Intro4u2u

Thirty six years have elapsed since Grondin and associates published in The Journal of Thoracic and Cardiovascular Surgery the paper “The tricuspid valve: A surgical challenge.” Since then, and probably due to it, a lot of attention was placed in a valve whose patho-physiology was not very well understood at the time.

Surgeons now know that a severe degree of tricuspid regurgitation must be corrected at the time of mitral operation, and we now have in our armamentarium several techniques that have successfully passed the test of time to achieve a competent tricuspid valve. It is also true that we don’t know why so many patients, up to 20-25% according to different experiences, whose tricuspid valve was considered quite normal at the time of surgery, later develop right ventricular failure with concomitant severe tricuspid regurgitation. Once this situation is established neither medical nor surgical treatment are clearly effective.

After more than thirty years dealing with this problem and having visually explored many tricuspid valves of rheumatic and non-rheumatic patients at the time of surgery, we have the impression that most of the rheumatic valves have some degree of pathological changes in the leaflets or the subvalvular apparatus even in the absence of any tricuspid regurgitation detectable clinically or echocardiographically.

If these changes progress with time, the valve can became slightly incompetent and trigger a vicious circle that leads to the above mentioned situation with right ventricular failure. Could this vicious circle be interrupted by fixing the annulus with any of the available techniques?

If we admit this hypothesis, surely we are going to treat some patients unnecessarily. What is the price of that? To our knowledge, to wear a pair of sutures around the tricuspid annulus does not imply any risk in the long term. The low economical cost plus the short extra time of cardiopulmonary bypass necessary to perform a suture annuloplasty are added attractions. We lack the necessary experience to decide if such a policy will be applicable using prosthetic rings. Probably the relative high cost of rings can be an obstacle, especially in third world countries where rheumatic valvular disease is most prevalent.

Some technical tricks to properly perform a De Vega tricuspid annuloplasty:

• Place the sutures before doing anything in the mitral valve. Otherwise it may be difficult to place a good stitch in the antero-septal commissure.

• Try to keep your sutures as buried in the annulus as possible by going inside again close to the point you came out.

• If you just need to fix the annulus or to slightly reduce it, you don’t need a stitch at both ends; one suture doubly passed is enough. If you need to really reduce the annulus two sutures, one starting at either end, will produce a more uniform plication.

• In some cases, when the annulus is very much dilated, the plication can be done in two or even three parts. After the left heart valve surgery is completed, with the aortic clamp released, the sutures are tied over a progressive occluder.

Percutaneous valve replacement is not a new initiative, since the pioneer attempts to deliver catheter-based valves date back to the sixties.  During the last few years, percutaneous heart valve (PHV) replacement and repair has emerged as an additional therapy to potentially avoid the reoperation in young patients with congenital heart disease or severely sick patients.  Percutaneous balloon valvuloplasty for pulmonic,[1] mitral,[2] and aortic stenosis has been used with satisfactory results during more than two decades.  In general, this technique was not so successful in the treatment of the acquired calcified aortic stenosis.[3]  The challenge for this technology is to develop a collapsible and durable PHV that can be delivered through a reasonably small diameter lumen catheter, non-interfering with the normal anatomy, and being competent without significant valve stenosis.

New perspectives on transcatheter replacement of heart valves has recently opened in Europe.  Percutaneous prosthetic valve insertion in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction in humans was first reported by Philipp Boenhoeffer in 2000,[4] and later 8 patients–seven children and one adult–with significant pulmonary regurgitation and/or right ventricular outflow tract obstruction using a bovine jugular vein valve (VenPro) sutured into a platinum stent (NuMed Inc.), with encourage clinical and hemodynamics results.  At the latest follow-up, no significant regurgitation or stenosis of the implanted valves, or stent migration were detected.[5]  However, this pediatric cardiologist group from Paris has recently reported[6] their total experience with PHV in the pulmonary position in 14 patients.  Five of them have problems after implantation: 3 had PHV dynamic obstruction (one required a second valve implantation and 2 were solved by redialating the valve stent), and the remaining 2 patients experienced fracture of the stent.  Surgical intervention was necessary in one case, 7 weeks after implantation because of recurrence of PHV obstruction.

