Various devices for transcatheter ASD closure are undergoing clinical trials. Each new device claims advantages in terms of safety and efficacy over earlier devices. We report three cases in which a new investigational device--the Das angel wings--failed. Emergency operations were necessary for device retrieval and defect closure. The possible mechanisms of the event and the options in management are discussed with a review of literature on all devices.
Purpose:
This study aimed to examine the corneal endothelial morphology and thickness in patients with Type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched nondiabetic controls.
Methods:
This hospital-based cross-sectional observational study was conducted in the ophthalmology department of a tertiary hospital consisting of 262 patients (131 with T2DM as cases and 131 without diabetes who served as controls). All patients underwent a comprehensive ocular examination including visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement. Central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CV), and percentage of hexagonal cells (HEX) were compared between the cases and controls. Predictors of corneal endothelial dysfunctions were analyzed. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 17.0. Chi-square test, Fisher’s exact test, and Spearman’s rho correlation analysis were used as appropriate.
Results:
Patients with T2DM showed poorer visual acuity and higher intraocular pressure. As compared to controls, patients with T2DM had thicker CCT, lesser ECD, decreased HEX, and higher CV but the differences were statistically nonsignificant. HbA1c levels showed a significant positive correlation with CCT and CV and a negative correlation with ECD. Macroalbuminuria and higher albumin creatinine ratio was associated with an increase in CV in patients with T2DM.
Conclusion:
Our study showed that poorly controlled patients with T2DM and those with macroalbuminuria have corneal endothelial abnormalities.
The over-drainage of CSF after shunt implantation, particularly when the patient is in the vertical posture, is well documented. Problems associated with it are negative pressure syndrome (postural headache and postural irritability), abnormal skull size, craniosynostosis and subdural haematoma. The pressure gradient in the vertical position between the cranial cavity and the right atrium is 15 to 20 cm of water and between the cranial and peritoneal cavity it is 25 to 32 cm of water and both these are much higher than those needed for the optimum functioning of a conventional shunt. The need, therefore, has been for a self-regulating device that can adjust itself to any change of posture from horizontal to vertical and vice versa and regulate the flow of CSF from the cranial cavity. "Z" Flow hydrocephalus shunt system has this in-built self-regulating mechanism to prevent over drainage of CSF and the resultant abnormal low pressure in the cranial cavity. The rationale behind the functioning of "Z" Flow hydrocephalus shunt system has been discussed, its design has been described and illustrated and the results of pressure monitoring after Z Flow shunt implantation in five adult patients have been detailed. As the opening pressures of the "Z" Flow shunt system are 15-29 cm of water, it has been found to prevent over-drainage of CSF and maintain intraventricular pressure within normal limits.
As in a complex growing mesh technologies field, autonomic computing is an auspicious new approach for building large scale distributed systems without assistance of any human interaction. This paradigm provides an environment, which has the potential to manage itself and adapt to the changes. The main objective of autonomic environment is to render the system administrator free by achieving self management properties at a higher level. The main characteristics of autonomic systems, which are to be achieved, are Selfhealing, Self-optimizing, Self-protecting and Self-configuring. This paper describes the architecture of stable autonomic systems.
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