The design of the n2EDM experiment: nEDM Collaboration.

We present the design of a next-generation experiment, n2EDM, currently under construction at the ultracold neutron source at the Paul Scherrer Institute (PSI) with the aim of carrying out a high-precision search for an electric dipole moment of the neutron. The project builds on experience gained with the previous apparatus operated at PSI until 2017, and is expected to deliver an order of magnitude better sensitivity with provision for further substantial improvements. An overview is of the experimental method and setup is given, the sensitivity requirements for the apparatus are derived, and its technical design is described.

Carotid artery dissection: a challenging diagnosis.

Spontaneous extracranial internal carotid artery dissection (ICAD) is a rare vascular event. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced clinicians of all specialties. This is a report of a patient who presented with symptomatic bilateral dissection manifested as partial Horner's syndrome. The diagnosis was made after several clinical evaluations with the use of duplex ultrasound and angiography.

Endovascular caval interruption in pregnant patients with deep vein thrombosis of the lower extremity.

PURPOSE: The choice of therapy for deep vein thrombosis (DVT) of the lower extremity during pregnancy has been widely debated. Warfarin passes through the placenta to the fetus and may cause fetal complications and/or death. Heparin, in contrast, does not cross the placenta, but its long-term use may be impractical and may increase the risk of bleeding, osteoporosis, and neurologic complications. The use of inferior vena cava filters in pregnancy has only been described as case reports in the English medical literature; therefore, this study reviews our experience on this subject. METHODS: We analyzed 18 pregnant patients who had Greenfield filters (GFs) inserted for DVT of the lower extremity, pulmonary embolism (PE), or both. The DVT diagnosis was made by means of duplex imaging. Conventional full-dose intravenous heparin was initiated until the filter was inserted, followed by subcutaneous heparin until labor, and continued for 6 weeks postpartum in 13 patients who were breast-feeding. Warfarin was given postpartum in the other five patients. RESULTS: The mean age of the patients was 25 years. The indications for GF insertion included 3 patients who had a PE while on anticoagulation, 2 patients with significant bleeding caused by anticoagulation, 4 patients with free-floating iliofemoral DVT, 2 patients with heparin-induced thrombocytopenia, and 7 patients with iliofemoropopliteal DVT occurring 1 to 3 weeks before labor, for prophylactic reasons. Fourteen of 18 cases were diagnosed in the third trimester of the patient's pregnancy. Filters were inserted via the right internal jugular vein by means of a cut-down technique in the first four patients (stainless steel filters) and percutaneously in 14 patients. The mean fluoroscopy time during filter insertion was less than 2 minutes. There was no fetal or maternal morbidity or mortality. During long-term follow-up (mean, 78 months), no PE or filter-related complications were encountered. CONCLUSION: GF insertion in pregnant patients with DVT of the lower extremity is safe and effective. Its prophylactic use in pregnant patients who have extensive iliofemoral DVT right before labor may be justified.

Familial synspondylism: progressive scoliosis and multiple hernias in a kinship.

A new genetic syndrome is reported of congenital lordoscoliosis due to lumbar segmentation defects and incomplete formation of lumbar vertebrae. The defect arose as a spontaneous mutation and was transmitted in an autosomal dominant fashion. The kindred included a mother and her three offspring. These affected individuals had several dysmorphic features including cavus feet and micrognathia. In addition the syndrome was associated with multiple hernias including inguinal, ventral, and diaphragmatic. These associated problems led to the early death of the first child at age 7 months. The lumbar scoliosis was already evident by that time. The progressive nature of the scoliosis was documented, especially in one child who was lost to follow-up and who was initially seen with a severe spinal deformity. Surgical management was required in members of the kindred, but because of differences in age and severity at the time of surgery, the techniques varied.

Frequency of postoperative carotid duplex surveillance and type of closure: results from a randomized trial.

BACKGROUND/PURPOSE: In several nonrandomized studies investigators have reported on the value of postoperative carotid duplex surveillance (PCDS) with mixed results; however the type of closure was not analyzed in these studies. In this study we analyze the frequency and timing of postoperative carotid duplex ultrasound scanning according to the type of closure from a randomized carotid endarterectomy (CEA) trial comparing primary closure (PC) versus patching. PATIENT POPULATION AND METHODS: We randomized 399 CEAs into 135 PCs, 134 polytetrafluoroethylene (PTFE) patch closures, and 130 vein patch closures (VPCs) with a mean follow-up of 47 months. PCDS was done at 1, 6, and 12 months and every year thereafter (a mean of 4.0 studies per artery). Kaplan-Meier analysis was used to estimate the rate of > or = 80% restenosis over time and the time frame of progression from < 50%, to 50%-79% and > or = 80% stenosis. RESULTS: Restenoses of > or =80% developed in 24 (21%) arteries with PC and nine (4%) with patching. Kaplan-Meier estimate of freedom of > or = 80% restenosis at 1, 2, 3, 4, and 5 years was 92%, 83%, 80%, 76%, and 68% for PC, respectively, and 100%, 99%, 98%, 98%, and 91% for patching, respectively, (P <.01). Of 56 arteries with 20% to 50% restenosis, two of 28 patch closures and 10 of 28 PCs progressed to 50% to < 80% restenosis (P =.02); none of the patch closures and six of 28 PCs progressed to > or =80% (P =.03). In PCs, the median time to progression from <50% to 50%-79%, < 50% to > or =80%, and 50%-79% to > or = 80% was 42, 46, and 7 months, respectively. Of the 24 arteries with > or =80% restenosis in PC, 10 were symptomatic. Thus, assuming th symptomatic restenosis would have undergone duplex scan examinations regardless, there were 14 asymptomatic arteries (12%) that could have been detected only with PCDS (estimated cost, $139, 200), and those patients would have been candidates for redo CEA. Of the 9 arteries (3 PTFE closures and 6 VPCs) with > or =80% restenosis with patch closures, 6 asymptomatic (4 VPCs and 2 PTFE closures) arteries (3%) could have been detected with PCDS. In patients with normal duplex scan findings at the first 6 months, only four (2%) of 222 patched arteries (two asymptomatic) developed > or = 80% restenosis versus five (38%) of 13 in patients with abnormal duplex scan examination findings (P<.001). CONCLUSIONS: PCDS is beneficial in patients with PC, but is less beneficial in patients with patch closure. PCDS examinations at 6 months and at 1- to 2-year intervals for several years after PC are adequate. For patients with patching, a 6-month postoperative duplex scan examination with normal results is adequate.