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In the bodybuilding and fitness communities, anecdotal evidence suggests that some take ‘steroid holidays’, traveling to and living in foreign countries so as to have greater access to performance ...

Absent or reduced sensory cueing can deprive pilots operating remotely piloted aircraft beyond visual line of sight (BVLOS) of vital information necessary for safe flight. The present study tested the effects of real-time auditory feedback on remote pilot perception and decision-making task performance in an automated BVLOS flight, under three levels of workload (Low, Moderate and High). Results from 36 participants revealed workload and auditory feedback influenced perception task performance in terms of error type count, with misses more frequent than wrong identifications. In terms of performance in the decision-making task, under low and moderate levels of workload, auditory feedback was found to improve performance. Conversely, under high workloads, an inflexion or tipping point occurred whereby auditory feedback became detrimental to task performance. These results correspond with the expected behavioural responses to external stressors as predicted by the Arousal and Maximal Adaptability theory, and build upon previous findings related to workload, auditory feedback and remote pilot task performance. Practitioner summary: This study tested the effect of real-time auditory feedback and dynamic workloads on remote pilots' task performance. Auditory feedback and workload each influenced the perception tasks in terms of error types committed. Auditory feedback improved decision-making task performance under low and moderate workloads, and reduced performance under high workloads. These results may benefit practitioners by considering the nuanced effects of auditory feedback on human task performance within sensory deprived working environments, including those utilising teleoperated systems.

Remotely Piloted Aircraft Systems (RPAS) have facilitated new growth in civil aviation. Unlike manned aircraft, however, they are operated without auditory feedback and normally flown under two visual conditions: in direct visual-line-of-sight to the remote pilot (VLOS) and beyond VLOS with first-person-view imagery transmitted via onboard cameras (BVLOS). The present research examined the effectiveness of audiovisual cueing on remote pilot manual flying performance. Eighteen pilots (three female) completed six navigation and 12 spotting tasks. Their flying performance (horizontal accuracy, vertical accuracy and timeliness) was examined under three different visual display types (VLOS (Control), BVLOS-Monitor & BVLOS-Goggles), with and without real-time auditory feedback, and two wind component (no wind and wind) conditions. Horizontal deviation and timeliness improved in the BVLOS-Monitor condition navigation task, while auditory feedback produced nuanced examples of improved and degraded pilot performance. These results indicate how the specificity of the task, combined with different levels of audiovisual feedback influences remote pilot performance. These findings support the rationalisation for the provision of multimodal dynamic sensory cueing in future RPAS. Practitioner summary: Accuracy and timeliness of remote pilot manual flying performance was measured under a combination of audiovisual feedback in calm and wind shear conditions. The inclusion of real-time auditory feedback as an additional sensory cue is uncommon; this study demonstrated nuanced examples of improved and degraded manual flying performance. The provision of dynamic sensory cueing made available to remote pilots in future RPAS should be considered.

Detailed degenerate four wave mixing (DFWM) studies of four molybdenum complexes, cis-Mo(CO)4(PPh3)2, cis-Mo(CO)4(AsPh3)2, cis-Mo(CO)4(PPh2Np)2 and cis-Mo(CO)4(P(OPh)3)2 are reported in this paper. Upon exposure to air/oxygen, the χ(3) values of solutions of the first three complexes increase dramatically with time. However, when excess free ligand is added to any of the solutions, no additional increase in the χ(3) value is observed. Hence, it is possible to obtain solutions with high χ(3) values by first oxidizing the solution and then adding excess ligand to stabilize the solution. Further, the increase in the χ(3) values of the solutions parallels the increase in the linear absorption, but it is unclear whether the increased linear absorption plays any role in the increase in the χ(3) values of the solutions. This study also shows how degenerate four wave mixing can be used as a very sensitive technique to detect the chemical change in a solution when the third order optical nonlinearities of the reactant and product are very different.

Eczema of the nipple is an important symptom presenting to the general surgeon in the out-patient department. The diagnosis of Paget's disease of the nipple has traditionally been made by incision biopsy necessitating at least a local anaesthetic. We present 14 patients with nipple skin change, in whom the technique of scrape cytology was used to identify patients with Paget's disease. In our series eight cases of Paget's disease were successfully identified by scrape cytology with no false negatives or positives. We suggest that this is a quick, easy, non-invasive method of screening eczema of the nipple in the out-patient clinic.

