
OBJECTIVE
To evaluate the accuracy, value, and safety of biplane intraoperative transesophageal echocardiography (TEE) in patients with congenital cardiac malformations.


DESIGN
We reviewed the results of the first 104 consecutive biplane intraoperative TEE examinations performed during the repair of congenital heart defects at the Mayo Clinic.


MATERIAL AND METHODS
TEE results were analyzed for accuracy of diagnosis, effect on the surgical procedure, and associated complications. In a subjective analysis, the relative contributions and advantages of each imaging plane (transverse and longitudinal) were also assessed.


RESULTS
Biplane TEE had "significant impact" on intraoperative management in 17 of 104 examinations (16.3%). Preoperative TEE altered the planned procedure in 11 patients (10.6%). Postbypass biplane TEE led to immediate revision of the initial repair in nine patients (8.7%). Patients who underwent modified Fontan operations or subaortic resections had the greatest frequency of significant impact (40% [P = 0.006] and 33% [P = 0.03], respectively). No major complications were associated with TEE. For a complete examination, use of both imaging planes was necessary in all the patients studied.


CONCLUSION
Biplane TEE is an accurate, valuable, and safe addition to the perioperative care of patients with congenital heart disease. Although intraoperative TEE is not needed in all operations for congenital heart disease, we recommend that biplane intraoperative TEE be performed routinely during modified Fontan procedures, subaortic resections, and other intracardiac operations for complex congenital cardiac malformations.Traditional phase II oncology clinical trials are focussed on a single treatment for a subgroup of patients with specific histological characteristics. Recently, the advances in cancer biology and genomic medicine have led to the flourish of new molecularly targeted therapies and to a re-thinking of the design of phase II trials assessing clinical activity. In this work, we evaluate the potential benefit of information borrowing across tumor subgroups in basket trials by comparing the operating characteristics of the models presented in the literature. In addition, we suggest a modification of the model proposed in [2] which exhibits good performances in terms of both the average number of patients treated and the ability to preserve the type I error rate.2020 Segù Engineering Division. All rights reserved.Hello, I’m Stephanie, AKA That skinny tall girl. At least that’s what I was called for most of my life. Fast forward to four babies in 6 years (none were multiples), a love of food, and a lack of exercise (unless you count chasing kids, cuz chauffeuring doesn’t burn calories), surgically induced menopause, and you’ve got me NOW….a gal finding her way back to being that skinny tall girl.
I’ve been blessed, these last 22 years, to be a stay-at-home-mommy to my four kiddos. I did have some side gigs during that time that gave me grown up time and fun money, but for the most part, I was identified as Allie, Johnny, Reagan and Jake’s mom, or Rick’s wife. Can anyone relate?
As we face empty nester season (it really does happen in the blink of the eye), I’m faced with finding out what I want to be in this next phase of my life.
I love travel, people, animals, anything near or in the water, natural solutions, exercise, jewelry, fashion, decorating, cooking, creating, furniture repurposing, flea market hunting….you name it…I’m like a squirrel on crack…if I haven’t tried it yet and it looks interesting, watch out!
So, this blog has become my quest to find my way back to myself in this next stage of life, and if you are adventurous, feel free to read all about it.
You can keep up with my daily antics on Instagram (@thatskinnytallgirl), if you like.
Here’s to fun, real life, hot flashes (I did say real life), ups and downs, and adventures!to hurry, to finally find the truth for myself.
It tumbles off the east face of Big Back Mountain, leaping and flowing down its rocky course as it has for eons. Dad and I had fished its lower sections when we’d first come to Tennessee back in the early sixties, and many times we had talked about someday fishing all the way up to the big boulder we’d heard about that was supposed to give birth to the little spring-fed creek.
But with Dad gone, I hadn’t fished the stream for years, and even then I’d never been above the flat nearly halfway up the mountain that the locals called Frog Level.
The old gentleman who’d first told us about the creek had shown us a pale crinkled photograph of himself as a boy with his own father, standing with three old coonhounds beside the big granite boulder that he said sheltered the little spring that gives the stream its birth. But we knew from experience that he was sometimes mistaken about such places and events, and so we weren’t at all sure this was actually the source of Cole Creek.
On a cool April evening approaching midnight in my fifty-first year, I decided it was finally time to fish Cole Creek all the way to the top. My fly fishing gear is always ready for such late-night or early morning impulses, so at five o’clock the next morning I stepped out of the truck and into the starry night and struck the narrow trail up the mountain as the first faint rays of daylight began feathering the sky at my back.
Firmly focused on finding the big granite source rock before the day was done, I eased quietly along the darkened trail beside the lower reaches of the stream for the first mile or so as the birds began to awaken around me. I knew these lower waters well from decades of fishing them, and when I came to the angular shelf of bedrock that holds back the high grassy meadow along the outer edge of a long-familiar bend, I made my first cast of the morning.
I had rigged my fly rod the night before just for this very run; it was here where I had caught my first trout on Cole Creek over forty years ago. 
The trout pivoted in mid-air and dove deep beneath the edge of the rock and shook its head in vehement protest of this rude interruption to his morning routine. When I finally convinced him to join me, I slipped my net around him only long enough to remove the little barbless hook from his lip and apologize for the intrusion.
The next two trout also came from old familiar runs, one beneath the roots of an ancient hemlock growing along an outer bend, the other next to a rock that split a seam where the current edged around a shelf of stone that nearly cut the creek in two. Like the first trout, both of these rainbows were around eleven inches, and both were cleanly hooked and quickly released back into this perfect morning, which was now fully mine.
The next three trout came on a #16 green-bodied elk hair caddis, for the creek had now changed from the familiar extended pools and bends that define its lower reaches to more stair-stepped pocket-waters, offering drifts that averaged at most only eight or ten feet. Two were rainbows and one was a small brown, and all were fat and healthy. I hoped there would be more browns as the day progressed, for I dearly love the colors of these beautiful fish from high-mountain streams such as this. Perhaps I would even find brook trout as I worked into the unknown upper reaches of the creek.
Somewhere I passed into virgin territory, at least for me, and now I was becoming the boy I once had been, feeling the same excitement I had felt back when I’d first fished this little creek with my Dad, along with the same exhilaration I always feel when I find myself on new water with an old fly rod. I cast short beneath a dark cut to my left, gave a quick upstream mend to clear the laurel and struck too soon as I saw a swirl of color coming up from the depths toward my caddis.
It took just long enough to find and disentangle my fly and leader from the overhanging limbs for the trout to reorient itself to its lie. Easing back into position, I was determined to control my nerves and this time wait for the strike.
My first cast was far too tentative, but the second cast landed perfectly, four feet above where the trout had just risen. The little caddis drifted through a tiny dapple of sunlight where I expected the trout to rise, but it failed to appear. And just as I was about to lift the fly from the water, the fish rose daintily at the tail of the run and sipped it in.
I struck lightly but firmly and she immediately swirled for the dark depths beneath the overhang, nearly entwining my leader with the laurel. I prayed she wouldn’t jump. Quickly I bowed and lowered my little six-foot wisp of a fly rod to the left, and in response she turned back into the main flow.
She rippled dark green and crimson in the morning light, and I finally knelt in the stream and tucked the little rod under my arm as I slipped my hand beneath her. I eased the tiny hook from her lip, and when I released her she slashed the surface with her broad square tail as she dove for the depths.
Still kneeling in the edge of the current, I looked up and around and thought of just how unique an experience this was