Prolonged Orbital Relaxation by Locally Modified Phonon Density of States for the SiV

Coherent quantum systems are a key resource for emerging quantum technology. Solid-state spin systems are of particular importance for compact and scalable devices. However, interaction with the solid-state host degrades the coherence properties. The negatively charged silicon vacancy center in diamond is such an example. While spectral properties are outstanding, with optical coherence protected by the defects symmetry, the spin coherence is susceptible to rapid orbital relaxation limiting the spin dephasing time. A prolongation of the orbital relaxation time is therefore of utmost urgency and has been tackled by operating at very low temperatures or by introducing large strain. However, both methods have significant drawbacks: the former requires use of dilution refrigerators and the latter affects intrinsic symmetries. Here, a novel method is presented to prolong the orbital relaxation with a locally modified phonon density of states in the relevant frequency range, by restricting the diamond host to below 100 nm. Subsequently measured coherent population trapping shows an extended spin dephasing time compared to the phonon-limited time in a pure bulk diamond. The method works at liquid helium temperatures of few Kelvin and in the low-strain regime.

Combined intestine and kidney transplantation in a patient with encapsulating peritoneal sclerosis: case report.

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis characterized by fibrosis and calcification of the intestine that, in severe cases, can progress to intestinal failure and total parenteral nutrition dependency. Medical and surgical interventions carry a poor prognosis in these patients. We describe a case of a 36-year-old female with end-stage kidney disease and severe EPS not amenable to surgical intervention who underwent a combined intestinal and kidney transplantation. At 3 years posttransplantation, the patient has normal intestinal and kidney function. This represents, to our knowledge, the first report of severe EPS and end-stage kidney disease treated with a combined transplant.

Hypouricemia in total parenteral nutrition.

Profound hypouricemia developed in significant number of patients receiving total parenteral nutrition. Nadir serum uric acid (values between 1 and 2.7 mg/100 ml) were noted between the 2nd and 17th day of the course. Return of serum uric acid to pretreatment values was noted within seven days after the termination of total parenteral nutrition. In an effort to explain this phenomenon urine uric acid and uric acid clearance were measured in a subsequent group of patients before and during the course of total parenteral nutrition was not directly identified.

Renal failure in surgical patients. Treatment with intravenous essential amino acids and hypertonic glucose.

Solutions containing balanced quantities of essential L-amino acids, hypertonic glucose, and other essential nutrients were administered by vein to ten patients who had acute or chronic renal failure associated with or resulting from catastrophic complications precluding use of the gastrointestinal tract for alimentation. Weight gain, wound healing, and positive nitrogen balance occurred uniformly during periods of total intravenous nutrition, while blood urea nitrogen remained stable or decreased and the signs and symptoms of azotemia resolved. Restoration of nutritional balance and achievement of protein synthesis is possible in patients who have renal failure and gastrointestinal dysfunction by the judicious administration of high biologic value diets exclusively by vein.

Results of surgical treatment of periampullary tumors: a thirty-five-year experience.

Data on 126 consecutive patients with periampullary tumors resected at the Cleveland Clinic between January 1950 and December 1984 were reviewed. One hundred five patients underwent pancreatoduodenal resection, 10 patients total pancreatectomy, and 11 patients local resection of the tumor. The site of tumor was ampulla of Vater (59), head of the pancreas (30), duodenum (20), and distal common bile duct (11). Six patients had benign disease. The operative mortality rate for radical resection for the entire period was 7.8%; it has declined to 5.4% since 1974. The operative mortality rate for local resection was 9.1% (one patient). The overall 5-year survival rate for all malignant tumors of the periampullary area was 28% and 25.5% for invasive adenocarcinoma. Survival was affected primarily by location and histologic findings. The 5-year survival rate for adenocarcinoma of the ampulla of Vater was 37.2%, 27.5% for the duodenum, 16.7% for the distal common bile, and 4.3% for the pancreas (p = 0.0001). Papillary adenocarcinoma had a 5-year survival rate of 49.2% in contrast to 18.4% for nonpapillary ductal adenocarcinoma (p = 0.002). Patients with ampullary adenocarcinoma treated by local resection had a 5-year survival rate of 40.9%. These data justify continued use of a selective radical approach in the resection of most periampullary tumors with local resection for small tumors in high-risk patients.

Maintenance of home hyperalimentation in patients with high-output jejunostomies.