Percutaneous pulmonary valve replacement opened new perspectives on PHV in the aortic position.  Experimental studies were carried out in Europe (7-9) to implant in different animal models.  Last year, Alain Cribier from Rouen in France described the first human percutaneous transcatheter implantation of an aortic valve prosthesis in a 57-year-old man with severe calcific aortic stenosis for whom conventional aortic valve replacement was contraindicated.[10]  A bovine pericardial percutaneous valve developed by Percutaneous Valve Technologies, Inc was used in this case.  Unfortunately, several nonvalve-related complications occurred during the follow-up, leading to death 17 weeks after PHV implantation.  Clinical trials with this off-pump transcatheter procedure in the aortic position were expected to start in Europe and the United States this year.

PHV in the pulmonary position is not free from technical and valve-related complications, and these possible troubles significantly increase in the aortic and mitral position.  The anatomy of the aortic root, the proximity of the coronary ostia, the redundant calcified valve tissue, or the fibrous continuity between the aortic and mitral valves made the PHV implantation an easier-said-than-done procedure.  Complex additional technical pitfalls and complications are the appropriate orientation and hooking of the device, the risks of misplacement and embolization of the PHV, the competence and, of course, the durability.  For sure, in the early future technology further improvements in these pioneer PHV prototypes will solve some of these hazards.

Percutaneous mitral valve repair (PMVr) technologies are also developing and they have been experimentally proved, and some European clinical trials are expected to begin this year. Percutaneous mitral annular reshaping (PMAR) using a simple device (C-Cure), produced by Mitralife, recently acquired by EV3 (Minneapolis, MN), which is placed transvenously into the coronary sinus.  The easy access and the speed of procedure make this procedure very attractive to the interventional cardiologists, but the variation in the normal anatomy makes the location of the coronary sinus not always in the proximity of the mitral valve annular plane.  Peroperative or mid-term coronary sinus rupture and thrombosis represent major concerns to the clinical investigators.  Jomed and Edwards Lifesciences are also developing PMVr technologies.  Jomed mitral valve repair device consists of a complete set including delivery, foreshortening mechanism, and implantable device.  Animal studies with a new percutaneous annuloplasty, designed by Viacor, were recently carried out.  More complex mitral valve leaflet repair technologies has been developed by Evalve, consisting of an expandable capture device for grasping and positioning the mitral leaflets, and a fixation instrument that sutures both leaflets together (percutaneous edge-to-edge operation).  A pre-clinical animal study is in process.

Dr. Martin Leon from Lenox Hill Hospital in New York has recently announced in Cardiovascular News (Issue 3, 2003) that “This procedure is early-stage technology, but it has a lot of potential for the future… and if in the future we can demonstrate that these valves are durable, that we can do the procedure repeatedly, reliably and safely, it may, in fact, be competitive with surgical valve replacement under many circumstances.”  He is predicting a dark future for cardiac surgery: “One of the last remaining safe havens of surgical therapy, treatment of valvular heart disease, is now being aggressively challenged by creative interventionalists committed to lesser-invasive therapies.”

Nowadays, more than ten corporations are pioneering these innovative and exciting technologies, some of them are small, start-up companies founded by well-known cardiologists.  They have created such a high expectation among the cardiologists, industry, and consequently among the patients, that Interventional Cardiology is now closer than ever to Cardiac Surgery.

The Tigers regrouped after losing Dontrelle Willis to a knee injury in the first inning, and Magglio Ordoñez had a bases-loaded single Friday night as Detroit beat the White Sox 5-2 in Chicago for their second victory in 10 games.

