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We demonstrate a simple, robust, and contactless method for nondestructive testing of magnetic materials such as steel. This uses a fiber-coupled magnetic sensor based on nitrogen-vacancy centers (NVCs) in diamond without magnetic shielding. Previous NVC magnetometry has sought a homogeneous bias magnetic field on the diamond to improve the sensitivity. In contrast, here we show that the spatial resolution for imaging is improved by applying an inhomogeneous magnetic field to the steel even though this leads to an inhomogeneous magnetic field on the diamond. Structural damage in the steel distorts the inhomogeneous magnetic field and by detecting this distortion we reconstruct the damage profile through quantifying the shifts in the NVC Zeeman splitting. With a 1-mm magnet as the source of our inhomogeneous magnetic field, we achieve a high spatial resolution of 1 mm in the plane parallel and 0.1 mm in the direction perpendicular to the surface of the steel. This works even when the steel is covered by a nonmagnetic material. The lift-off distance of our sensor head from the surface of 316 stainless steel is up to 3 mm.

We present characterization of a lock-in amplifier based on a field programmable gate array capable of demodulation at up to 50 MHz. The system exhibits 90 nV/sqrt(Hz) of input noise at an optimum demodulation frequency of 500 kHz.The passband has a full-width half-maximum of 2.6 kHz for modulation frequencies above 100 kHz. Our code is opensource and operates on a commercially available platform.

Background and objective: Inaccurate measurements of body temperature following cardiopulmonary bypass may be associated with serious complications. The purpose of this study was to determine whether axillary and tympanic temperature measurements correlate with the urinary bladder temperature in the early postcardiac surgery period. Methods: Forty-nine adult patients who underwent cardiac surgery under cardiopulmonary bypass at our institution were prospectively studied. Urinary bladder, right axillary, right tympanic and left tympanic temperature measurements were simultaneously recorded at 0, 6, 12 and 18 h following cardiopulmonary bypass. Patients had one to four sets of recordings and a total of 629 temperature measurements were recorded. The mean difference (bias) between the bladder and each of the other methods and limits of agreement were calculated using Bland and Altman method. Results: The mean core body temperature recorded from the bladder on admission to the intensive care unit was 36.4 degrees C. After 6, 12 and 18 h the mean core body temperature was 37.4 degrees C (range: 35.2-39.0), 37.5 degrees C and 37.45 degrees C, respectively. The mean differences (bias) between the bladder temperature and the other three methods were: left tympanic, 0.65 degrees C (95% CI: -0.24 to 1.58); right tympanic, 0.57 degrees C (95% CI: -0.48 to 1.63) and right axillary, 0.55 degrees C (95% CI: -0.27 to 1.36). Conclusions: The axilla and tympanic membrane are unreliable sites for core body temperature measurement early after cardiopulmonary bypass in adult patients and clinical decisions should be based on more reliable methods.

A prospective electrophysiological study of phrenic nerve was performed in 59 subjects undergoing open-heart surgery. The nerve was stimulated percutaneously at the neck and the diaphragmatic response was recorded with surface electrodes placed over the 8th intercostal space. The latency, amplitude, duration and area of the evoked response were measured before and after the operation. Post-operatively no response was elicited in 2 patients bilaterally, in 5 from the left and in 2 from the right. Comparison of the post-operative with the pre-operative group values in the remaining subjects showed that the amplitude and area of the left phrenic were lower in the post-operative study, indicating that some of the nerve fibres were not conducting. There were no statistically significant differences between pre and post-operative values of latency or duration on the left or any of the parameters on the right. Our findings suggest that the amplitude and area of the diaphragmatic response are more sensitive than latency in detecting phrenic nerve paresis associated with open-heart surgery.

Alterations in cerebral blood flow (CBF) occurring during cardiopulmonary bypass (CPB), which are thought to be responsible for increased morbidity, are probably related to changes in arterial carbon dioxide during acid-base management. In this study, 70 patients undergoing elective coronary artery bypass surgery (CABS) were randomised to one of two differing, but widely practised, cardiopulmonary bypass acid-base protocols; pH-stat and alpha-stat. Cerebral blood flow was measured during surgery using the xenon-133 isotope clearance technique. Cerebral oxygen metabolism was measured as the cerebral metabolic rate for oxygen (CMRO2) and matching of the cerebral blood flow to oxygen demand as the cerebral extraction ratio for oxygen (CERO2). Detailed neuropsychological tests were conducted in all patients before surgery and repeated at 6 weeks after surgery for assessment of changes in cognitive function. During hypothermic (28 degrees C) CPB, CBF was significantly greater (P < 0.001) in the pH-stat group (41 ml/100 g per min; 95% confidence intervals (CI), 39-43) than in the alpha-stat group (24 ml/100 g per min; 95% CI, 22-26). The cerebral extraction ratio for oxygen indicated a degree of mismatch of cerebral perfusion and demand during CPB in both pH-stat and alpha-stat groups (0.12; 95% CI, 0.11-0.14 and 0.25; 95% CI, 0.22-0.28, respectively). This mismatch was far more pronounced in the pH-stat group than in the alpha-stat group, indicating greater disruption in cerebral autoregulation in the former group.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral dysfunction following cardiopulmonary bypass may be aggravated by altered autoregulation of cerebral blood flow. We have used trans-cranial Doppler to measure middle cerebral artery blood flow velocity during cardiopulmonary bypass managed by either pH-stat or alpha-stat acid-base protocols. Fourteen patients were studied, 7 in each group. During bypass at 28 degrees C, patients underwent incremental alterations in mean arterial pressure from 20-90 mmHg, maintaining systemic perfusion flow at 1.75 L/min per m2. The cerebral extraction ratio of oxygen was measured to indicate matching of cerebral blood flow to demand. The pH-stat group showed a pressure passive cerebral circulation with significant (r = 0.999, P less than 0.05) increase in blood flow velocity with increasing arterial pressure. This also occurred in alpha-stat group during the pressure range of 20-50 mmHg (r = 0.951, P less than 0.05). During the pressure range of 50-90 mmHg in alpha-stat group the change in flow velocity (0.16 cm/sec per mmHg) was significantly (P less than 0.05) less than that in pH-stat group (0.58 cm/second per mmHg). The cerebral extraction ratio of oxygen was less depressed in the alpha-stat group than in the pH-stat group, indicating more appropriate matching of cerebral blood flow and tissue demand. These results suggest that, during alpha-stat managed cardiopulmonary bypass, cerebral blood flow velocity is less subject to wide pressure alteration than pH-stat.

