Concurrent primary carcinoma of the gallbladder and acute cholecystitis

BACKGROUND/AIMS: Primary carcinoma of the gallbladder is rare and associated with a late diagnosis and poor prognosis. Concurrent acute cholecystitis frequently obscures the presence of carcinoma. The information regarding gallbladder carcinoma with acute cholecystitis is limited. In order to better understand the presentation of gallbladder carcinoma with acute cholecystitis, we retrospectively reviewed the data of patients with primary carcinoma of the gallbladder. METHODOLOGY: The data of 86 patients with primary carcinoma of the gallbladder treated between 1979 and 1994 were compiled and reviewed. The patients were divided into 2 groups: Group 1 (with acute cholecystitis, 21 patients) and Group 2 (without cholecystitis, 65 patients). Clinicopathological comparisons were made and evaluated between these two groups RESULTS: The average age of Group 1 patients was older than that of Group 2 patients (75+/-2 years vs. 63+/-2 years; p<0.05). Three Group 1 patients presented with sepsis. The interval between the onset of symptoms and hospital admission in Group 2 patients was significantly (p<0.05) longer than that in Group 1 patients (243+/-95 days vs. 20+/-11 days). Leukocytosis (>11,000/mm3) was more common in Group 1 patients than in Group 2 patients (47.6% vs. 15.4%). Jaundice was more common in Group 2, and fever was common in Group 1. The majority of Group 2 gallbladder cancers were stage V (75.4%). In contrast, 52.4% of Group 1 gallbladder cancers were stage III and 38.1% were stage V. The 30-day postoperative mortality rate in Group 1 and Group 2 patients was 9.5% and 7.7%, respectively. The cumulative survival of Group 1 patients was not different from that of Group 2 patients (log-rank test, p>0.05). CONCLUSIONS: Age, the interval of symptoms prior to admission, the location of abdominal pain, fever, leukocytosis, and the absence of jaundice suggested the presence of acute cholecystitis in gallbladder carcinoma. A high index of suspicion of the disease, intraoperative examination of gallbladder specimens, and more aggressive surgical treatment may improve patient survival.     

Modeling and simulation of the effect of fiber breakage on creep behavior of fiber-reinforced metal matrix composites

A theoretical model and computer simulation methodology was developed to predict the effect of fiber fracture on creep behavior of continuous fiber-reinforced metal matrix composites. Initially, a single fiber model was developed based upon the fiber statistical characteristics and a shear-lag analysis to establish the computation simulation route. Then, the methodology was extended to predict the creep behavior of a multiple fiber composite. A failure criterion was also incorporated in the model to predict the rupture life of the composite. A parametric study was also conducted to investigate the effects of properties of the constituents on the longitudinal creep behavior of the SCS-6/Ti composite.     

Modular synthesis of Petri nets for modeling flexible manufacturing systems

This paper proposes a modular Petri net synthesis method for modeling flexible manufacturing systems based on synchronization among control processes of the manufacturing resources (such as robots and machines). In the method, the target system is modeled in a bottom-up and uniform manner by first describing the system's control processes using strongly connected state machines (SCSMs) as the basic modules. Each SCSM may contain multiple tokens to represent resources from the same type such as spaces in a buffer. Next, the common transitions and common transition subnets of the modules are merged to represent their synchronization. The system model constructed is proven to be conservative and thus bounded. Moreover, a restricted class of merged nets is proven to be live and reversible. For general classes of merged nets, this paper shows theorems that easily calculateP-invariants of the final net without solving the linear system equations. TheseP-invariants can be used to help in verifying the model's qualitative properties such as liveness.     

Effect of pravastatin treatment on glucose, insulin, and lipoprotein metabolism in patients with hypercholesterolemia

Treatment of patients with type IIA hyperlipoproteinemia (HLP) with pravastatin for 3 months led to significant decreases (p < 0.001) in total cholesterol (7.18 +/- 0.30 to 5.75 +/- 0.30 mmol/L), LDL cholesterol (5.56 +/- 0.33 to 4.02 +/- 0.32 mmol/L), and ratio of total cholesterol to HDL cholesterol (6.5 +/- 0.4 to 4.6 +/- 0.4). Decreases of a similar magnitude were also seen in patients with type IIB HLP. Plasma glucose and insulin concentrations after an oral glucose load and from 8 AM to 4PM in response to meals were higher in patients with Type IIB HLP, who also had higher steady-state plasma glucose concentrations after an infusion of somatostatin, insulin, and glucose (12.4 +/- 1 vs 5.5 +/- 0.8 mmol/L, p < 0.001). Because steady-state plasma insulin concentrations were similar in both groups, patients with type IIB HLP were relatively insulin resistant. Furthermore, day-long plasma glucose concentrations and insulin resistance were modestly, but significantly (p < 0.01), greater after treatment in both groups. In conclusion, LDL cholesterol metabolism improved in hypercholesterolemic subjects treated with pravastatin, but the hypertriglyceridemia, insulin resistance, relative glucose intolerance, and hyperinsulinemia present in patients with type IIB HLP either did not improve with treatment or was somewhat worse.     

