Temporary Clipping of the Intracavernous Internal Carotid Artery: A Novel Technique for Proximal Control

BACKGROUND Securing proximal control in complex paraclinoid aneurysm surgery through traditional techniques may be challenging and risky in certain situations. Advancements of anatomical knowledge of the cavernous sinus (CS) and hemostasis have made it more accessible as a surgical option. OBJECTIVE To describe the technique of temporary clipping of the horizontal segment of the intracavernous internal carotid artery (IC-ICA) in preparation for permanent clipping of complex paraclinoid aneurysms. METHODS Through an extradural pretemporal approach, the lateral wall of the CS is exposed. The dura between the trochlear nerve and V1 is opened, and access is made to the horizontal segment of the IC-ICA. After circumferential dissection, the temporary clip can be introduced to the artery, and the extradural clinoidectomy can be continued under secured proximal control. RESULTS Seven patients with complex paraclinoid aneurysms were treated between May 2013 and May 2016 by the senior author. Temporary clipping of the IC-ICA was performed in all cases. Average time to achieve proximal control was 22.6 min (22.6 ± 13.8). One patient developed transient oculomotor palsy postoperatively. There were no other complications. CONCLUSION When the exposed clinoidal segment of the internal carotid artery does not offer sufficient proximal space for temporary clipping, the extradural approach can be extended to the horizontal portion of the IC-ICA. In our experience, this technique is a quick, reliable, and safe alternative to the classical modalities of temporary occlusion.

Wilkie’s syndrome. Analysis of 150 cases of the Iberian and Ibero-American medical literature

Willkie’s syndrome or superior mesenteric artery (SMA) syndrome is a rare cause of gastrointestinal obstruction, due to exterior compression of the horizontal part of the duodenum by the SMA. For the study of the clinical, diagnostic and therapeutic characteristics of Wilkie’s syndrome in the Iberian and Ibero-American population, we compiled the reports of 150 cases by Iberican and Ibero-American authors, and we found a predominance of cases in females over males in a ratio of 2.57: 1. Fifty percent of the cases were in patients under 20-years of age, with the highest number of cases in schoolchildren and adolescents. The most frequent symptoms were abdominal pain, vomiting and weight loss. The disease had two forms of presentation: acute with signs of high intestinal obstruction (16.47%), and chronic (83.53%). Diagnostic radiographic studies showed in of the upper gastrointestinal tract narrowing of the horizontal portion of the duodenum and delay in the transit of contrast through the gastroduodenal region, with or without gastroduodenal dilation in 85% of cases. In computed tomographic studies it was observed decreased mesenteric-aortic angle and distance. Upper endoscopic studies showed narrowing of the horizontal part of the duodenum, with or without gastroduodenal dilation in 61.90% of cases. Of the 144 patients that received treatment, 94 cases received medical treatment, with a success rate of 62.77%; and 84 cases required surgical treatment, 59.52% of these, upon admission. The most practiced surgical procedure was laterolateral duodenojejunostomy in 70.24% of cases. We concluded that Wilkie’s syndrome is an entity that results from the reduction of the mesenteric-aortic angle and distance, with two forms of presentation: acute and chronic, that required surgical treatment in 58.33% of cases.

HugeNon-Organ Retroperitoneal Tumor inCombination with aCystoma of Uterine Appendages