Willis slipped as he delivered a pitch in the first, hyperextended his right knee and managed to throw only 14 pitches before being removed. Willis will be re-evaluated and when he might be able to pitch again was unclear.

Ordoñez, who had one RBI entering the game, hit a two-run single in Detroit’s third to put the Tigers ahead 3-2. Brandon Inge also had an RBI single in the inning. Willis walked leadoff hitter Carlos Quentin.

On his first pitch to Orlando Cabrera, his right knee that he plants while delivering gave way and he slipped in front of the mound. The game started late because of rain.

A trainer and manager Jim Leyland came out, but Willis told them he was OK to continue.

After Willis walked Cabrera and threw a wild pitch with a 1-1 count on Jim Thome, the trainer and Leyland went back to the mound. Willis again appeared to tell them he was OK, but Leyland removed the lefty and brought in Aquilino Lopez.

Mariners 8, Angels 5: Raul Ibañez hit two home runs off Jered Weaver, lifting Felix Hernandez to a win in Seattle. Ibañez drove in three runs during the season’s first game between top rivals in the AL West.

Twins 5, Royals 0: Livan Hernandez scattered seven hits over seven innings to win his third straight start, this time in Kansas City, Mo. Six of the hits Hernandez allowed were singles. He struck out three and walked one, lowered his earned run average to 2.57, and is 3-0 for the first time since 2002, when he won his first four starts for the Giants.

Yankees 4, Red Sox 1: Chien-Ming Wang pitched a complete game two-hitter at Fenway Park in running his season record to 3-0 and lowering his ERA to 1.23. The Yankees’ Jason Giambi was off to a 1-for-22 start before hitting his first homer of the year.

Rays 10, Orioles 5: Carlos Peña homered twice and drew a bases-loaded walk in the eighth inning to finish with six RBIs in leading host Tampa Bay.

Blue Jays 8, Rangers 5: Lyle Overbay hit a three-run double, Vernon Wells drove in two runs and visiting Toronto ended a three-game losing streak.

The West glitterati descended upon Staples Center Friday night, the presumptive conference champion, the presumptive MVP, the presumptive runners-up . . .

All they had to do was sort out who got what.

In a walkover, the Lakers opened up an early 30-point lead over the New Orleans Hornets and cruised to . . . oh, sorry.

In one of the great comebacks in New Orleans Hornets history or chokes in Lakers history, the visitors stormed from 30 points behind . . . oh, sorry.

OK, in a showdown as epic as the West race that preceded it, the second-place Lakers took a 30-point lead, had the first-place Hornets wipe out 29 points of it but fought them off at the end to win, 107-104.

Now Pacific Division champions, the Lakers trail the Hornets by half a game but own the tiebreaker if they catch them.

As for the MVP, which has yet to be decided, it looked like they might give Kobe Bryant the trophy at halftime.

In what is thought to be a two-horse race with the Hornets’ Chris Paul, Bryant was brilliant (29 points, 10 rebounds, eight assists, nine for 17 from the floor) while Paul started slowly but wound up with 15 points and 17 assists.

Feature angles notwithstanding, the most valuable player is a season-long award and usually isn’t evaluated on a game-to-game basis, but sentiment already seemed to be running toward Bryant.

A week ago, a Times poll of 21 writers gave Bryant 10 first-place votes, Paul eight, Kevin Garnett two and LeBron James one.

Another poll of 17 writers this weekend showed Bryant with 10 first-place votes, Paul with five and Garnett with two.

Look at it this way as many voters must be: Paul is 22 and has many years to win MVPs.

Bryant is in his 12th season, and it may be getting embarrassing to explain why the game’s best player has never come closer than two third-place finishes.

(In 2005-6, Bryant didn’t get a single vote, which meant he finished behind New Orleans’ P.J. Brown, who got one 10th-place vote.)