During the first 2 years (July 1989 to July 1991) of the Avon Breast Screening Service, fine-wire localization biopsy was indicated in 213 impalpable breast lesions. A total of 144 lesions were benign and 69 malignant. Only four of 213 lesions (1.9 per cent) were not excised at the first localization. Factors influencing reoperation in the 69 patients with malignant impalpable lesions were examined. There was a significant association (P < 0.001) between parenchymal disturbances on mammography and invasive carcinoma, and between non-invasive carcinoma and microcalcification (P < 0.001). In 31 patients the localization biopsy was the only surgical procedure. Thirty-eight patients required further surgery: 12 underwent further local excision and 26 mastectomy. Reoperation was more frequent in patients with calcification than in those with parenchymal disturbance (P < 0.001). The most frequent indications for mastectomy were inadequate excision of widespread comedo ductal carcinoma in situ or invasive ductal carcinoma combined with extensive ductal carcinoma in situ. Fine-wire localization biopsy was a combined therapeutic and diagnostic procedure in 31 of 69 women with impalpable screen-detected lesions. The majority of patients required further surgery because radiological abnormalities underestimated the extent of disease.

Eleven Yorkshire x Landrace gravid gilts were used in two Latin square trials to determine the N requirement for pregnancy. Semipurified diets were formulated to be adequate in indispensable amino acids (IAA) and other nutrients. Diets were fed once daily (1.82 kg); L-glutamic acid, corn sugar, powdered cellulose, and soybean oil percentages differed to maintain isocaloric diets. In Trial 1, six gilts were fed diets containing 6.6 to 17.2% CP equivalent (19.2 to 50.1 g of N/d) during six 10-d periods beginning on d 40 postcoitum. In Trial 2, five gilts were fed diets containing 4.3 to 12.6% CP equivalent (12.5 to 36.8 g of N/d) during five 10-d periods beginning on d 50 postcoitum. Nitrogen balance trials were conducted during the last 5 d of each period. Blood samples were taken both before and 3 h after the last feeding of each period. Results from Trial 1 suggested that adequate N retention (10 g/d) could be attained by pregnant gilts fed less than 28 g of N/d intake when the diet contained indispensible amino acids at levels suggested by Nutrient Requirements of Swine (NRC, 1988). An intake of 20.6 g of N/d (7.1% CP equivalent) yielded near maximum N retention among pregnant gilts fed the semipurified diets in Trial 2. Other criteria measured (urine urea nitrogen and plasma urea nitrogen) had limited value in the evaluation of the N status of the pregnant gilts in these trials.

Epidermal growth factor (EGF) receptor status is a useful prognostic indicator in women with breast cancer. Lack of standardization and correlation of methodology for the detection of EGF receptor has hampered its further evaluation. EGF receptor status was ascertained by immunohistochemistry and radioligand assay in 120 breast cancers. Of 52 tumours negative for EGF receptor on radioligand assay, 47 were negative on immunohistochemistry and, of 68 tumours positive for the receptor on assay, 52 were positive on immunohistochemistry. If the more widely evaluated radioligand assay is assumed to be the ‘gold standard’, immunohistochemistry has a sensitivity of 81 per cent and a specificity of 91 per cent.

Abnormalities of the p53 gene and protein were examined in 81 primary breast carcinoma samples. Using a polymerase chain reaction–single-strand conformational polymorphism (PCR—SSCP) analysis, mutations in p53 exons 5–8 were identified in 13 of 81 tumours (16 per cent) and confirmed by DNA sequencing. Positive staining for p53 protein was detected in ten of 77 (13 per cent) of these tumours using polyclonal CM1 antibody on formalin-fixed tissue. Mutations detected by PCR—SSCP analysis were more common in grade III tumours (P = 0·015), but no correlation was found with tumour size, node status or level of epidermal growth factor receptor expression. A p53 mutation was associated with positive antibody staining in only two patients. Positive immunohistochemical staining using a p53 antibody may detect p53 protein expression, but this may not correlate directly with an underlying mutation in the hot spot region examined.

