques mois, excepte pour 6 patients atteints de lupus. La PKI etait le plus souvent diagnostiquee par un scanner. La prise en charge pouvait etre seulement medicale (n = 41), medicale apres une laparotomie exploratoire (n = 8), chirurgicale (n = 12), l’abstention (n = 6). Le traitement medical pouvait etre une oxygenotherapie, des antibiotiques couvrant les anaerobies, un regime d’epargne colique, une nutrition parenterale, une intensification de l’immunosuppression. Une remission etait constatee dans 37 cas ; 15 deces etaient rapportes, le plus souvent du fait de complications secondaires a la PKI. Conclusion La pneumatose kystique intestinale est une complication inhabituelle des connectivites. Le diagnostic est pose par le scanner. Meme si les images radiologiques sont tres impressionnantes, le traitement medical permet habituellement d’obtenir la remission, quelle que soit la maladie causale.

Affinity purified, freshly isolated CD34+ progenitors were shown to express low levels of type I interferon (IFN) receptors (740 +/- 60 binding sites/cell, K(d) 0.7 +/- 0.04 nM) determined by Scatchard's analysis using a radiolabelled, neutralizing, monoclonal antibody directed against the IFNAR1 chain of the human type I IFN receptor. Treatment of freshly isolated (day 0), highly purified (>95% pure) CD34+ cells with recombinant IFN-alpha resulted in rapid tyrosine phosphorylation and activation of STAT1, Tyk2 and JAK1 as shown by Western immunoblotting. Similarly, IFN treatment was shown by confocal microscopy to result in rapid nuclear localization of the transcription factors IRF1 and STAT2, demonstrating the presence of functional IFN receptors on freshly isolated (day 0) CD34+ cells. The number of specific type I IFN receptor binding sites expressed on hematopoietic progenitor cells increased to some 1440 +/- 40 per cell after 11 days of cultivation of CD34+ cells in vitrosuggesting that receptor expression increases with cell differentiation. IFN-mediated signal transduction and the inhibitory effect of IFN-alpha on 7 or 14 days CFU-GM and BFU-E colony formation was abrogated in the presence of the anti-IFNAR1 mAb, indicating that IFN-alpha acts directly on the proliferation of human hematopoietic progenitor cells via receptor activated signal transduction without excluding the induction of other cytokines or growth factors by residual accessory cells.

This work presents an interactive simulation software package for delivering an environmental engineering design project. The primary goal of the effort is to supplement theory-based course content with a complex and relevant design project, and to do so without increasing student course loads or placing excessive time demands on instructors. An additional goal for research-based instructors is to provide an efficient mechanism for infusing current research findings and experimental techniques into the curriculum. The software that administers the design project is called Interactive Site Investigation Software (ISIS). This paper summarizes the rationale for the development of ISIS, outlines the instructor-generated input required by ISIS, and details current ISIS features. These features allow students to drill boreholes, collect core samples, construct wells, collect groundwater samples, submit samples for laboratory analysis, and execute hydraulic and transport experiments at a virtual hazardous waste site. Initial feedback on the usability and usefulness of ISIS was generally positive, and the automated data requisition and dispensation substantially reduced the project's administrative demands on the instructor. Common student complaints pertained to controlled access to the software in the face of deadline pressure, uncertain expectations regarding their work product, and the need for real-time advice.

