Quantum Rabi Oscillations in Coherent and in Mesoscopic Cat Field States.

The simple resonant Rabi oscillation of a two-level system in a single-mode coherent field reveals complex features at the mesoscopic scale, with oscillation collapses and revivals. Using slow circular Rydberg atoms interacting with a superconducting microwave cavity, we explore this phenomenon in an unprecedented range of interaction times and photon numbers. We demonstrate the efficient production of cat states, which are the quantum superposition of coherent components with nearly opposite phases and sizes in the range of few tens of photons. We measure cuts of their Wigner functions revealing their quantum coherence and observe their fast decoherence. This experiment opens promising perspectives for the rapid generation and manipulation of nonclassical states in cavity and circuit quantum electrodynamics.

Coherent Transfer between Low-Angular-Momentum and Circular Rydberg States.

We realize a coherent transfer between a laser-accessible low-angular-momentum Rydberg state and the circular Rydberg level with maximal angular momentum. It is induced by a radio frequency field with a high-purity σ^{+} polarization resonant on Stark transitions inside the hydrogenic Rydberg manifold. We observe over a few microseconds more than 20 coherent Rabi oscillations between the initial Rydberg state and the circular level. We characterize these many-Rydberg-level oscillations and find them in perfect agreement with a simple model. This coherent transfer opens the way to hybrid quantum gates bridging the gap between optical communication and quantum information manipulations with microwave cavity and circuit quantum electrodynamics.

An avoidable cause of thymoglobulin anaphylaxis.

BACKGROUND: Thymoglobulin® (anti-thymocyte globulin [rabbit]) is a purified pasteurised, gamma immune globulin obtained by immunisation of rabbits with human thymocytes. Anaphylactic allergic reactions to a first injection of thymoglobulin are rare. CASE PRESENTATION: We report a case of serious anaphylactic reaction occurring after a first intraoperative injection of thymoglobulin during renal transplantation in a patient with undiagnosed respiratory allergy to rabbit allergens. CONCLUSIONS: This case report reinforces the importance of identifying rabbit allergy by a simple combination of clinical interview followed by confirmatory skin testing or blood tests of all patients prior to injection of thymoglobulin, which is formally contraindicated in patients with a history of hypersensitivity to rabbit proteins.

[Global management of patients with ebola viral disease, experience of the Healthcare workers Treatment of Conakry, Guinea]. / Prise en charge globale du patient contaminé par le virus Ebola, expérience du Centre de traitement des soignants de Conakry, Guinée.

The Healthcare Workers Treatment Center of Conakry, Guinea, was inaugurated in january 2015. It is dedicated to the diagnosis and the treatment of healthcare workers with probable or confirmed Ebola viral disease. It is staffed by the french army medical service. The french military team may reconcile their medical practice and the ethno-cultural imperatives to optimise the patient adherence during his hospitalization.

[Mannequin-based simulation to evaluate difficult intubation training for emergency physicians]. / Intérêt de la simulation réaliste dans l'évaluation de l'enseignement de l'intubation difficile aux médecins urgentistes.

OBJECTIVES: The aim of this study was to evaluate for the interest of realistic mannequin-based simulations as a tool to assess the knowledge of emergency medicine physicians in the field of difficult tracheal intubation. STUDY DESIGN: Prospective. POPULATION: Emergency physicians. METHODS: Twenty-four emergency physicians were invited entering the study. The first step of the study consisted of an initial assessment of their knowledge in the field of difficult tracheal intubation. Then theoretical lectures on the tools and techniques of difficult tracheal intubation were given, followed by standard mannequin-based driven workshops. The second step was conducted six weeks later. Each physician's knowledge was re-evaluated and their ability to manage two difficult airway scenarios simulated on the AirMan simulator (Laerdal was assessed. RESULTS: Only one physician could not complete the program. Half of them worked at the University Hospital (UH) with half of them for less than three years. Lectures and standard mannequin-based driven workshops significantly improved physician's theoretical knowledge. Practical performance during difficult airway management scenarios was poor. CONCLUSION: We have demonstrated that theoretical lectures and standard mannequin-based driven workshops improved overall theoretical knowledge but did not translated to practical skill during of realistic mannequin-based simulations. Realistic mannequin-based simulations teaching programs in the field of difficult tracheal intubation should be considered.

Anaphylactic reaction to local administration of rifamycin SV.

