Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients

OBJECTIVE: Treatment of central and paracentral pulmonary embolism in patients with hemodynamic compromise remains a subject of debate, and no consensus exists regarding the best method: thrombolytic agents, catheter-based thrombus aspiration or fragmentation, or surgical embolectomy. We reviewed our experience with emergency surgical pulmonary embolectomy. METHODS: Between January of 2000 and March of 2007, 25 patients (17 male, mean age 60 years) underwent emergency open embolectomy for central and paracentral pulmonary embolism. Eighteen patients presented in cardiogenic shock, 8 of whom had cardiac arrest and required cardiopulmonary resuscitation. All patients underwent operation with mild hypothermic cardiopulmonary bypass. Concomitant procedures were performed in 8 patients (3 coronary artery bypass grafts, 2 patent foramen ovale closures, 4 ligations of the left atrial appendage, 3 removals of a right atrial thrombus). Follow-up is 96% complete with a median of 2 years (range, 2 months to 6 years). RESULTS: All patients survived the procedure, but 2 patients died in the hospital on postoperative days 1 (intracerebral bleeding) and 11 (multiorgan failure), accounting for a 30-day mortality of 8% (95% confidence interval: 0.98-0.26). Four patients died later because of their underlying disease. Pre- and postoperative echocardiographic pressure measurements demonstrated the reduction of the pulmonary hypertension to half of the systemic pressure values or less. CONCLUSION: Surgical pulmonary embolectomy is an excellent option for patients with major pulmonary embolism and can be performed with minimal mortality and morbidity. Even patients who present with cardiac arrest and require preoperative cardiopulmonary resuscitation show satisfying results. Immediate surgical desobstruction favorably influences the pulmonary pressure and the recovery of right ventricular function, and remains the treatment of choice for patients with massive central and paracentral embolism with hemodynamic and respiratory compromise.

Surgical approach in massive intraoperative atherosclerotic embolism

We describe a case of massive embolization of atherosclerotic material during aortic cannulation and the surgical approach chosen to treat it, that is, retrograde cerebral perfusion and subtotal arch replacement in deep hypothermic circulatory arrest.

Massive intraoperative thrombus of the aortic arch and proximal descending aorta

A 49-year-old male patient presented with a paravalvular leakage 18 years after aortic valve replacement. The patient received a mechanical valve and was weaned uneventfully from cardiopulmonary bypass. After a drop in the pressure curve of the left radial artery an additional line was placed in the proximal ascending aorta showing normal systemic pressure. Transesophageal echocardiography showed a massive circular thrombosis of the distal aortic arch. The patient received a covered stent to expand the residual aortic lumen and left the hospital in good health.

Massive Boson Production at Small qT in Soft-Collinear Effective Theory

We study the differential cross sections for electroweak gauge-boson and Higgs production at small and very small transverse-momentum qT. Large logarithms are resummed using soft-collinear effective theory. The collinear anomaly generates a non-perturbative scale q⁎, which protects the processes from receiving large long-distance hadronic contributions. A numerical comparison of our predictions with data on the transverse-momentum distribution in Z-boson production at the Tevatron and LHC is given.

Search for pair-produced massive coloured scalars in four-jet final states with the ATLAS detector in proton-proton collisions at sqrts=7 TeV

A search for pair-produced massive coloured scalar particles decaying to a four-jet final state is performed by the ATLAS experiment at the LHC in proton-proton collisions at root s = 7 TeV. The analysed data sample corresponds to an integrated luminosity of 4.6 fb(-1). No deviation from the Standard Model is observed in the invariant mass spectrum of the two-jet pairs. A limit on the scalar gluon pair production cross section of 70 pb (10 pb) is obtained at the 95 % confidence level for a scalar gluon mass of 150 GeV (350 GeV). Interpreting these results as mass limits on scalar gluons, masses ranging from 150 GeV to 287 GeV are excluded at the 95 % confidence level.