Background characterize To the effects of high asbestos exposure during annual periods of insulation. Method 170 ex-workers underwent clinical examination, spirometry, standard chest X-rays and high-resolution computed tomography (HRCT). Asbestos exposure was retrospectively assessed for latency, duration, and intensity. Results Sixty-six percent of these workers were annually exposed to high concentrations of asbestos dust. Respiratory symptoms were mild. One hundred and nineteen subjects had pleural or pulmonary changes on HRCT, compatible with asbestos exposure. Localized pleural thickening was found in 113 subjects (66.5%); pulmonary nodules or lines in 35 (20.6%). The presence of pleural plaques was linked to intensity of asbestos exposure (P

Resume Dans les suites d'une pneumonectomie pour cancer, les patients sont classiquement surveilles par l'examen clinique et la radiographie standard du thorax. Certaines formes torpides d'empyeme peuvent cependant passer inapercues quand elles surviennent apres la periode d'hospitalisation et qu'elles ne s'accompagnent pas de fievre. Lorsqu'une radiotherapie postoperatoire est realisee, la scanographie dosimetrique constitue dans ce cas le premier examen fournissant des donnees objectives du contenu endothoracique. Il faut donc, a cette occasion, s'assurer de la normalite de la loge de pneumonectomie en verifiant que le liquide de substitution est homogene et surtout que la partie interne, mediastinale, de la loge de pneumonectomie a un aspect concave. Si ce n'est pas le cas, un empyeme doit etre suspecte. Le diagnostic, confirme par l'examen cytobacteriologique du liquide pleural, constitue une contre-indication a la realisation de la radiotherapie. Nous presentons deux cas d'empyeme paucisymptomatique postpneumonectomie dont le diagnostic a ete etabli en cours de radiotherapie postoperatoire, alors que la scanographie dosimetrique initiale etait pathologique et aurait pu permettre un diagnostic plus precoce.

Objective: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. Material and methods: Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. Results: Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. Conclusion: This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.

We report the case of an infant affected with congenital systemic juvenile xanthogranuloma scheduled for central venous access system implantation (Port-a-Cath) and a liver and bone marrow biopsy. The patient had impaired liver function, thrombocytopenia, and coagulopathy which was refractory to daily fresh-frozen plasma and platelet infusions: 80 microg x kg(-1) dose(-1) of recombinant factor VIIa (rFVIIa) was administered i.v. every 2 h starting 30 min before the procedure and ending 6 h afterwards. Very minor bleeding was observed during the procedure. In conclusion, rFVIIa therapy was effective as prophylaxis for both invasive procedures in this patient with a coagulopathy which was refractory to other different therapies.

Plasma volume expanders (PVEs) such as hydroxyethyl starch (HES) and dextran are misused in sports because they can prevent dehydration and reduce haematocrit values to mask erythropoietin abuse. Endogenous hydrolysis generates multiple HES and dextran oligosaccharides which are excreted in urine. Composition of the urinary metabolic profiles of PVEs varies depending on post-administration time and can have an impact on their detectability. In this work, different mass spectrometry data acquisition modes (full scan with and without in-source collision-induced dissociation) were used to study urinary excretion profiles of HES and dextran, particularly by investigating time-dependent detectability of HES and dextran urinary oligosaccharide metabolites in post-administration samples. In-source fragmentation yielded the best results in terms of limit of detection (LOD) and detection times, whereas detection of HES and dextran metabolites in full scan mode with no in-source fragmentation is related to recent administration (24 hours). Urinary excretion studies showed detection windows for HES and dextran respectively of 72 and 48 hours after administration. Dextran concentrations were above the previously proposed threshold of 500 µg · mL(-1) for 12 hours. A "dilute-and-shoot" method for the detection of HES and dextran in human urine by ultra-high-pressure liquid chromatography-electrospray ionization-high resolution Orbitrap™ mass spectrometry was developed for this study. Validation of the method showed an LOD in the range of 10-500 µg · mL(-1) for the most significant HES and dextran metabolites in the different modes. The method allows retrospective data analysis and can be implemented in existing high-resolution mass spectrometry-based doping control screening analysis.