We studied four patients with high-output end jejunostomies (greater than 3,000 mL/day) who were receiving home hyperalimentation. With knowledge of urine and stoma output, standard total parenteral nutrition fluid was infused and titrated according to individual needs, first during the hospital stay and then on follow-up office visits. Mean daily stoma output for the group was 3,556 mL/day. With oral fluid intake restricted to 1,500 mL/day, average daily stoma output dropped to 2,892 mL. The mean daily volume of nutrient fluid required to achieve stabel biochemistries and weight was 3,550 mL. Daily caloric requirements ranged from 23 kcal/kg to 44 kcal/kg, with a mean of 32.5 kcal/kg. Amino acid requirements averaged 1.6 g/kg. With 65 patient months of continuous overnight catheter infusion, there have been no serious metabolic derangements or deaths. The program of home hyperalimentation can maintain a satisfactory metabolic state in patients with high-output jejunostomies.

Metastatic axillary adenopathy. Use of estrogen receptor protein as an aid in diagnosis.

In a patient with nonpalpable carcinoma of the breast, the diagnosis from a metastalic axillary node was made by measuring estrogen receptor protein (ERP). The specificity of the technique makes it useful as a diagnostic aid in a patient with mammogram negative for tumor.

Nitrogen balance in adult hospitalized patients with the use of a pediatric amino acid model.

Normalization of plasma amino acid patterns and that relationship to improved nitrogen balance was studied using a pediatric-specific amino acid solution in 21 adults requiring total parenteral nutrition therapy. There was a significantly positive correlation between improved nitrogen balance and the amino acids cystine, tyrosine, total cysteine/cystine, and ornithine. When additional cysteine was added to the solution of 11 subjects, taurine also correlated with nitrogen balance. Despite higher amounts of histidine in solution, plasma amino acid levels were not normalized. These amino acids, heretofore considered nonessential, may be required in specific molar ratios in stress. The use of a 30% branched-chain pediatric-balanced amino acid solution resulted in near normalization of plasma amino acid levels and group mean positive nitrogen balance.

Predicting the likelihood of residual disease in women treated for ductal carcinoma in situ.

BACKGROUND: To identify women at risk for residual disease after excision of ductal carcinoma in situ (DCIS), we assessed the relationship between characteristics of the initial biopsy and the presence of residual DCIS at a subsequent operation. STUDY DESIGN: We identified 134 consecutive "paired" operations from 112 women who had undergone 2 or more operations for DCIS between February 1995 and December 1996. Cancer status of the margins, patient age and leading presentation, tumor subtype and grade, and the presence of multifocal-extensive disease were assessed as potential predictors. RESULTS: Residual DCIS was found in 60 patients (45%): in 2 of 12 patients (17%) with negative margins, in 11 of 36 (31%) with close margins (< 2 mm), in 30 of 52 (58%) with positive margins, and in 17 of 34 patients (50%) with margins of unknown status. Patients with positive or unknown margins were 7.7 and 8.3 times, respectively, more likely to have residual disease than patients with negative margins (95% CI 1.1-59.1; 1.1-66.4). Patients with clinical presentations were 8.0 times more likely to have residual disease than patients who presented with abnormal mammograms (95% CI 2.3-27.6). Multifocal-extensive DCIS was associated with residual disease (adjusted odds ratio [OR] = 7.7, 95% CI 2.9-20.5), as was comedo subtype (OR = 2.7, 95% CI 1.1-6.7). CONCLUSIONS: Positive or unknown biopsy margins, a clinical presentation, multifocal-extensive cancer, and the comedo subtype are associated with higher risk of residual DCIS.

A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report.

BACKGROUND: Uncontrolled studies using laparoscopic techniques in colorectal surgery have not demonstrated clear advantages to these procedures compared with conventional ones, and surgeons are concerned about unusual early recurrences reported after laparoscopic colorectal cancer surgery. STUDY DESIGN: We conducted a prospective, randomized trial in one surgical department comparing laparoscopic (LAP) and conventional (CON) techniques in 109 patients undergoing bowel resection for colorectal cancers or polyps. Postoperatively, all patients underwent measurement of pulmonary function tests every 12 hours, and were treated identically on a highly controlled protocol with regard to analgesic administration, feeding, and postoperative care. RESULTS: Of the 55 patients assigned to LAP and 54 to the CON group, there were 42 and 38 with cancer, respectively (the other patients had large adenomas). Overall recovery of 80% of forced expiratory volume in 1 second and forced vital capacity was a median of 3 days for LAP and 6.0 days for CON (p = 0.01). LAP patients used significantly less morphine than CON patients up to the second day after surgery (0.78 +/- 0.32 versus 0.92 +/- 0.34 mg/kg per day, p = 0.02). Flatus returned a median of 3.0 days after LAP versus 4.0 days after CON surgery (p = 0.006). Tumor margins were clear in all patients. After a median followup of 1.5 years (LAP) and 1.7 years (CON), there were no port site recurrences in the LAP group. Seven cancer-related deaths have occurred (three in the LAP group, four in the CON group). CONCLUSIONS: Within this prospective, randomized trial, laparoscopic techniques were as safe as conventional surgical techniques and offered a faster recovery of pulmonary and gastrointestinal function compared with conventional surgery for selected patients undergoing large bowel resection for cancer or polyps. There were no apparent shortterm oncologic disadvantages. Longer followup is needed to fully assess oncologic outcomes.