NLL QCD contribution of the electromagnetic dipole operator to B -> Xs gamma gamma with a massive strange quark

We calculate the O(αs) corrections to the double differential decay width dΓ77/(ds1ds2) for the process B¯→Xsγγ, originating from diagrams involving the electromagnetic dipole operator O7. The kinematical variables s1 and s2 are defined as si=(pb−qi)2/m2b, where pb, q1, q2 are the momenta of the b quark and two photons. We introduce a nonzero mass ms for the strange quark to regulate configurations where the gluon or one of the photons become collinear with the strange quark and retain terms which are logarithmic in ms, while discarding terms which go to zero in the limit ms→0. When combining virtual and bremsstrahlung corrections, the infrared and collinear singularities induced by soft and/or collinear gluons drop out. By our cuts the photons do not become soft, but one of them can become collinear with the strange quark. This implies that in the final result a single logarithm of ms survives. In principle, the configurations with collinear photon emission could be treated using fragmentation functions. In a related work we find that similar results can be obtained when simply interpreting ms appearing in the final result as a constituent mass. We do so in the present paper and vary ms between 400 and 600 MeV in the numerics. This work extends a previous paper by us, where only the leading power terms with respect to the (normalized) hadronic mass s3=(pb−q1−q2)2/m2b were taken into account in the underlying triple differential decay width dΓ77/(ds1ds2ds3).

Graphics Processor Unit Based Parallelization of Optimized Baseline Wander Filtering Algorithms for Long-term Electrocardiography

Long-term electrocardiogram (ECG) often suffers from relevant noise. Baseline wander in particular is pronounced in ECG recordings using dry or esophageal electrodes, which are dedicated for prolonged registration. While analog high-pass filters introduce phase distortions, reliable offline filtering of the baseline wander implies a computational burden that has to be put in relation to the increase in signal-to-baseline ratio (SBR). Here we present a graphics processor unit (GPU) based parallelization method to speed up offline baseline wander filter algorithms, namely the wavelet, finite, and infinite impulse response, moving mean, and moving median filter. Individual filter parameters were optimized with respect to the SBR increase based on ECGs from the Physionet database superimposed to auto-regressive modeled, real baseline wander. A Monte-Carlo simulation showed that for low input SBR the moving median filter outperforms any other method but negatively affects ECG wave detection. In contrast, the infinite impulse response filter is preferred in case of high input SBR. However, the parallelized wavelet filter is processed 500 and 4 times faster than these two algorithms on the GPU, respectively, and offers superior baseline wander suppression in low SBR situations. Using a signal segment of 64 mega samples that is filtered as entire unit, wavelet filtering of a 7-day high-resolution ECG is computed within less than 3 seconds. Taking the high filtering speed into account, the GPU wavelet filter is the most efficient method to remove baseline wander present in long-term ECGs, with which computational burden can be strongly reduced.

Volcanostratigraphic Controls on the Occurrence of Massive Sulfide (VMS) Deposits in the Semail Ophiolite, Oman

The Semail ophiolite in Oman is capped by up to 2 km of basaltic-andesitic lavas that host copper-dominant, Cyprus-type, volcanogenic massive sulfide (VMS) deposits. This study identifies multiple volcanostratigraphic horizons on which the deposits are situated, based on characterization of footwall and hanging-wall lavas from 16 deposits or deposit clusters. Comparison of field and petrographic features, compositions of igneous clinopyroxenes, and whole-rock geochemical signatures permits classification of the lavas within a modified version of the established regional volcanostratigraphy. Four extrusive units host deposits: Geotimes (earliest), Lasail, Alley, and Boninitic Alley (latest). The latter was previously known only at few localities, but this study reveals its regional extent and significance as a host for VMS deposits. The Geotimes and Lasail units represent Late Cretaceous, ocean spreading ridge and related off-axis volcanic environments, respectively. The Alley and Boninitic Alley units represent younger, subduction-related volcanism prior to Coniacian-Santonian obduction of the ophiolite. Our results show that VMS deposits occur on or near the Geotimes/Lasail and Geotimes/Alley contacts as well as entirely within the Geotimes, Lasail, Alley, and Boninitic Alley units. Highest Cu grades tend to occur in deposits lying on or within the Geotimes, whereas highest Au grades occur in deposits within the Boninitic Alley. In contrast to earlier studies, we conclude that essentially every horizon marking a hiatus in lava deposition in the Semail ophiolite, i.e., contacts between the four major eruptive units, and umbers and sedimentary chert layers within the units, has exploration potential for Cu-Au VMS deposits.

Influence of quantized massive matter fields on the Casimir effect

Charged massive matter fields of spin-0 and spin- 1/2 are quantized in the presence of an external uniform magnetic field in a spatial region bounded by two parallel plates. The most general set of boundary conditions at the plates, that is required by mathematical consistency and the self-adjointness of the Hamiltonian operator, is employed. The vacuum fluctuations of the matter field in the case of the magnetic field orthogonal to the plates are analyzed, and it is shown that the pressure from the vacuum onto the plates is positive and independent of the boundary condition, as well as of the distance between the plates. Possibilities of the detection of this new-type Casimir effect are discussed. Read More: http://www.worldscientific.com/doi/10.1142/S0217732315500996