We performed this study to define the normal patterns of the glenohumeral joint with kinematic MR imaging in healthy volunteers.Twenty healthy volunteers (39 shoulders) were studied with a 1.5-T imager. Successive fast low-angle shot images (75/11 [TR/TE], 15 degrees flip angle) were obtained in the axial plane from full internal to full external rotation at the superior, middle, and inferior glenoid levels.The free margin of the anterior labrum was seen to be slightly mobile and its base was always fixed. The anterior labrum showed changes in shape and signal intensity during internal rotation (54%). The posterior labrum remained motionless in 97% of patients and no shape or signal-intensity changes were noted during internal rotation. The anterior joint capsule was taut during external and internal rotation, exhibited a slack pattern in 51% of patients, and a folded pattern in 14% of patients.Kinematic MR imaging, which permits dynamic evaluation of the various anatomic components that may be involved in shoulder instability, also provides information on the labrocapsular ligamentous complex.

The authors review the various interventional radiology techniques currently used in 1996 by a Medico-Radio-Surgical team. CT guided needle biopsy has an important place in the diagnostic approach to parenchymal as well as mediastinal tumours. But CT guidance allows also routine drainage of thoracic collections and sometimes thoracic sympatholysis. Superior vena cava and tracheobronchial stenting are palliative treatments as the percutaneous aspergilloma treatment. Embolization of bronchial and thoracic systemic arteries are also palliative but effective therapeutic procedures as well as vasoocclusion for arterio-venous fistulae.

SUMMARY The basic recursive equations of the Kalman filter, for independent normally distributed error sources in both the observation and the system equations, are shown to hold for a larger class of distributions. It is shown that, for error sources following jointly a general elliptical distribution, the conditional posterior distribution of the parameters and the one-step ahead predictive distribution at every stage t are also elliptical. This generalizes some recent results of Meinhold & Singpurwalla for error sources distributed as multivariate Student t and some older results of Zellner for the linear regression model.

CT scans have been studied only in asthmatics who were smokers, and no such study has been performed in patients with chronic uncomplicated asthma where a permanent bronchial destruction is likely to occur after a long course of the disease. The object of the study was to characterize CT-scan abnormalities and determine whether bronchial destructive lesions may be observed. Fifty-seven adults with chronic asthma of variable severity and etiology and 10 normal subjects were studied. None of the subjects smoked. Chest radiographs and HR-CT scans were performed in all patients. To discriminate between reversible and irreversible CT-scan abnormalities, two examinations were made in 10 patients with acute asthma both before and 2 wk after parenteral high dose corticosteroid treatment. The chest radiographs showed the expected abnormalities of asthma in 37.8% of the asthmatics. CT scans were abnormal in 71.9% of the asthmatics. Reversible abnormalities included mucoid impactions, acinar pattern, and lobar collapse. Irreversible abnormalities included bronchiectasis, bronchial wall-thickening, sequellar line shadows, and emphysema. Most of these abnormalities are likely to be related to bronchial destruction.

BACKGROUND Lidocaine selective spinal anesthesia has been effective for short-duration gynecological outpatient laparoscopy. We compared the intraoperative effectiveness, anesthetic recovery times, and patient satisfaction after levobupivacaine-fentanyl versus lidocaine-fentanyl spinal anesthesia during short-duration gynecological laparoscopy. METHODS In this double-blind study, 52 healthy women scheduled to undergo tubal sterilization were randomly assigned to receive either intrathecal 10 mg lidocaine 2% plus 10 microg fentanyl (Group I) or intrathecal 3 mg levobupivacaine 0.5% plus 10 microg fentanyl (Group II), each solution made to a total volume of 3 mL with sterile water. The following variables were monitored intraoperatively: anesthesia onset time, need for anesthesia-analgesia supplementation, depth of sedation, surgical conditions, and occurrence of hemodynamic events. After surgery, motor block, proprioception, vibration sense, light touch, and Romberg's test were performed to evaluate whether the patients could bypass the postanesthesia care unit and be allowed to walk by themselves. Sensory block level was determined at 5, 10, and 15 min after anesthetic injection, and then every 15 min until resolution was complete. A difference of 25 min in sensory block resolution time was considered clinically relevant. RESULTS Onset time and intraoperative conditions were comparable in both groups. No patient required general anesthesia to complete surgery. All patients from both groups bypassed the postanesthesia care unit. Ambulation took place after 27 (18-45) min in Group I and 30 (18-56) min in Group II (P = 0.24). Complete regression of spinal anesthesia occurred after 93 (65-120) min in Group I and 105 (78-150) min in Group II (P = 0.019); however, no differences were observed in time for home discharge 185 (150-300) min in Group I and 188 (125-300) min in Group II (P = 0.62). Global patient satisfaction was comparable between both groups. CONCLUSIONS Levobupivacaine 3 mg plus 10 microg fentanyl may be used as a suitable alternative to 10 mg lidocaine plus 10 microg fentanyl for spinal anesthesia of short duration. It achieved a clinically equivalent time for resolution of sensory block, similar intraoperative conditions, and comparable patient satisfaction..