“I think that’s the most remarkable stat of all, that he’s been in the league 12 years and hasn’t won it,” said Hornets Coach Byron Scott of Bryant before the game.

“I don’t think he’s been runner-up. I don’t think he’s come in third. I think it’s remarkable that he hasn’t and for the past five or six years, he’s been the best player in this game.”

Scott, a star on the Showtime Lakers in the ’80s, was a mentor to Bryant as teammates in Byron’s second stint in L.A. in the 1996-97 season.

Now Scott is this season’s presumptive coach of the year after taking the Hornets, who didn’t make the playoffs last season and weren’t expected to this season, this close to winning the West.

“Focus, determination and a lot of people telling us we couldn’t do it,” said Scott, explaining his secret. “That probably had a lot to do with it because we heard it from All-Star break on.

“At All-Star break, we had the best record, but yeah, they’ll fall off, the pressure will get to them, the schedule will get to them when they go on this road trip in March.

“There was always something and I think that motivated our guys to go out and prove people wrong.”

Motivation helps a lot, especially when you’re good enough.

To the utter amazement of all, Paul was not only ready for prime time in the West race in his third season, he was neck-and-neck in the MVP race with Bryant.

The Hornets got Paul, whom they considered the top pick in the 2005 draft, with the fourth pick.

However, not even Scott dreamed Paul would be this far within three years.

“Not this soon,” said Scott. “Nah, never would have thought that he would be this good this soon and he’d be getting the type of praise he’s getting this early in his career.

“But he deserves it,” Scott added. “He’s put in a lot of work. He’s been a tremendous leader to this team and the things we talked about this summer that he had to improve, he went out and improved them.

“The thing that’s scary is, he’s 22 and he’s going to get better.”

He’s good enough now. Ask the Lakers who had better gear up for next season when Paul is 23

Trevor and Brandt are setting the pace at the Masters, so everyone expecting something more along the lines of, well, Tiger, let’s just say that’s not the name of the game so far.

But that guy named Phil is definitely in the mix after Friday’s second round.

Masters, Round 2
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Masters, Round 2

Tiger Woods 2008 highlights
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Tiger Woods 2008 highlights

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Trevor Immelman birdied the last two holes to put the finishing touches on a second consecutive four-under-par 68 and a one-shot lead at a much more workable Augusta National Golf Club. He’s at eight-under 136.

Next is Brandt Snedeker, who had more problems keeping his shaggy hair stuck under his visor than he had on the course after his own 68.

And right behind is none other than Phil Mickelson, whose bogey-free 68 puts him at five-under 139 and right in line to make a run at his third Masters title.

Mickelson, tied with Steve Flesch and Ian Poulter, was a quick starter, with birdies on two of his first three holes, and even managed to coax a birdie out of the tough 17th when he rolled in a 30-foot putt, but he had just one regret.

“I would love to be in the lead,” he said.

Tiger Woods would love to be somewhere in the top 10. He had to settle for a tie for 13th, at one-under 143, but he said that’s not necessarily a bad place, especially with an inventive par save at the 18th, where he closed out his round of one-under 71.

Woods, who birdied the 17th hole, hit his drive at the 18th far to the right under some trees. He had no chance to advance the ball the normal way, so he split the gap between two trees and landed the ball on the 10th fairway, which runs next to the 18th fairway. From there, he chipped the ball onto the green, clicked Stuart Appleby’s ball, and eventually made an eight-foot putt to save his par.

Woods, who is only two under on the par fives this week, hasn’t broken 70 at the Masters since the third round in 2005, but he chose to accentuate the positive aspects.

“I’m in good shape,” he said. “Obviously, I’m seven back, but on this golf course, you’ve got to stay patient. This golf course, you can make up shots, so just hang in there.”

Woods may have a little history on his side. The last player to come outside the top 10 to win after 36 holes was Jack Nicklaus in 1986. Nicklaus had been tied for 17th. The most Woods has come from behind to win the Masters after 36 holes was six shots in 2005.