BACKGROUND AND OBJECTIVE: Systemic reactions during anesthesia are commonly attributed to muscle relaxants, hypnotics, macromolecular solutions, latex, or parenteral antibiotics. After exclusion of these different components as causes, we were interested in the potential implication of rifamycin in the systemic reaction, which occurred during anesthesia, and in the immunologic mechanism by which it can trigger this reaction. METHODS: We report four cases of systemic reactions occurring after local administration of rifamycin. Three patients needed orthopedic surgery, and the fourth needed a urethrotomy. Severe systemic reactions occurred in all four patients when the surgeon washed the incision area with a rifamycin solution. All patients correctly responded to appropriate treatment and recovered. Skin tests were performed 2 months after the incident with the drugs used during anesthesia, latex, and rifamycin. To assess the relationship with a possible IgE-mediated mechanism, two in vitro tests were concomitantly performed to evaluate the cell reactivity to rifamycin: (1) determination of histamine release from peripheral basophils and (2) platelet cytotoxicity test, which explored the presence on platelets of specific IgE antibodies bound to the low-affinity receptor for IgE. RESULTS: Skin tests were performed with different drugs used during surgery, and results were only positive for rifamycin in the four cases, accompanied in two cases by a systemic reaction. Histamine release from basophils was positive in three of four patients. The platelet cytotoxicity test results were positive in all four cases. CONCLUSION: It appears that rifamycin, used locally during surgery, is apt to trigger severe systemic anaphylactic reactions, which are linked to an IgE-related process. This situation is worth pointing out, especially in patients who undergo repeated orthopedic operations during which, at least in Europe, rifamycin is commonly used for the prevention of local sepsis.

[Anesthetics responsible for anaphylactic shock. A French multicenter study]. / Substances anesthésiques responsables de chocs anaphylactiques. Enquête multicentrique française.

Combined allergological and anaesthetic consultations have been started in the last few years in eight French Teaching Hospitals so as to explore peranaesthetic anaphylactoid shocks. A survey was carried out in these centers in order to collect patients investigated with the same protocol, for the assessment of the incidence of anaphylaxis in France, as well as the involved drugs. Investigations were always carried out at least 6 to 8 weeks after the accident. The tests used to diagnose IgE-dependent anaphylaxis were skin tests (prick and intradermal tests, carried out in all eight centers), the radioimmunological assay of specific anti-quaternary ammonium IgE, together with an inhibition test with thiopentone and propofol (six centers), leukocyte histamine release (five centers) and human basophil degranulation tests (three centers) for those drugs for which no specific antibody assay exists. The collected data involved 1,240 patients, investigated within the last four years. Anaphylaxis was diagnosed in 821 patients (66.2%). Muscle relaxants were responsible in 668 cases (80% of cases of anaphylaxis). Suxamethonium was the main cause (54.3% of shocks due to muscle relaxants), followed by vecuronium (15.3%). General anaesthetics (hypnotics and benzodiazepines) were responsible for 9.2% of all cases of anaphylaxis opioids for 2.6%. There were only three cases of shock due to local anaesthetic agents. Latex and ethylene oxide are becoming increasingly involved. It would therefore seem mandatory to carry out after any anaphylactoid accident an assessment with sensitive and specific tests for anaphylaxis. Diagnosing anaphylaxis means that the involved drug should be used never again in that patient. Because muscle relaxants are by far the most involved drugs, anaesthetists should use them only when really required.

[Allergy to anesthetic agents: analysis of 96 recent cases]. / L'allergie aux agents anesthésiques: analyse de 96 observations récentes.

This retrospective study concerning 96 observations from 1984 to 1987 allows to estimate the incidence of anaphylactoid reactions, the risk factors and the drugs involved in these accidents. During these three years, 96 anaphylactoid reactions due to anaesthetic drugs were collected. These anaphylactoid reactions were investigated by intradermal skin tests and in vitro by leukocyte histamine release. The drugs most often involved were the muscle relaxants and over all suxamethonium. This muscle relaxant must be reserved to strict indications.

[Evaluation of the histamine-liberating property of midazolam]. / Evaluation du pouvoir histamino-libérateur du midazolam.

The variations of plasma histamine levels were studied in two groups of ten patients arriving in the operating room; the first group received midazolam, and the second a saline isotonic solution. The plasma histamine levels were compared, for each patient, to the histamine level measured the day before the operation. An histamine release was found as soon as the patient arrived in the operating room. No variation of the histamine level was found after the injection of midazolam.

[Value of leukocytic histamine liberation tests and intradermal tests in the diagnosis of anaphylactoid reactions to anesthetic products]. / Intérêt des tests de libération de l'histamine leucocytaire et des intradermoréactions dans le diagnostic des accidents anaphylactoïdes aux produits anesthésiques.

Skin tests and leukocyte histamine release (LHR) were carried out in 14 patients who had presented an anaphylactic reaction during general anaesthesia; they were compared with a control group of 14 normal subjects. Histamine release was measured by a fluorimetric method after contact in vitro between patient's basophils and native drug at various concentrations. More than 10% LHR and a diphasic release curve were considered to be mandatory to certify an anaphylactic origin. The reliability and the specificity of the LHR seemed excellent. The discriminative power between the two groups was statistically significant (p less than 0.0001). Except for two cases, investigated soon after the accident, in which the total histamine level was too low, LHR appeared reliable and its association with skin tests gave the diagnosis of anaphylaxis in 13 of the 14 cases.