Epidermal growth factor receptor (EGFR) is a sensitive prognostic indicator in women with breast cancer. A new technique for the detection of EGFR on breast cancer imprints is described and evaluated in relation to immunohistochemistry on frozen sections. The standard streptavidin-biotin method using the R1 antibody on frozen sections was modified for use on tumour imprints. In the first group (group 1 imprints) 43 tumours were assessed by frozen section and imprint staining. The group 1 imprint method had a sensitivity of 50% and a specificity of 89% compared with the frozen sections. Further modifications were made for the following 32 tumours (group 2) and this method had a much improved sensitivity of 94% while specificity was preserved. This method is simple and could be performed in any hospital histopathology department.

The nutritional abnormalities resulting from HIV/AIDS are discussed, including the consequences of wasting and its profound effects on patient quality of life. Deficits of vitamins A, E, B6 and B12, and riboflavin, zinc, and copper have been found in asymptomatic HIV-positive persons. The nutrient abnormalities may be linked to HIV disease progression. The cyclic process of contracting infections, requiring increased nutrients, is discussed. How the body suffering from HIV/AIDS-related wasting reacts to daily protein loss is examined, focusing on nitrogen depletion and increased lipogenesis.

A total of 393 nipple discharge or scrape smears from 360 women were examined cytologically over a 12-year period. Twenty-nine breast cancers (8 per cent) have been histologically confirmed in this group, of which 16 had malignant smear cytology (sensitivity 55 per cent). Nine patients with breast cancer and positive cytology had impalpable tumours. Two of these cancers were not detected by any other investigation. Thirteen patients with nipple discharge had false-negative cytology, but there were no false-positive results (specificity 100 per cent). All patients with expressible or spontaneous nipple discharges and those with skin changes at the nipple should undergo examination of cytological smears.

After arterial reconstruction, patients have traditionally been followed up in clinic in the long term. We have pursued a policy of limited clinic follow-up, with an 'open access' service for suspected graft failure (and latterly duplex scanning surveillance for vein grafts). This policy was assessed by measurement of the success of self-referral, graft patency and patient satisfaction after operation for lower limb ischaemia in 173 patients. At median follow-up of 50 months, 61 (35%) patients had died and 45 (25%) had required amputation. Of those with salvaged limbs and available for follow-up, 55 (86%) patients reported continuing symptomatic improvement with a graft patency rate of 80%. During the review period, 27 (42%) patients had presented themselves on suspicion of graft occlusion and 14 (52%) of these had required surgical intervention. Of the patients, 45 (70%) found a single postoperative clinic visit helpful, and the majority thought that further visits would not have been helpful to them. Limited clinic appointments seem especially desirable for elderly patients for whom journeys are an imposition, as well as reducing travel costs, and giving surgeons more time to deal with new referrals. These results suggest that properly educated patients present themselves when signs of graft occlusion occur, and there is little to be gained by regular long-term clinic follow-up in vascular surgical practice.

Medullary thyroid carcinoma accounts for 5–10 per cent of thyroid malignancies and occurs sporadically, and in three familial settings with autosomal dominant inheritance. Calcitonin, a 32 amino acid 3.5-kDa protein, is a biochemical marker of the tumour. Serum levels correlate with disease burden. Treatment initiated by screening allows disease removal at a premalignant phase: C cell hyperplasia. Genetic linkage studies locate the multiple endocrine neoplasia type 2A gene near the centromere of chromosome 10. Flanking genetic markers may allow polymorphic probes to examine DNA from a once-only blood sample to identify affected individuals. At what age thyroidectomy should be carried out in these patients is unclear.

The purpose of this study was to validate a field test of cardiorespiratory fitness for men with mental retardation. The subjects were 19 healthy young men (26 +/- 6 yr) with moderate mental retardation (IQ = 48 +/- 11). Each subject underwent a maximal treadmill test after a three-phase familiarization process. Each subject also completed a 1-mile walk test twice (Rockport Fitness Walking Test = RFWT). The correlation coefficients between peak VO2 on the treadmill and the two 1-mile walks varied from 0.78 to 0.83. When weight, height, age, heart rates of 1-mile walks, and their combinations were held constant, the correlations were strengthened. Using multiple correlation analysis the best equation for predicting peak VO2 was: Peak VO2 = 101.92 - 2.356(mile-1 time) - 0.42(weight). This model accounted for 85% of total variance. The standard error of estimate was 4.06 ml.kg-1.min-1. The test-retest reliability of the RFWT for the 19 subjects used in this study was very high (R = 0.97). This finding suggests that the RFWT is a valid and reliable field test for this population and appears to be a valid indicator of cardiorespiratory fitness for these men with mental retardation.