The article describes the experience of successful diagnostics and treatment of giant non-organ extraperitoneal tumor combined with a cystoma of uterine appendages.Patient P., 43 years old, was hospitalized in the oncology department, diagnosed with “Abdominal tumor, right ovary?” The state was satisfactory, after palpation of the abdomen, a lumpy formation of a densely elastic consistency, from the womb to the epigastric region, was found. An ultrasound revealed a homogeneous tumor formation 30×28 cm from the border of the uterus to the liver. When performing median laparotomy, a dumbbell-shaped tumor (36×26×20 cm) was found in the retroperitoneal space with involvement of the mesentery of the small intestine, lower horizontal portion of the duodenum, mesentery of the transverse colon, superior mesenteric vessels, aorta and jejunum. In the right appendages, a cystoma 12–15 cm in diameter was found, with inversion and necrosis. Adnexectomy was performed. An express lymph node biopsy revealed cells suspicious for malignancy. The tumor was mobilized and removed as a single unit with retroperitoneal tissue, lymph nodes in combination with resection of 70 cm of the jejunum and fenestrated resection of the duodenum. The resulting gut defect 9×7 cm was sutured with a precision single-row suture. Inter-intestinal anastomosis “endto-end” was formed. Nasointestinal intubation was performed. The abdominal cavity was sutured, and two tubular drainages were installed. The postoperative period was uneventful. The histological conclusion: fibrous histiocytoma of the mesentery of the intestine with malignancy in the center of the node, in the ovary – total hemorrhagic infiltration of all layers, edema. The tumor conference consultation was recommended. After 1.5 years, the patient was admitted with the same clinical picture. During laparotomy, a tumor recurrence was discovered, the nodes of which were located in the retroperitoneal space, in the abdominal cavity with invasion to organs and large vessels. The case was recognized as inoperable, the laparotomic wound was closed completely. Sixteen days after surgery the patient was discharged.

Asymptotic behaviour of dam break flow for small times

Двумерное импульсное течение жидкости изучается в рамках теории потенциального потока. Первоначально жидкость находится в состоянии покоя и удерживается на одной стороне вертикальной пластины. Она внезапно убирается и поток жидкости начинает течь под действием силы тяжести. Внимание уделяется особому поведению поля скоростей в нижней точке, где вертикальная свободная поверхность встречается с жестким дном. Линейная задача решается методом рядов Фурье. Решение внутренней области находится с помощью преобразования Меллина в нижней точке. Формирование струи наблюдается в нижней точке. Разрыв в верхней угловой точке исследуется с помощью Лагранжевых переменных. Для внешней задачи второго порядка используется метод декомпозиции области. Сравнение форм свободных поверхностей вблизи верхней угловой точки с решениями переднего и второго порядка показывает, что внешнее решение второго порядка имеет большее различие в вертикальной свободной поверхности, чем в горизонтальной части, по сравнению с решением ведущего порядка. Получена картина форм свободных поверхностей с использованием Лагранжевого описания для верхней части и Эйлерого описания для нижней части во втором порядке. Two dimensional impulsive flow of a fluid is studied within the potential flow theory. Initially the fluid is at rest and is held on one side of a vertical plate. The plate is withdrawn suddenly and gravity driven flow of the fluid starts. Attention is paid to the singular behaviour of the velocity field at the bottom point, where the vertical free surface meets the rigid bottom. The linear problem is solved by the Fourier series method. An inner region solution is found using Mellin transform at the bottom point. The jet formation is observed at the bottom point. Also the discontinuity at the upper corner point is dealt with Lagrangian variables. For the second order outer problem, domain decomposition method is used. Comparison of the shapes of the free surfaces near the upper corner point with leading and second order solutions shows that the second order outer solution outer makes a larger difference in the vertical free surface than in the horizontal portion, compared with leading order solution.The complete picture of the shapes of the free surfaces using Lagrangian description for the upper part and Eulerian description for the bottom part at the second order is obtained.

fMRI Evidence of Magnitude Manipulation during Numerical Order Processing in Congenitally Deaf Signers

Congenital deafness is often compensated by early sign language use leading to typical language development with corresponding neural underpinnings. However, deaf individuals are frequently reported to have poorer numerical abilities than hearing individuals and it is not known whether the underlying neuronal networks differ between groups. In the present study, adult deaf signers and hearing nonsigners performed a digit and letter order tasks, during functional magnetic resonance imaging. We found the neuronal networks recruited in the two tasks to be generally similar across groups, with significant activation in the dorsal visual stream for the letter order task, suggesting letter identification and position encoding. For the digit order task, no significant activation was found for either of the two groups. Region of interest analyses on parietal numerical processing regions revealed different patterns of activation across groups. Importantly, deaf signers showed significant activation in the right horizontal portion of the intraparietal sulcus for the digit order task, suggesting engagement of magnitude manipulation during numerical order processing in this group.