Immunoglobulin- and hepatitis B surface antigen-specific circulating immune complexes in chronic hepatitis B virus infection

24 consecutive AIDS patients with wasting, and who had never received anabolic therapies, were evaluated to determine their profile of sex hormones and whether transformation of testosterone (T) to the nuclear androgen, dihydrotestosterone (DHT), was impaired. Eleven (46%) patients had normal testosterone and DHT (group I), 10 (42%) had normal testosterone but low DHT (group II), and 3 (12%) had low testosterone and low DHT (group III). Age, prior opportunistic complications, symptoms, serum albumin, hemoglobin levels, and CD4 lymphocyte counts were similar in the groups. DHT was significantly lower (22.2 +/- 6.8 microg/dl) in group II compared with group I (50.8 +/- 15.3 microg/dl). The ratio of T/DHT, a measure of the conversion of testosterone to DHT, in group I was 15.1 +/- 3.5, which was within the range for eugonadal young men. In group II, the ratio was 22.3 +/- 1.5, indicating a defect in generation of DHT. Patients in group II had lost 9.2 +/- 3.5 kg compared with 5.6 +/- 2.6 kg in group I (p = .015). Thus, a syndrome of low DHT with normal testosterone was associated with significantly greater weight loss than in patients with normal testosterone and DHT. Further studies are needed to clarify whether low DHT is a result of AIDS wasting or is causally related to weight loss and whether androgen therapy in the form of DHT could reverse some of the metabolic changes associated with AIDS wasting.     

Effect of rigid inclusions on the sintering of mullite synthesized by sol-gel processing

The effect of crystalline particulate inclusions of mullite or zirconia on the sintering and crystallization of a mullite powder matrix was investigated as a function of the inclusion volume fraction and size. The mullite powder was synthesized by sol-gel processing and, within the limits of X-ray diffraction, was amorphous. Composites containing up to 22.5 vol % zirconia reached almost full density after sintering at 1500 °C for 1 h. Under identical conditions, the sintered density of the composites containing crystalline mullite inclusions was considerably lower. The zirconia inclusions were inert but the mullite inclusions enhanced the independent nucleation and growth rate of the mullite crystals in the matrix. The lower sintering rate of the matrix reinforced with crystalline mullite is attributed to the enhanced matrix crystallization.     

Environmentally conscious design by using fuzzy multi-attribute decision-making

Products affect the environment at many points in their life cycles. Once a product moves from the drawing board into the production line, its environmental attributes are largely fixed. Many researchers have focused on developing intelligent systems to provide a variety of design and manufacturing information to help designers make environmentally conscious decisions. However, in the early design stage, not all the information available is precise. A large amount of information, especially those that are based on designer experience, is fuzzy in nature. This paper presents an innovative method, namely green fuzzy design analysis (GFDA), which involves simple and efficient procedures to evaluate product design alternatives based on environmental consideration using fuzzy logic. The hierarchical structure of environmentally conscious design indices was constructed using the analytical hierarchy process (AHP), which include five aspects: (1) energy, (2) recycling, (3) toxicity, (4) cost, and (5) material. After weighting factors for the environmental attributes are determined, the most desirable design alternative can be selected based on the fuzzy multi-attribute decision-making (FMADM) technique. The benefit of using such a technique is to effectively solve the design problem by capturing human expertise.     

Hepatocellular carcinoma presenting as pyogenic liver abscess: characteristics, diagnosis, and management

We performed a 17-year retrospective analysis of 10 cases of hepatocellular carcinoma presenting as pyogenic liver abscess. Spontaneous tumor necrosis and biliary obstruction caused by tumor thrombi, superimposed with bacterial infection, were the two major pathogeneses. Exact diagnosis of the underlying hepatocellular carcinoma was made for five of the 10 patients before management was attempted. Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly. Characteristics such as middle age and male sex, seropositivity for hepatitis B and/or hepatitis C, chronic liver disease, unexplained anemia, marked weight loss, and a severely inversed albumin/globulin ratio raise suspicions about the underlying hepatocellular carcinoma. Management strategies included percutaneous drainage (n = 3), surgical drainage (n = 4), and hepatectomy (n = 3) in addition to administration of parenteral antibiotics in all cases. The prognosis was dismal, with a mean survival of 3.5 months (range, 8 days to 6 months).     

A Molecular Dynamics Study of Lubrication Rheology of Polymer Fluids

This study investigated the characteristics of lubrication rheology for polymer fluids using the molecular dynamics method. The confining potential and FENE potential were used to describe the bonding force in a polymer chain. Both Poiseuille and Couette flows were simulated and the results are presented for the density distribution, velocity profiles, slip ratio, viscosity, and relation between shear stress and shear rate. The effects of the number of molecular layers and film thickness on the rheology characteristics were also investigated.