(1990). Protein microparticulation: the principle and the process. Journal of the American College of Nutrition: Vol. 9, No. 4, pp. 388-97.

The first successful clinical cardiac transplant was performed by Barnard in 1967 in an adult1. In the same year Kantrowitz et al. reported a clinical transplant in a 16-day-old child with tricuspid atresia2. The following year Cooley et al. reported a transplant in a 2-month-old child with an atrioventricular canal defect3. Both of these pediatric transplants were ultimately unsuccessful.

Fast and accurate numerical techniques are developed for calculating the optical depth of modulation of integrated-optical devices with various dielectric buffer layers. The matrix effective refractive-index (MERI) method is used in calculating the LiNbO3 proton-exchange single-channel optical-mode parameters. An approximate technique for calculating electrode electric field distributions as a function of various buffer layers is presented. Comparisons of computer simulations to experimental measurements performed on Mach-Zehnder modulators containing various buffer layers demonstrate that the numerical techniques are sufficiently accurate for usein computer-aided design. The errors between calculated and measured V(pi) are given for modulators with a 200 nm SiOî buffer layer and with a 200 nm ITO electrode structure. In general, given the same electrode dimensions, the use of ITO electrodes results in a significant reduction of the drive voltage required as compared to electrodes on thin (200 nm) dielectric buffer layers.

One of the exciting recent trends in the field of special physical education is the development of appropriate learning experiences for students with severe handicapping conditions. Until very recently those who deviated significantly from the societal norm were frequently committed to institutions where they would reside for their entire lives. Unfortunately, the institutions into which the severely handicapped were placed were usually underfunded and understaffed. The conditions in many of these institutions were dehumanizing and without the necessary resources to provide treatment, rehabilitation, and educational programs. Fortunately, today there is a new international commitment to accept the severely handicapped as citizens with the same basic needs and rights as all citizens.

On Two Deflationary Truth Theories.- Some Reflections On The Prosentential Theory of Truth.- Paradox and Reference.- Two Theorems concerning Stability.- The Complexity of Decision Procedures in Relevance Logic.- Relevant Predication 3: Essential Properties.- The Dog: Relevance and Rationality.- Consistency and Logical Consequence.- On What Cannot Be.- Durations: Temporal Intervals with Gaps and Undetermined Edges.- Categorical Semantics.- The Myth of the Intuitionistic "Or".- What Mathematical Truth Need Not Be.- A Tour of the Multivariate Lambda Calculus.- Choice Trees.- The Extensional but Hyper-Intensional Calculus C? with Orderless Constants and Variables.- A Skeptical Theory of Mixed Inheritance.- The Logic of Mitchill v. Lath.- What are Absolute Probabilities a Function of?.- How Prediction Enhances Confirmation.- Figures in a Probability Landscape.- Nuel Belnap: Curriculum Vitae.- Nuel Belnap: Doctoral Students.- Nuel Belnap: Publications.- Index of Names.- Index of Subjects.

In the Preface to his Two Treatises of Government in 1689 Locke expressed the hope that the arguments of his book would besufficient to establish the Throne of our Great Restorer, Our present King William; to make good his Title, in the Consent of the People, which being the only one of all lawful Governments, he has more fully and clearly than any Prince in Christendom: And to justifie to the World, the People of England, whose love of their Just and Natural Rights, with their Resolution to preserve them, saved the Nation when it was on the very brink of Slavery and Ruin.(1) He went on to express his confidence that the King and Body of the Nation had between them by this time so thoroughly confuted the divine right hypothesis of Sir Robert Filmer that no future writer would be likely to have the effrontery to advocate slavery and threaten the common safety again. It was an eminently partisan summary of English political experience over the preceding decade. But there can be no doubt of its sincerity and accuracy as an expression of Locke’s own political attitudes on the February afternoon that he sailed from Holland in the flotilla of Princess Mary, to land in England the day before Mary and her consort announced their joint acceptance of the English throne (2).