As for Immelman, he feels lucky to be here, but then, he feels fortunate to be anywhere after two upsetting health scares last year. The South African lost 20 pounds after the 2007 Masters because of a stomach parasite, and then later in the year, he had a benign tumor removed from his diaphragm.

“Obviously, this year is pretty special,” Immelman said. “Last year, guys go through that . . . bad timing. To shoot two 68s in the first two days is probably beyond my expectations, so I’m pretty thrilled right now.”

Immelman won the Nedbank Challenge last year, but he is still on the mend from his health scare and has missed four cuts in eight PGA Tour events in 2008. He said he has gained perspective from his experiences.

“I went from winning a tournament to lying in a hospital bed waiting for results on a tumor,” he said. “So it definitely made me realize that golf wasn’t my whole life.”

Snedeker finished the same way as Immelman with back-to-back birdies, the only blemish on his round a three-putt bogey at the par-three 16th.

Snedeker chipped in to birdie the sixth and called it one of the luckiest shots he has ever hit. Chances are, Snedeker could use a little more good fortune the rest of the way.

“If I had told you at the beginning of the week that I thought I was going to be in second place, you probably would have thought I was crazy, and I probably would have thought you were right,” he said.

Snedeker is two shots ahead of fashion plate Poulter, Mickelson and another lefty, Flesch, who has jumped out from behind the Georgia pines and into contention after missing four cuts in nine tournaments this year.

It wasn’t a statement-making victory, a win that will spark a new world order in the American League West, but after being thumped so thoroughly by the Angels last season, the Seattle Mariners will take it.

After nearly losing a two-run lead by committing two errors in the top of the eighth inning, the Mariners scored twice in the bottom of the eighth to pull away for an 8-5 victory over the Angels on Friday night in Safeco Field.

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Mariners 8, Angels 5

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Kenji Johjima hit a run-scoring double off Angels reliever Darren Oliver and Yuniesky Betancourt greeted Jason Bulger with an RBI triple over the head of center fielder Torii Hunter, who jammed his left wrist and a toe crashing into the wall but remained in the game.

Mark Lowe, subbing for injured closer J.J. Putz, gave up a leadoff double to Vladimir Guerrero in the ninth but retired Garret Anderson, Hunter and Robb Quinlan for his first career save. Raul Ibanez hit two solo home runs and an RBI double for Seattle.

“We needed this win,” Manager John McLaren said of his Mariners, who were coming off a 2-5 trip to Baltimore and Tampa Bay. “No one has to tell us who the Angels are and what they’ve done. They’re the team to beat.”

Since the Angels went 13-6 against the Mariners in 2007 and outscored them, 24-8, to sweep a three-game series in Seattle in late August, the Mariners have seemed fixated on the Angels.

McLaren even went so far as to bring most of his regulars to a road exhibition game against the Angels in Tempe, Ariz., in the first week of March, hoping to set a tone for the season.

“If you feel like you’ve got to make a statement in spring training. . . .” Angels pitcher John Lackey said before Friday night’s game. “It’s too early to get too crazy about a series like this. Let’s get about 50 games into the season and see where everyone is at.”

Seven innings into their first meeting of the season, the Mariners were ahead, 6-4. Then, after Hunter singled to lead off the eighth, Seattle broke out the gift wrap. Reliever Sean Green’s throwing error on Casey Kotchman’s potential double-play grounder and first baseman Richie Sexson’s fielding error on Maicer Izturis’ grounder enabled Hunter to score and the Angels to put two on with no outs.

Jeff Mathis, who hit a solo home run off Felix Hernandez in the third, bunted the runners up, but pinch-runner Reggie Willits was thrown out at home trying to score on Erick Aybar’s grounder to third baseman Adrian Beltre.