Home parenteral nutrition for the short bowel syndrome. Psychological issues.

Home parenteral nutrition (HPN) for the short bowel syndrome represents a treatment modality that raises issues about prolonged machine dependency for living. Psychological reactions are described for patients with inflammatory bowel disorders and anatomical loss of small bowel. Liaison psychiatry involvement with 50 patients in the HPN program has identified such problems as grief reactions, depression, organic brain syndromes, drug dependency, and body image changes as they influence the initial adjustment to the in-hospital phase of HPN learning for patient and family. The importance of family and mental status examination are emphasized in the evaluation of the patient before and during the institution of an PHN program. Outlined are psychological parameters that need to be considered when assessing what factors might impede or enhance the acquisition and use of HPN information.

Morbidity and mortality related to home parenteral nutrition in patients with gut failure.

The clinical course of 39 patients on HPN for 5.5 years at The Cleveland Clinic Foundation were reviewed. Rehospitalization and mortality rates were relatively low in this group of patients who had significant disease processes. Rehospitalization and mortality were usually due to the primary underlying disease process rather than to the therapy. HPN is an efficacious, therapeutic modality that helps return patients with gut failure to a near normal life-style.

Computed tomography: a valuable aid to the abdominal surgeon.

The application of computed tomography (CT) for diseases of the liver, pancreas, kidney, and retroperitoneum has been described. The diagnostic accuracy of CT when compared with angiography, radioisotope scanning, endoscopic pancreatography, and transhepatic cholangiography is now being studied prospectively. The attractive features of CT include low risk, wide applicability, noninvasive technics, high diagnostic accuracy, and patient acceptance.

Reversal of severe fatty hepatic infiltration after intestinal bypass for morbid obesity by calorie-free amino acid infusion.

Hepatic fatty infiltration complicating jejunoileal bypass can be massive and may require restoration of gastrointestinal continuity. This fatty infiltration appears to be caused by protein depletion associated with adequate or high carbohydrate intake. The present study has shown that calorie-free amino acid alimentation can reverse these changes. In three of thirteen patients who underwent 12 inch to 6 inch jejunoileal bypass procedures, symptomatic hepatomegaly developed with near total replacement of hepatocytes by massive fatty infiltration. After undergoing liver scan, liver biopsy, and liver function tests, the patients were started on a peripheral infusion of 2L per day of a 4.25 per cent crystalline amino acid solution, allowing for fat mobilization while preserving body protein stores. All oral intake was withheld except for water. At the end of a fourteen to twenty-one day infusion period, serum albumin levels increased by 1 gm in all patients. Decreases in liver volume of 83, 45, and 40 per cent occurred. During the infusion period ketonuria was 4 plus in all patients indicating active lipolysis. Weight loss was impressive (17, 19, and 40 pounds). All patients showed marked symptomatic improvement, and postinfusion liver biopsy specimens showed a return to near normal architecture. Maintenance of normal liver size by a high-protein, low-carbohydrate diet was observed in a five to seven month follow-up period. In contrast to previous studies using standard hyperalimentation solutions, the use of calorie-free amino acid solutions reverses the hepatic fatty infiltration seen after intestinal bypass by mobilization of fat. This fat mobilization does not occur as readily in the presence of large amounts of glucose.

A century of home parenteral nutrition for Crohn's disease.

During an 11-year period, 41 patients with Crohn's disease were placed on home parenteral nutrition (HPN) for a mean of 1,083 days (range: 33 to 3,258 days). Data were retrospectively analyzed to determine whether HPN had an effect on the course of their disease, i.e., on the number of operative procedures performed and the intensity of required medical therapy. Data represented information obtained during a total of 121 patient-years of HPN for Crohn's disease. The main indications for HPN were short bowel syndrome (66%) and high stoma output. Twenty-four of 41 patients (59%) underwent surgery for Crohn's disease during the course of HPN. There was no significant difference between the number of procedures performed per patient per year of Crohn's disease during pre-HPN and HPN periods (p greater than 0.25). Although there was no significant change in body weight, both serum albumin and transferrin levels increased during HPN (p less than 0.01 and p less than 0.01, respectively). Twenty-nine percent of patients were taking prednisone while on HPN, compared with 54% of patients during the pre-HPN period (p less than 0.01). HPN appeared to result in a significant improvement in the numerically assessed quality of life. During the HPN period, 24 patients had 1 or more HPN-related complications that required 1 to 13 hospital admissions (mean: 1.8). These complications included catheter sepsis in 19 patients, blocked or damaged catheters in 15 patients, and dehydration and/or electrolyte imbalance in 5 patients. Eight patients died, with 7% of deaths secondary to catheter-related sepsis. Although permanent HPN is associated with an identifiable morbidity and mortality and is not associated with a reduction in the frequency of surgery for Crohn's disease, benefits include a decrease in the intensity of medical therapy, an improvement in patients' nutritional state, and a significant perceived improvement in patients' quality of life. Without HPN, we believe all patients would have died secondary to malnutrition and/or dehydration.