In order to study intercalates formed by the complete reaction of ammonia with TiS 2 and NbS 2 , very long reaction times are required. These intercalates attain equilibrium ammonium concentrations of 25 mole% according to the formula (NH + 4 ) y' (NH 3 ) y' TS y'- 2 , where T=Ti of Nb, only after reaction periods of months. A value of y '=0.25 also is consistent with the charge transfer of 0.25 e - /TaS 2 observed for ammoniated TaS 2 . The above ammonium concentration is in good agreement with a proposed 2 a ×2 a ammonium superstructure for the above stage I intercalates, suggesting that the extent of ammonium formation is not primarily governed by the host band structure, which is substantially different for the above hosts, but by Coulombic intercalant repulsions. This superstructure is consistent with the presence of planar ammonia in (ND + 4 ) 0.22 (ND 3 ) 0.34 TiS 0.22- 2 , since the ammonia positions are always midway between nearest-neighbor ammonium positions, with the ammonia plane perpendicular to the corresponding ammonium-ammonium vector. The sensitivity of the ammonia structure to guest-guest interactions is evidenced by the observation of a non-planar ammonia structure for Li + 0.23 (ND 3 ) 0.63 TiS 0.23- 2 , where ammonia cannot be symmetrically and linearly coordinated by Li + .

Pericardial patch grafts were implanted in the hearts of young sheep for periods ranging from two to 120 days. Explants seven to 21 days old revealed the formation of a "pseudoneointima" (PNI) on the blood contacting surface of the pericardium. The PNI was more heavily mineralized than the pericardium. Mineralization was most intense on the blood contacting surface of the PNI and on the chamber surface of the pericardium. After three weeks of implantation, the PNI was much thinner and was organized into a thin fibrous capsule without any signs of mineralization. In the pericardium, mineral deposits were seen in fibroblasts. Moreover, cell-related mineralization was evident prior to calcification of the surrounding collagen matrix.

Most cases of decompression sickness that occur at altitude resolve upon descent to lower altitudes. Before the use of hyperbaric therapy, cases that did not resolve accounted for some of the most difficult medical management problems in military aerospace medicine. On 27 March, 1941, the U.S. Navy Diving School successfully used hyperbaric therapy for a case of altitude-induced decompression sickness that did not resolve on return to ground level. Since then, over 145 such cases have been treated by hyperbaric therapy. At first, treatments involved using compressed air, with varying success. Current medical management of altitude-induced decompression sickness requires immediate compression to 2.8 ATA, equivalent to 60 ft of sea water (FSW) pressure, and a series of intermittent oxygen and air breathing periods during the subsequent slow decompression to surface. This report confirms the treatment recommendations set forth by Behnke and Downey, and crystallized by Goodman in 1964. Conclusions are based on treatment experience in the management of 120 cases in U.S. Air Force hyperbaric chambers, and a survey of hyperbaric facilities which have treated 25 other cases.

Clinical evaluation, physical examination, and noninvasive testing have been suggested as adjuncts to endomyocardial biopsy for diagnosing acute graft rejection in children after heart transplantation. Because the consequences of delayed diagnosis or unnecessary treatment of rejection may be serious in pediatric transplant recipients, we reviewed our experience with repeated endomyocardial biopsy in seven children (aged 6 months to 19 years) and assessed the sensitivity and specificity of clinical and noninvasive data for diagnosing acute rejection. There were no serious complications in 71 biopsy procedures. In no patient did the presence of abnormal clinical findings or noninvasive testing coincide with treatable rejection that was proved on biopsy. However, there were nine episodes of treatable rejection in the absence of abnormal physical findings or noninvasive studies. At this time we consider repeated endomyocardial biopsy to be a feasible and safe procedure in infants and children and do not consider clinical findings and noninvasive testing sufficient to make therapeutic judgments in regard to acute graft rejection.

Pseudomonas maltophilia was isolated from intraoperative blood cultures in eight of 13 children undergoing open heart surgery during a five-week period. Antibiograms were identical and included resistance to prophylactic antibiotics. The source of the outbreak was traced to contamination of both the calibration device used on the pressure monitoring system and the sensor surface of transducers used in this system. In a mock system, calibration with a contaminated device resulted in recovery of the organism from transducer dome fluid. Dye studies confirmed the integrity of the transducer membrane but demonstrated reflux of dome fluid into the monitoring line fluid. A case-control study revealed no patient- or surgery-related factors predisposing to P maltophilia bacteremia and no excess of morbidity or mortality in patients as a result of bacteremia. The outbreak was confined to patients undergoing open heart surgery and was terminated abruptly by sterilization of transducers and revision of the calibration device.