Chone Figgins walked to load the bases, but Gary Matthews Jr., who hit a solo homer off Hernandez in the sixth, flied to left, and the Mariners held on, snagging at least a little momentum from their division nemesis.

“Maybe if you beat them a few times,” Sexson said, “they start thinking, ‘Hey, it’s going to be tougher than we thought.’ ”

Angels starter Jered Weaver gave up two hits through five innings but had a tough time with Ibanez, who homered in the first and fourth innings and is batting .571 (12 for 21) with four homers against the right-hander.

Asked if he figured out a way to get Ibanez out, Weaver snapped, “Obviously not . . . next question.”

So, what happened in that sixth inning? The Angels scored twice in the top half for a 3-2 lead, but Seattle second baseman Jose Lopez doubled with one out in the bottom of the sixth, and Ibanez was intentionally walked. Beltre flied to center, but Jose Vidro walked to load the bases.

Up stepped Sexson, hitless with five strikeouts in 11 career at-bats against Weaver. Weaver walked him on a full-count pitch, forcing the tying run. Brad Wilkerson followed with a two-run single for a 5-3 lead.

“I got away from my game,” Weaver said. “They got some runners on, and I tried to be too fine. That’s it.

Chinese President Hu Jintao took a hard line Saturday on recent unrest in Tibet, saying problems in the region are a purely internal affair that directly threatens Chinese sovereignty.

Hu’s comments to visiting Australian Prime Minister Kevin Rudd marked his first public comments on anti-government protests that broke out in the Tibetan capital of Lhasa last month.

“Our conflict with the Dalai clique is not an ethnic problem, not a religious problem, nor a human rights problem,” the official Xinhua News Agency quoted Hu as saying, referring to supporters of Tibet’s exiled Buddhist leader, the Dalai Lama, who Beijing blames for fomenting the unrest.

“It is a problem either to safeguard national unification or to split the motherland,” Hu told Rudd at a meeting on the sidelines of a regional economic forum in China’s southern province of Hainan.

As Tibet’s former Communist Party boss, Hu enforced a harsh crackdown against the last major anti-government protests there in 1989 and has tightened Chinese rule over the Himalayan region since taking over as president in 2003. Under Hu, the party has increased controls over Tibetan Buddhism and increasingly opened the region to travel and migration from other parts of China.
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Hu’s remarks come a day after China ratcheted up its attacks on overseas critics, blasting a U.S. congressional resolution on Tibet as “crude interference” and labeling a leading Tibetan exile group a terrorist organization.

The accusations follow massive demonstrations by pro-Tibet activists and other groups surrounding the Olympic torch’s passage through San Francisco, London and Paris. The protests have stirred anger from both the government in Beijing and among Chinese citizens.

Foreign Ministry spokeswoman Jiang Yu said the resolution passed Wednesday by the U.S. House of Representatives “crudely interfered in China’s internal politics, seriously hurting the feelings of the Chinese people.”

“The Chinese side expresses its strong indignation and resolute opposition toward this,” Jiang said in a statement posted on the ministry’s Web site.

The resolution called on Beijing to stop suppressing nonviolent protests and end what it called cultural, religious, economic and linguistic repression in Tibet.

The latest round of protests began peacefully among Buddhist monks in Lhasa on March 10, the anniversary of a failed 1959 during which the Dalai Lama fled to India. Four days later, they turned violent, with hundreds of shops torched and Chinese civilians attacked.

China says 22 people were killed in the riots, many in arson attacks, and more than 1,000 were detained. The Dalai Lama’s India-based government-in-exile says more than 140 people were killed.

The U.S. resolution also called on China to begin an unconditional “results-based dialogue” with the 72-year-old Dalai Lama to address Tibetan concerns and work toward a long-term solution to the dispute. China has said it will only hold talks if he first meets a list of preconditions, including abandoning what Beijing alleges is his continuing support for Tibetan independence.