Modified radical mastectomy.

The recent history of operations for breast cancer indicates a growing trend toward conservatism. The modified radical mastectomy achieves the goal of removing all evidence of cancer in the breast involved and removes the regional lymph nodes for accurate staging of the disease. In addition, it provides a cosmetic result superior to that of the standard radical mastectomy. Breast reconstruction may be undertaken at a later time with excellent result. The 5 and 10 year survival rates of comparable groups of patients after modified radical mastectomy and standard radical mastectomy appear to be almost identical.

The role of intravenous hyperalimentation in intestinal disease.

This article has dealt briefly with intravenous nutrition in intestinal disorders. The indications for its use and techniques of nutritional assessment have been stressed. The use of intravenous hyperalimentation in a few of the more common diseases of the small bowel and colon has been discussed. Every patient with disease of the small or large intestine has some degree of dysfunction in the gastrointestinal tract. In many instances, this functional impairment interferes with normal ingestion or absorption of nutrients and predisposes the patient to malnutrition. The presence of malnutrition increases the morbidity and mortality of surgery and can be reversed by using intravenous hyperalimentation. Those patients with extreme short bowel syndrome secondary to intestinal disease or its parenteral nutrition at home. We stress the importance of a team approach to hyperalimentation. The evolution of a team of nutritional experts will improve the care of the patient and the education of the patient and physician and make nutritional support more readily available to those medical and surgical patients in need.

Home parenteral nutrition.

Home parenteral nutrition is a life-sustaining mode of therapy for patients with short bowel syndrome that is unresponsive to conventional therapy. It requires learning specialized skills through an intensive training program and carefully following this program in a home setting. This training can be best provided by a group of health care specialists including a physician, nurse, dietitian, psychiatrist, social worker, and pharmacist who are knowledgeable about the issues that face the patient requiring home parenteral nutrition. The resources of career medical centers ar most appropriately utilized to provide the support needed to successfully undertake a home parenteral nutrition program. The nutritional requirements of these truly long-term patients have to be more accurately defined to guarantee that macronutrient and micronutrient requirements are being adequately provided for over the many years of required treatment. Fluid delivery systems and techniques for infection-free long-term venous catheterization have to be perfected. Home parenteral nutrition is a valuable life support system for patients with gut failure. Although expensive, it costs substantially less than in-hospital parenteral nutrition and can return the patient to a near normal life at home.

Facile preparation of 6-chloro-9-amino-2-hydroxyacridine, a urinary metabolite of quinacrine and quinacrine mustard.

6-Chloro-9-amino-2-hydroxyacridine was found to be a metabolite of both quinacrine and the antimalarial alkylating agent quinacrine mustard. Its structure was confirmed by a one-step reaction of quinacrine with 48 percent hydrobromic acid. The presence of this compound as a metabolite of quinacrine mustard suggests a possible in vivo activation mechanism for its antitumor activity and a pharmacological basis for its toxicity to the liver. In vitro experiments showed that this new compound does react with chromosomes and, therefore, can be both a useful chromosome stain and an intercalating agent.

Exerience with the Broviac catheter for prolonged parenteral alimentation.

Home hyperalimentation is now recognized as a technique which allows patients with severe short bowel syndrome or inflammatory bowel disease to return to a near normal life style. The success of this program is dependent on the longterm use of a catheter through which intravenous fluids are infused. In the past 20 months, we have inserted 32 catheters into 22 patients for purposes of home parenteral nutrition. In a 1 to 20-month follow-up, the average duration of catheter insertion was 6 months, the longest has been 19 months in 2 patients. One patient with superior vena cava thrombosis has had a catheter inserted via a femoral vein which has been functioning well for 5 months. Thirteen catheters have been removed: 3 for obstruction, 2 for sepsis, 1 due to breakage of the catheter, 4 for slippage (3 were pulled out by the patient, and 1 was removed because of inability to psychologically accept the presence of the catheter). The removal of 6 of these 13 catheters was necessitated by breaks in the proper techniques of catheter care, which include daily dressing changes and heparinization of the catheter at least once daily. Techniques of catheter insertion and catheter care will be presented