Forty patients with chronic osteomyelitis were treated with hyperbaric oxygen as an adjunct to surgical therapy and antibiotics and followed for an average of 2 years with a recurrence rate of 15%. The mechanism of action of hyperbaric oxygen in osteomyelitis is probably an indirect one of improving local vascularity and potentiating phagocytosis. Many of these patients represent a refractory group with poor prognosis due to the etiology of the infection, site of involvement, and duration of infection prior to treatment. The recurrence rate following this mode of treatment seems to be primarily related to inadequate surgical management. There was no definite correlation between the site of the infection of pathologic organism and recurrence. Although this is a preliminary report, the results are encouraging. Hyperbaric oxygen may be indicated as an adjunct to good surgical and medical management, particularly in patients with refractory chronic osteomyelitis and in whom ablative surgery is under consideration as the only other means of controlling the infection.

Since wounds in patients with diabetes will heal slowly at best, and since they are so much more susceptible to infection and the infection will be more devastating, the old adage of "first do no harm" must be adhered to. Diabetics have poor circulation, poor resistance to infection, and poor local nutrition. Their white blood cell killing power is decreased by the hypoxia from poor circulation and by the periodic hyperglycemia. The periodic hypoglycemia and decreased insulin interferes with the energy for healing and for host defenses. Because of this poor healing and low resistance, the use of strong, toxic chemicals should be avoided. They all inhibit healing and/or increase the risk of infection. Vigorous, repeated debridement of necrotic, devitalized tissue along with old blood, exudates, and tissue fluids is essential. This includes sharp debridement and mechanical debridement through high-pressure irrigation and frequent wet to dry fine mesh gauze dressings. The choice of bandaging material should be determined by the desired action on the wound, such as protection, debridement, and so on. The idea is to restore the conditions in the wound to normal physiology.

Indomethacin bioavailability was compared in 22 healthy men who received two tablet dosage formulations and a capsule formulation of indomethacin in a three-way crossover study. In each study period, 50 mg of the indomethacin formulation (25-mg or 50-mg tablets or 50-mg capsules) was administered as a single dose to fasting subjects. Thirteen blood samples were collected at intervals over 24 hours after each dose. Urine samples were collected for 12 hours before each dose and 48 hours after each dose. Serum indomethacin concentrations were measured by a gas chromatographic procedure. The extent of indomethacin absorption for the two tablet formulations was not significantly different from that for the reference capsule. A trend toward earlier and higher peak serum concentrations with the capsule was observed. There was less than 20% difference in mean values for area under the concentration-time curve (AUC) for the three formulations. More than 75% of the subjects had serum concentrations falling between 75 and 125% of the mean serum concentrations. The extent of absorption of indomethacin from the two tablet formulations was similar to that from the capsule.

Recoarctation is a problem in some patients after subclavian flap aortoplasty. To investigate the reason for recoarctation, we reviewed the records of 26 infants who underwent subclavian flap repair for symptomatic coarctation of the aorta at less than 3 months of age between June, 1979, and December, 1983. Age at repair ranged from 2 to 65 days (median 16 days) and weight from 2.1 to 4.9 kg (median 3.4 kg). In 14 patients the coarctation was associated with significant intracardiac defects (complex in six). There were two intraoperative deaths and one early death (surgical mortality 12%). The survivors were followed from 6 weeks to 66 months (median 12 months). Five survivors (22%), all operated on at less than 14 days of age, developed severe recoarctation 6 weeks to 6 months (median 5 months) after repair. The obstruction appeared to be due to lumen obliteration by shelf-life posterior wall tissue. Morphometric analysis of preoperative angiograms showed no correlation between recoarctation and distance between the left subclavian artery and the site of coarctation, length of the isthmus, diameter of the isthmus, combined cross-sectional area of the left subclavian artery and isthmus, or the ratio of the combined cross-sectional area of the left subclavian artery and isthmus to the cross-sectional area of the descending thoracic aorta. Recoarctation did not correlate with weight at operation, but it correlated significantly with age at aortoplasty (p = 0.02). The results suggest that intrinsic abnormalities of the periductal aortic wall are responsible for recoarctation after subclavian flap aortoplasty. Particular attention to this abnormal tissue at repair may prevent early recurrence in young infants.