Metastatic tumours are the commonest cardiac tumours being found in 1-3% of patients dying of cancer while primary tumours are unusual and have an incidence of 0.02-0.5%. The majority (80%) of all primary cardiac tumours are benign with myxomas accounting for 50%. Myxomas arising from the right atrium are uncommon. We present the case of a 39-year-old female with a 4-month history of progressive exertional dyspnoea accompanied by symptoms of palpitations and presyncope. Transthoracic echocardiography showed an extremely large right atrial myxoma prolapsing into the right ventricle and obstructing the tricuspid valve. We demonstrate how intraoperative transoesophageal echocardiography, prior to sternotomy, was useful in providing information about the myxoma which clearly displayed its attachment and anatomical relationship in the planning of the 'safe' surgical excision.

Neuropsychologic impairment in patients undergoing cardiopulmonary bypass may be associated with cerebral blood flow changes arising from different management protocols for carbon dioxide tension during bypass. Seventy patients having coronary artery bypass grafting were randomized to either pH-stat or alpha-stat acid-base management during cardiopulmonary bypass with a membrane oxygenator. In each patient, cerebral blood flow (xenon 133 clearance), middle cerebral artery blood flow velocity (transcranial Doppler sonography), and cerebral oxygen metabolism (cerebral metabolic rate and cerebral extraction ratio) were measured during four phases of the operation: before bypass, during bypass (at hypothermia and at normothermia), and after bypass. A battery of neuropsychologic tests were also conducted before and 6 weeks after the operation. During hypothermic (28º C) bypass, cerebral blood flow was significantly (p < 0.001) greater in the pH-stat group (41 ml•100 gm -1 •min -1 ; 95% confidence interval 39 to 43 ml•100 gm -1 •min -1 ) than in the alpha-stat group (24 ml•100 gm -1 •min -1 ; confidence interval 22 to 26 ml•100 gm -1 •min -1 ) at constant pressure and flow. Arterial carbon dioxide tensions were 41 mm Hg (40 to 41 mm Hg) and 26 mm Hg (25 to 27 mm Hg), respectively; pH was 7.36 (7.34 to 7.38) and 7.53 (7.51 to 7.55), respectively. Middle cerebral artery flow velocity was significantly (p < 0.05) reduced in the alpha-stat group to 87% (77% to 96%) of the prebypass value, whereas it was significantly (p < 0.05) increased (152%; 141% to 162%) in the pH-stat group. Cerebral extraction ratio for oxygen demonstrated relative cerebral hyperemia during hypothermic (28º C) bypass in both the pH-stat and alpha-stat groups (0.12 [0.11 to 0.14] and 0.25 [0.22 to 0.28], respectively); however, hyperemia was significantly more pronounced in the pH-stat group, indicating greater disruption in cerebral autoregulation. Neuropsychologic impairment criteria of deterioration in results of three or more tests revealed that a significantly (Fisher's exact test, p = 0.02) higher proportion of patients in the pH-stat group fared poorly than in the alpha-stat group at 6 weeks (17/35, 48.6% [32% to 65.1%], and 7/35, 20% [6.7% to 33.2.2%], respectively). In conclusion, patients receiving alpha-stat management had less disruption of cerebral autoregulation during cardiopulmonary bypass, accompanied by a reduced incidence of postoperative cerebral dysfunction. (J THORAC CARDIOVASC SURG 1996;111:1267-79)

Haemodynamic studies have shown that diseased cardiac valves, whether stenosed or incompetent, create regions of increased turbulence and shear stresses that are large enough to damage the vascular endothelium and cellular blood elements, leading to abnormal haemorheology, platelet activation, and endothelial dysfunction.1 For example, the intensity of turbulence in patients with pure aortic stenosis (AS) may be 10 times greater than normal while the intensity of turbulence in patients with pure aortic regurgitation (AR) may be three times greater than normal1. We hypothesised that patients with aortic valve disease may show abnormal haemorheology, platelet activation, and endothelial dysfunction, that may increase their risk of thromboembolism. These abnormalities may perhaps reflect haemodynamic changes resulting from AS or AR, in particular their respective severity. To test our hypothesis, we measured plasma concentrations of soluble P-selectin (sP-sel, a marker for platelet activation2), von Willebrand factor (vWf, a marker for endothelial cell dysfunction3) and fibrinogen (as an index of haemorheology and a clotting factor), in 61 patients with moderate to severe aortic valve disease in sinus rhythm. We recruited consecutive patients attending outpatient clinics or admitted to our regional referral cardiothoracic unit with primary (native) aortic valve disease. We excluded patients with atrial fibrillation, patients on warfarin, statins or hormone replacement therapy, those with double valve disease (namely, mitral and aortic valve disease) and associated medical conditions known to influence the markers under investigation (including coronary artery …