Chinese state media also lashed out at the Tibetan Youth Congress, accusing it of orchestrating recent protests in a bid to overthrow Chinese rule and sabotage the Beijing Olympics in August.

Such acts “exposed the terrorist nature” of the group, Xinhua said in an article Friday, citing alleged statements and speeches by the group’s leaders as well as a purported plot to smuggle weapons into Tibet to launch attacks.

“Judging by these criteria, the Tibetan Youth Congress is a terrorist organization in a pure sense,” Xinhua said.

The Tibetan group’s vice president, Dhondup Dorji, condemned the allegation, saying China had no evidence for the claim and had long sought to weaken the group’s effectiveness by smearing its reputation.

“The Chinese officials, after seeing that the Tibetan Youth Congress is the most potent force today in the peaceful movement-in-exile, have been trying to brand it as a terrorist organization for many years without any basis,” he told The Associated Press.

Founded by leading exile figures in 1970, the India-based congress is historically linked to the government-in-exile, although it advocates full independence for Tibet as opposed to the Dalai Lama’s calls for substantial autonomy under Chinese sovereignty.

The accusation was among the strongest against an exile Tibetan group in the latest round of anti-government protests. Chinese police earlier this month accused radicals of organizing suicide squads to launch violent attacks but offered no evidence for the claim

A unique diet, specially tailored clothes, counseling: The daily cost of providing care to the 555 women and children relocated from a West Texas polygamist compound is running upward of $25,000 a day.

The state on Friday said it was prepared to foot the bulk of the cost.

“We’ll find the dollar and cents somehow, somewhere, under the sofa cushion perhaps,” said Krista Piferrer, a spokeswoman for Gov. Rick Perry.

She said the state would assume all unanticipated costs associated with the forced removal and care of 416 children that Child Protective Services officials say were being abused or at risk of abuse, and their mothers, 139 of them, who accompanied the children.

The relocated followers of the Fundamentalist Church of Jesus Christ of Latter Day Saints, which broke from mainstream Mormonism a century ago to continue practicing polygamy, are being housed here, 45 miles north of their Schleicher County compound, in two makeshift shelters.

Journals confiscated
As about 500 public and private workers tried to care for them, authorities Friday released an 81-page list of items seized during the weeklong raid of the Yearning for Zion Ranch outside Eldorado.

The inventory contained hundreds of family photos and journals, notebooks containing marriage dates and births, and something described only as a “cyanide poisoning document.” All remain under court seal.

Texas Department of Public Safety spokeswoman Tela Mange later said the cyanide item was a set of pages torn from a first-aid book on how to treat cyanide poisoning, but she didn’t know why the sect would have such information on hand.

Authorities believe marriage and birth records, even informal ones, will prove their contention that a pattern of sexual abuse existed within the compound in which men had sex with underage girls under cover of religion, taking them as their spiritual wives and possibly consummating the unions in their temple.

No sex-related criminal charges have been filed against any of the men at the compound.

Investigators have collected DNA samples from an unknown number of them, to be used to establish child-parent relationships, a source at the compound said.

Birth records could be used to establish a mother’s age when she gave birth.

Physical evidence would be crucial to building any type of case, given how little the sect’s members have cooperated.

Marleigh Meisner, a CPS spokeswoman, said the task of identifying the sect members has become a grueling challenge. Those who work with the members say the women and children are always polite, but one may give different names and several may give the same name, she said.

The workers say they are doing everything they can to gain the members’ trust and ensure their comfort.

Only natural foods
The sect members are being served only natural foods, since they shun all things processed. Kevin Dinnin with Baptist Children and Family Services, contracted to coordinate services for the governor’s division of emergency management, said their frontier-style clothing can’t be ignored, either.

“If they want black socks, I want them to have black socks,” he said.

Counselors from Utah familiar with their customs are to arrive soon to advise CPS workers.