Shear resistance of welded inclined bars in rectangular reinforced concrete beams

The bent-up bars have not been used as shear reinforcement in beams since the past 40 years or so. In all cases of design and construction nowadays, shear forces are resisted by vertical links only. Some complications in installing the multiple set of bent-up bars, the less opportunity to have sufficient number of bent-up bars due to small number of flexural reinforcement provided at the mid-span of the beams and also the large anchorage required for the horizontal portion of the bars beyond the upper end of the bend could be the reasons behind this. This paper presents the results of tests on five rectangular reinforced concrete beams in which the effectiveness of welded inclined bars (WIB) as shear reinforcement was studied. Two of the beams were controlled specimens, with no shear reinforcement in one, and full design vertical links in another. The other three beams were provided with three different quantities of WIB, measured in terms of area to distance ratio, Asw / S as shear reinforcement in the shear spans. All beams were tested to failure under two point loads with a shear span to effective depth ratio of 2.34, which would ensure that the failure was due to shear unless their shear capacities were larger than the flexural capacity. The performances of the beams were measured in terms of deflection, crack formation, strains in WIB and on the concrete surfaces in the shear region, ultimate loads and failure modes. The results show that WIB alone is capable of carrying the whole shear forces in the beam, and larger shear capacities are achieved with a larger quantity of WIB, and a higher grade of the bars used. The beam with WIB requires 22% less in the quantity of Asw / S compared to that with vertical links to achieve the same shear resistance. These suggest that WIB can be used as an effective system of shear reinforcement in beams.

Impact of UV pulsed laser radiation and of the electron flow on dielectric states of polymer composite nanomaterial based on LDPE matrix

The influence of the soft electron flow and irradiating pulsed UV laser on dielectric states of polymer composite nanomaterial based on LDPE matrix is experimentally studied. It was shown that irradiation of the samples LDPE–ZnO by electron beam (10 keV) for 10–15 minutes gives rise the appearance of the horizontal portion of the temperature dependence of capacitance (permittivity) and to memory effect (slow relaxation of dielectric situation within a few days). Irradiation with pulsed UV laser of the LDPE–CdS sample allows you to switch into a conducting state and return it to their original state upon application of a weak electric field. The observed phenomena may find practical applications for the polymer electronic memories and switching devices.

A Compact Dual-Band Circularly Polarized Antenna with Wide HPBWs for CNSS Applications

A compact dual-band circularly polarized antenna with wide half-power beamwidths (HPBWs) for compass navigation satellite system applications is proposed in this paper. The CP radiation is realized by arranging four compact dual-band inverted-F monopoles symmetrically to the center point, where the four monopoles are excited with a 90° phase offset through a compact sequential-phase feeding network. The compactness of the dual-band inverted-F monopole is realized by inserting two chip inductors in the horizontal portion of the monopole. The overall dimension of the antenna is only 0.211λ0 × 0.211λ0 × 0.057λ0, where λ0 is the corresponding free-space wavelength at 1.268 GHz. Experimental results show that the proposed antenna exhibits two overlapped impedance and axial ratio bandwidths of 50 MHz (1.236–1.286 GHz) and 40 MHz (1.532–1.572 GHz). Wide HPBWs of about 120°/125° and 121°/116° (XOZ/YOZ planes) at center frequencies (1.268, 1.561 GHz) of the CNSS-2 B3 and B1 bands are obtained, respectively. With these good performances, the antenna can be a good candidate for CNSS applications.