Delayed post-surgical development of dural arteriovenous fistula after cervical meningocele repair

A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.

Aerodynamic performance of a bypass engine with fan nozzle exit area change by warped chevrons

Variation of the bypass nozzle exit area enables optimization of the turbofan engine operating cycle over a wider range of operational conditions resulting in improved thrust and/or fuel consumption. Two mechanisms for varying the nozzle area have been investigated. The first uses an array of chevrons which when closed, form a full body of revolution and when warped/curved, increase the exit area while forming a serrated trailing edge. The second technique incorporates an axially translating section of the nacelle shroud and uses the change in the nozzle boat-tail radial location with the axial location as a means to vary the nozzle exit area. To analyse the effects on a typical rotor/stator stage, computational fluid dynamics simulations of the NASA Rotor 67, Stator 67A stage integrated into a custom-built nacelle were performed. Nozzles with 8, 12, and 16 chevrons were simulated to evaluate the impact of the variation in geometry upon the nacelle wake and local forces. Gross thrust of the nacelle and the turbulent kinetic energy (TKE) variation through the wake is compared. The chevron nozzle attains a nearly 2 per cent maximum thrust improvement over the translating nozzle technique. The chevron nozzle also has significantly lower (nearly 8 per cent) peak TKE levels in the jet plume.

Does pre-operative estimation of oesophageal tumour metabolic length using F-18-fluorodeoxyglucose PET/CT images compare with surgical pathology length?

PURPOSE:
The aim of the study was to compare the pre-operative metabolic tumour length on FDG PET/CT with the resected pathological specimen in patients with oesophageal cancer.

METHODS:
All patients diagnosed with oesophageal carcinoma who had undergone staging PET/CT imaging between the period of June 2002 and May 2008 who were then suitable for curative surgery, either with or without neo-adjuvant chemotherapy, were included in this study. Metabolic tumour length was assessed using both visual analysis and a maximum standardised uptake value (SUV(max)) cutoff of 2.5.

RESULTS:
Thirty-nine patients proceeded directly to curative surgical resection, whereas 48 patients received neo-adjuvant chemotherapy, followed by curative surgery. The 95% limits of agreement in the surgical arm were more accurate when the metabolic tumour length was visually assessed with a mean difference of -0.05 cm (SD 2.16 cm) compared to a mean difference of +2.42 cm (SD 3.46 cm) when assessed with an SUV(max) cutoff of 2.5. In the neo-adjuvant group, the 95% limits of agreement were once again more accurate when assessed visually with a mean difference of -0.6 cm (SD 1.84 cm) compared to a mean difference of +1.58 cm (SD 3.1 cm) when assessed with an SUV(max) cutoff of 2.5.

CONCLUSION:
This study confirms the high accuracy of PET/CT in measuring gross target volume (GTV) length. A visual method for GTV length measurement was demonstrated to be superior and more accurate than when using an SUV(max) cutoff of 2.5. This has the potential of reducing the planning target volume with dose escalation to the tumour with a corresponding reduction in normal tissue complication probability.