Overnight closed suction drainage after axillary lymphadenectomy for breast cancer

Axillary lymphadenectomy in breast conservation surgery is associated with substantial morbidity in either seroma formation or infection. Seroma formation in the axilla requiring aspiration occurs in up to 42 per cent of patients treated without drainage. Prolonged outpatient suction drainage reduces but does not eliminate the incidence of seroma formation, while increasing cost, discomfort, and possibly infection rates. We studied the efficacy of overnight closed suction drainage in patients undergoing breast conservation surgery. Fifty consecutive patients undergoing a standard axillary dissection for breast cancer were studied. The axilla was drained with a 7-French closed suction drain. All drains were removed within 23 hours of surgery and prior to discharge from the outpatient surgical center. Patients were examined by the operating surgeon 7 to 10 days after surgery. One patient (2%) experienced a seroma postoperatively. No infections were observed in all 50 patients, and the remaining 49 patients did not experience visible or symptomatic seromas. The number of lymph nodes removed ranged between 5 and 33 with a mean of 15.5 +/- 0.6. Nine out of 50 (18%) patients had metastatic breast cancer to the axillary lymph nodes. Patients undergoing breast conservation surgery benefit from overnight closed suction drainage of the axilla. This short-term method reduces the incidence and the inherent morbidity of axillary seroma formation.     

Coronary bypass in vascular patients: a relatively high-risk procedure

A premise of cardiac risk stratification is that the added risk of coronary artery bypass grafting (CABG) is offset by the improved safety of subsequent vascular reconstruction (VR). We questioned if elective CABG is patients with severe peripheral vascular disease (PVD) is a relatively high-risk procedure. A cohort study of 680 elective CABG patients from January 1993 to December 1994 was performed using three mutually exclusive outcomes of complication-free survival, morbidity, and mortality. Patient characteristic, operative, and outcome data were prospectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morbidity occurred at rates 3.6-fold higher in PVD patients (39.7%) than in disease-free patients (16.7%) after adjustment for the effects of patient and operative variables (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most likely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aortic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD patients is associated with significant major morbidity. Such morbidity may preclude or alter the timing of subsequent VR.     

Psychotherapy and the twelve step approach for substance abusers: The limits of integration.

Argues that while there is potential for successful blending of 12-step approaches and psychotherapies for chemical dependency at the level of helping strategies/techniques, some basic differences in values and philosophy will make it impossible to ever fully integrate the 2 approaches without compromising one or the other approach. Some of the differences between the 2 approaches involve leadership (indigenous vs professional), individual control (increasing vs decreasing), and spirituality (enhanced vs decreased). Given that psychotherapy and the 12-step approach must remain largely independent, a model for interactions based on mutual respect, independent control, and cooperation is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Microprocessor-Based Control of an Ion Beam Deposition System

A microprocessor-based system with 32 A/D, 24 D/A, and 16 ac load controllers, has been designed and built to monitor and control an ion beam thin-film deposition system. The A/D and D/A channels have electrical isolation of 7.5 kV between channels and between input and output. The microprocessor system keeps the ion beam deposition parameters stable for extended periods of operation and it is proposed as a means to greatly simplify switching from one deposition species to another to grow thin multilayer or alloy films.     

Object-oriented DBMS requirements

The requirements on an object-oriented DBMS for management of information in a large, complex enterprise are presented. These requirements aid in the achievement of an environment characterized by data sharing, open architectures, application and data portability, and assurance of data integrity. They were defined from the point of view of a user of the DBMS; therefore they describe the expected functionality of the DBMS and do not specify the method of implementation to achieve this functionality. They encompass requirements on the data model, query and data manipulation languages, the system architecure, interfaces to the system, change management, and transaction management.     

Properties of nanoporous organosilicate hybrid thin films with a bimodal pore size distribution

Low dielectric poly[methylsilsesquioxane‐ran‐trifluoropropylsilsesquioxane‐ran‐(2,4,6,8‐tetramethyl‐2,4,6,8‐tetraethylenecyclotetrasiloxane)silsesquioxane]s {P[M‐ran‐TFP‐ran‐(TCS)]SSQs} having various compositions were synthesized using trifluoropropyl trimethoxysilane, methyl trimethoxysilane and 2,4,6,8‐tetramethyl‐2,4,6,8‐tetra(trimethoxysilylethyl)cyclotetrasiloxane. The chemical composition of the polymers and the content of SiOH end‐groups were controlled by adjusting the reaction conditions, and they were characterized by ¹H‐NMR. The thermally decomposable trifluoropropyl groups on the P[M‐ran‐TFP‐ran‐(TCS)]SSQ backbone and heptakis(2,3,6‐tri‐O‐methyl)‐β‐cyclodextrin (CD) were employed as pore generators. The dielectric constants of the porous CD/P[M‐ran‐TFP‐ran‐(TCS)]SSQ films were in the range 2.0–2.7 (at 100 kHz) depending on the concentration of the porogens, and showed no change over 4 days under aqueous conditions. The pore size of the films showed a bimodal distribution, with diameters of ca 0.5–1.0 nm for those originating from the trifluoropropyl groups and 1.7 nm from the CD. The elastic modulus and hardness of the 30 vol% CD‐blended film with a dielectric constant of 2.26 were 2.40 and 0.38 GPa, respectively, as determined by a nanoindenter. Copyright © 2005 Society of Chemical Industry     

Modelling the effects of dam removal on migratory walleye (Sander vitreus) early life‐history stages

Many dams in the USA have outlived their intended purpose and an increasing number are being considered for removal. Yet, quantitative studies of the potential physical, biological and ecological responses are needed to assess dam removal decisions. In this paper, the responses of migratory walleye (Sander vitreus) to increased spawning habitat availability as a result of dam removal was studied by comparing scenarios with and without a high‐head dam in the Sandusky River (Ohio), a major tributary to Lake Erie. A conceptual, ecological model was proposed to define the relationship between hydrodynamics and walleye spawning, egg hatching, larval drift and survival. A mathematical, ecological model of the early life‐history stages was then developed and coupled with time series of depth and velocity predictions over the spawning grounds from a 1‐D hydrodynamic model. Model simulations were run for 1984–1993 for both the with‐ and without‐dam scenarios to assess the potential benefit of dam removal. The simulation results demonstrated that velocity, depth and water temperature are major factors influencing adult walleye spawning success. Without the dam, 10 times the amount of spawning habitat would be available for walleye to spawn. This increase in spawning habitat area resulted in up to five times the total egg deposition and seven times the larval output to the nursing grounds, based on the assumption that 5% of the walleye population of Lake Erie migrated up the Sandusky River to spawn. We concluded that the spawning habitat in the current condition (with the dam) is limiting and additional spawning habitat upstream could significantly increase the number of larval walleye drifting to Lake Erie. The model sensitivity analysis showed that the number of walleye migrating up the river in spring is the dominant factor for larval recruitment to the lake. Copyright © 2006 John Wiley & Sons, Ltd.     

针对医疗设备的精确电池备份

本文通过测试测量方案介绍了如何进行医疗设备的精确电池备份。