Ground-State Phase Diagram of a Spin-Orbital-Angular-Momentum Coupled Bose-Einstein Condensate.

By inducing a Raman transition using a pair of Gaussian and Laguerre-Gaussian laser beams, we realize a ^{87}Rb condensate whose orbital angular momentum (OAM) and its internal spin states are coupled. By varying the detuning and the coupling strength of the Raman transition, we experimentally map out the ground-state phase diagram of the system for the first time. The transitions between different phases feature a discontinuous jump of the OAM and the spin polarization, and hence are of first order. We demonstrate the hysteresis loop associated with such first-order phase transitions. The role of interatomic interaction is also elucidated. Our work paves the way to explore exotic quantum phases in the spin-orbital-angular-momentum coupled quantum gases.

Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided Procedures Commonly Used in Interventional Radiology.

RATIONALE AND OBJECTIVES: Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care. MATERIALS AND METHODS: Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access. RESULTS: The ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient. CONCLUSION: Lightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.

Successful Management of Neobladder Variceal Bleeding.

Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

Principles of subcutaneous port placement.

The introduction of totally implantable subcutaneous devices in the early 1980s provided patients with secure, reliable venous access and also gave them the ability to move more freely and have a more normal lifestyle with these devices in place. The most common totally implantable device used today is the subcutaneous port. These ports consist of an injection port connected to a catheter. Ports provide a number of advantages compared with other venous catheters; the most important is the reduced risk of infection. These devices have significantly lower rates of infection than nontunneled and tunneled catheters. Additional advantages include less frequent irrigation and minimal home care, and they are less prone to environmental or cutaneous contamination when not being accessed. This article will focus on the placement of these ports.

Multidetector CT angiography of infrainguinal arterial bypass.

Infrainguinal arterial bypass (IGAB) surgery is commonly performed in patients with claudication, critical limb ischemia, or other arterial problems in the lower extremities. An IGAB is constructed from different materials depending on the anatomy of the lesion and the availability of an autogenous vein. The ideal material for IGAB is the greater saphenous vein, especially for distal below-knee bypass. In patients with no available autogenous vein, IGAB can be performed by using different prosthetic materials or biologic grafts. After the surgery, periodic surveillance is performed with duplex ultrasonography and clinical assessment of peripheral pulses and ankle-brachial indexes. If complications are detected, further work-up is performed with conventional arteriography, multidetector computed tomographic (CT) angiography, or magnetic resonance angiography. CT angiography has become a powerful tool for assessing the potential early and late complications of IGAB and for planning further therapy in a fast, reliable, and noninvasive manner.

Declining-dose study of reteplase treatment for lower extremity arterial occlusions.

PURPOSE: To prospectively determine the technical success and complication rates of three different reteplase dosing regimens during catheter-directed arterial thrombolysis. MATERIALS AND METHODS: Prospective data were obtained from three groups of patients who underwent lower extremity arterial thrombolysis with three different regimens of reteplase: 0.5 U/h, 0.25 U/h, and 0.125 U/h. A total of 101 thrombosed lower extremity arterial occlusions in 87 patients were treated. A subtherapeutic intravenous heparin dose of 400-500 U/h was administered. All limbs were viable at presentation. Thrombolytic success was defined as 95% thrombolysis of the occluded artery or graft with restored distal antegrade flow. Thirty-day mortality and amputation rates were calculated. Bleeding complications and need for transfusions were recorded. Laboratory values recorded included fibrinogen level, platelet count, hematocrit level, hemoglobin level, and prothrombin time. RESULTS: Thrombolytic success was achieved in 86.7% of patients in the 0.5-U/h dose group, 83.8% of patients in the 0.25-U/h dose group, and 85.3% of patients in the 0.125-U/h dose group. The major bleeding and transfusion rates were 13.3% in the 0.5-U/h dose group, 5.4% in the 0.25-U/h dose group, and 2.9% in the 0.125-U/h dose group. The 30-day amputation-free survival rates were 90% in the 0.5-U/h dose group, 97.3% in the 0.25-U/h dose group, and 94.1% in the 0.125-U/h dose group. Pre- and postprocedural fibrinogen levels and the fibrinogen nadir were not statistically different between the groups. No differences in total infusion times were found between the 0.5-U/h dose and 0.25-U/h dose groups. However, the infusion time in the 0.125-U/h dose group was significantly longer than in the other two groups (42 h vs 30 h; P <.05). CONCLUSION: All dosing regimens were equally effective in the treatment of acute lower extremity occlusions. The infusion times were longer with the 0.125-U/h dose. Significantly fewer major bleeding complications were encountered with the 0.25-U/h and 0.125-U/h dose regimens than with the 0.5-U/h dose regimen.

Catheter-directed thrombolysis in deep venous thrombosis with use of reteplase: immediate results and complications from a pilot study.

PURPOSE: To prospectively determine the thrombolytic success and complication rates of catheter-directed thrombolytic infusions in deep vein thrombosis (DVT) with use of reteplase. MATERIALS AND METHODS: After approval by the institutional review board, prospective, detailed data were obtained for 25 consecutive patients with acute and chronic DVT of the upper or lower extremity (seven upper extremity; 14 lower extremity; four vena cava). Infusion rates were 1.0 U/h in five patients and 0.5 U/h in the remaining 20. Subtherapeutic heparin doses of 300-400 U/h were administered. Thrombolytic success was defined as 95% thrombolysis with return of antegrade flow. Data, including complications such as bleeding, need for transfusions, and laboratory values (fibrinogen, platelets, hematocrit, hemoglobin, and prothrombin time) were obtained throughout the infusions. RESULTS: The total dose of reteplase administered ranged from 2.5 to 42 U (median, 16.5 U). The total infusion time ranged from 0.3 to 84 hours (median, 29 h). Thrombolytic success was achieved in 92% of patients. Endovascular stent placement and/or percutaneous transluminal angioplasty were required in 52% of patients to ensure maintenance of patency. Pre- and postprocedural average fibrinogen levels were 340 mg/dL and 315.3 mg/dL, respectively. The lowest mean fibrinogen levels for the two dose groups were 265.86 mg/dL for the 0.5 U/h group and 314.18 mg/dL for the 1.0 U/h group. The lowest fibrinogen level during the procedure was 252.3 mg/dL (range, 35 to >700). There were only two instances of fibrinogen levels that decreased to below 90 mg/dL: 35 mg/dL and 43 mg/dL. Thrombolytic failures occurred in two patients: one with acquired immune deficiency syndrome in a hypercoagulable state and one with a major bleeding complication. This was the only patient with a bleeding complication (4%). Hemorrhage occurred from the site of a previous mediastinal biopsy-which should have rendered her ineligible for the study-performed 18 hours before the thrombolysis. If thrombolysis had not been attempted in this patient, the complication rate would have been 0%. CONCLUSION: Although there are reports of thrombolytic therapy in peripheral vascular occlusive disease, this study is one of the first to evaluate thrombolytic drugs in the deep venous system exclusively. Reteplase was found to be effective in the thrombolytic treatment of acute and chronic DVT.