Dinnin said the women and children have neither asked for nor received televisions or newspapers. They have telephoned relatives back at the compound, though. CPS has forbidden all face-to-face contact between those in the shelters and male sect members.

Several women have called or arrived at the shelters to claim that the state is holding their children, officials said.

Hearing next week
Meisner said the children would not be permitted any visitors until the state’s effort to take full custody was decided. A hearing is scheduled for Thursday in District Judge Barbara Walther’s court.

The state is trying to line up foster families for them, Meisner said.

Most of the children are the offspring of the faith’s inner circle — including its now-imprisoned prophet, Warren Jeffs — who were born since construction began on the compound, or were hand-selected by Jeffs to come to the enclave.

Phone calls from a pregnant 16-year-old girl at the compound, who said she is married to a much older and abusive man, sparked the raid. Her whereabouts remain unknown

American Airlines says it hopes to get back to running a normal service by Sunday.

The airline, which is the world’s biggest, has had to cancel more than 3,000 flights this week to inspect the wiring on its MD-80 aircraft.

The cancellations have left hundreds of thousands of passengers stranded.

The airline has cancelled 200 of Saturday’s flights, but said it hoped to have all of the aircraft ready to return to service by the afternoon.

American Airlines had cancelled 595 flights on Friday, three days after the company grounded 300 of its planes.

The Federal Aviation Administration (FAA) had raised concerns about inspections of the planes’ wiring.

The FAA has been clamping down on safety inspections and several airlines have been forced to ground planes.

Three quarters of its MD-80 planes, which mostly fly US domestic routes, have now been inspected and returned to service, the airline said.

So far a third of a million passengers have been left stranded by the cancellations.

The airline says the cost of compensating them could run into “tens of millions of dollars”

Toshiba tends to split its business in two quite distinctive trends, you have the full multimedia statements, such as its Qosmio line, and then there is the rather subdued and safe business machine. While the Toshiba Satellite Pro U300 falls into the second camp it’s not an unattractive notebook.

Finished in black and grey plastic, this isn’t the most stylish of notebooks but it certainly proved robust for use on the move. It’s a slim machine considering there is a DVD rewriter built-in and the size means it great for the commute, as it will easily slip in to any standard carry case.

With an overall weight of 2.1kg, it’s reasonably portable and coupled with a battery life well in excess of 3 hours, we were more than satisfied with its portability.

This size is kept to a minimum by the use of a 13.3-inch display. It’s a Super-TFT panel so has a gloss finish, which is great for digital photos and DVDs but can cast reflections if used in bright conditions. While it’s more usual for business notebooks to have a standard TFT panel, we like this sort of screen as images really shine.

Graphics come as an integrated Intel X3100 solution, so you won’t be able to run anything other than everyday applications but we found it worked well.

The size of panel allows for a decent size of keyboard, which proved comfortable to use. The keys have a decent amount of travel and while there was a slight rattle as we typed, it certainly proved good value for money.

When it comes to the core specification, we weren’t expecting the U300 to be a powerhouse but with an Intel 2.2GHz Core 2 Duo T7500, 2048MB of memory and 160GB hard drive, we were surprised how much power was packed into such a small casing. So much so that you can easily have this notebook as you sole PC instead of just using it on the move.

With this degree of processing power, we were expecting the notebook to grow reasonably warm to the touch or for the fan to run for long periods. However, this didn’t prove the case, with the fan only running when multiple windows were open and the case only grew warm once the machine had been on for close to 2 hours.

When it comes to extras this isn’t the most future-proof of machines. For instance, you won’t find any digital-out port, but rather a VGA-out port for connecting to older screens or projector technologies. The 6-in-1 media card reader lets you transfer files between your smartphone, PDA or digital camera, and there’s also a tri-format DVD rewriter for backing up your files.

Toshiba prides itself on the quality of its bundled software and along with a host of Toshiba tools to help setup and manage your notebook there is a comprehensive software suite, including anti-virus and DVD-burning applications.