To describe the sonographic features of entesopathy in patients with psoriatic dactylitis. Materials and methods. Clinical, radiographic and sonographic evaluation of 120 hand joints with clinical abnormality including 20 fingers in 17 patients with rheumatoid arthritis (RA) and 20 fingers in 17 patients with psoriatic arthritis (PA).Forty cases of dactylitis. In patients with RA: 29 cases of synovitis, 15 cases of tenosynovitis, and 2 cases of tendinitis; in patients with PA: 21 cases of synovitis and 3 cases of tenosynovitis. Bone erosions were present in RA patients whereas erosions with bone production were present in PA patients. A total of 60% of RA and PA patients showed erosions on conventional radiographs. Features suggesting entesopathy were present in PA patients only: specific changes of P3, capsular hyperostosis and periarticular periostitis.Based on evaluation of PA patients, it seems that sonographic features suggesting entesopathy in patients with dactylitis may be present.

Spontaneous pneumomediastinum is a rare complication of dermatomyositis.We report a case of pneumomediastinum with massive subcutaneous emphysema occurring in a female patient with dermatomyositis treated with cortico-steroids.Our case illustrates perfectly the mechanism of spread of air along the broncho-vascular structures and also explains the presence of pneumomediastinum in the absence of pneumothorax.

The scimitar syndrome or pulmonary venolobar syndrome is a rare, complex and variable malformation of the right lung characterized by an abnormal right sided pulmonary venous drainage in the inferior vena cava, malformation of the right lung, abnormal arterial supply and sometimes cardiac malformations. We present a case in which this diagnosis was suspected on an abnormal routine chest radiograph in a 38-year-old asymptomatic woman. Most patients are asymptomatic; symptomatic patients have a marked left-to-right shunt or a severe congenital heart disease. They usually suffer from shortness of breath, asthenia or repeated chest infections. Usually, the posteroanterior chest radiograph can confirm the diagnostic. It shows the abnormal vein draining into the inferior vena cava as a curved vascular shadow with a scimitar like appearance. However, in some cases, when the scimitar vein is masked by the overlying cardiac shadow, computed tomography, angiography and magnetic resonance imaging can be helpful by showing the abnormal vein and its insertion into the inferior vena cava. Scimitar syndrome seldom necessitates surgical intervention. However, repeated lung infections can sometimes require lobectomy or pneumonectomy, left-to-right shunt vascular surgery to redirect the scimitar vein into the left atrium.

NK cells express receptors characterized by opposite functions that finely regulate their activities. Among inhibitory receptors, some are specific for different groups of MHC class I alleles, while others are still orphan receptors. On the contrary, various activating receptors are involved in the triggering of NK-mediated natural cytotoxicity. In general, their engagement induces human NK cells to kill target cells that are either HLA class I-negative or -deficient. Thus, the process of NK cell triggering mediated by Natural Cytotoxicity Receptors can be mainly considered as a non MHC-restricted mechanism. Here, a brief description of the molecular nature of these receptors, as well as, of their 3D-structures and of the implications for ligand recognition, is given.