Coupling Rydberg Atoms to Microwave Fields in a Superconducting Coplanar Waveguide Resonator.

Rydberg helium atoms traveling in pulsed supersonic beams have been coupled to microwave fields in a superconducting coplanar waveguide (CPW) resonator. The atoms were initially prepared in the 1s55s ^{3}S_{1} Rydberg level by two-color two-photon laser excitation from the metastable 1s2s ^{3}S_{1} level. Two-photon microwave transitions between the 1s55s ^{3}S_{1} and 1s56s ^{3}S_{1} levels were then driven by the 19.556 GHz third-harmonic microwave field in a quarter-wave CPW resonator. This superconducting microwave resonator was fabricated from niobium nitride on a silicon substrate and operated at temperatures between 3.65 and 4.30 K. The populations of the Rydberg levels in the experiments were determined by state-selective pulsed electric field ionization. The coherence of the atom-resonator coupling was studied by time-domain measurements of Rabi oscillations.

Case Report: Analytically Confirmed Severe Albenzadole Overdose Presenting with Alopecia and Pancytopenia.

Internet-facilitated self-diagnosis and treatment is becoming more prevalent, putting individuals at risk of toxicity when drugs are acquired without medical oversight. We report a patient with delusional parasitosis who consumed veterinary albendazole purchased on the Internet, leading to pancytopenia, transaminase elevation, and alopecia. A 53-year-old man was sent to the emergency department (ED) by his gastroenterologist because of abnormal laboratory results. The patient had chronic abdominal pain and believed he was infected with parasites. He purchased two bottles of veterinary-grade albendazole on the Internet, and over the 3 weeks before his ED visit, he consumed 113.6 g of albendazole (a normal maximal daily dose is 800 mg). Five days before admission, he noticed hair loss and a rash on his face. His examination was notable for significant scalp hair loss and hyperpigmentation along the jaw line. Laboratory studies were remarkable for pancytopenia (most notably a white blood cell count (WBC) of 0.4 × 103 cells/mm3, with an absolute neutrophil count (ANC) of 0 × 103 cells/mm3) and transaminase elevation (aspartate aminotransferase [AST] 268 IU/L, alanine aminotransferase [ALT] 89 IU/L). He developed a fever and was treated with antibiotics and colony-stimulating factors for presumed neutropenic bacteremia. Over the course of 1 week, his hepatic function normalized and his ANC increased to 3,000 × 103 cells/mm3. Serial albendazole and albendazole sulfoxide concentrations were measured in serum and urine by liquid chromatography-quadruple time-of-flight mass spectrometry. On day 2, his serum concentrations were 20.7 ng/mL and 4,257.7 ng/mL for albendazole and albendazole sulfoxide, respectively. A typical peak therapeutic concentration for albendazole sulfoxide occuring at 2-5 hours post-ingestion is 220-1,580 ng/mL. Known adverse effects of albendazole include alopecia, transaminase elevation, and neutropenia. Pancytopenia leading to death from septic shock is reported. In our patient, prolonged use of high-dose albendazole resulted in a significant body burden of albendazole and albendazole sulfoxide, leading to pancytopenia, transaminase elevation, and alopecia. He recovered with supportive therapy.

The cosmetic outcome in early breast cancer treated with breast conservation.

AIMS: To measure the cosmetic outcome of breast-conserving surgery and identify the factors which influence cosmesis. METHODS: A total of 254 patients with primary breast cancer treated by wide local excision, with or without radiotherapy, were subjectively assessed for cosmesis by a six-member panel using photographic evaluation and objectively by an independent observer using specific measurement. RESULTS: Good to excellent cosmetic results were achieved in 184 (72%) patients on panel subjective assessment and 201 (79%) patients on objective assessment. Good correlation (P<0.001) and agreement were found between the panel's subjective photographic assessment and the objective assessment. The main factors found to affect cosmesis negatively were: medially located tumours; weight of specimen; re-excision procedures; radiotherapy; small breasts and longer scars. CONCLUSION: These cosmetic results, combined with a low local recurrence rate following wide local excision, validate the operative method used.

Recurrent gastrointestinal hemorrhage: an unusual cause.

A young man presented with gastrointestinal bleeding which necessitated a partial gastrectomy. No lesion was discovered in the stomach or duodenum. Subsequently episodes of hemorrhage recurred. Barium studies and blood investigations failed to reveal the cause. The observation of skin lesions on the neck led to the diagnosis of pseudoxanthoma elasticum. The importance is stressed of examining the skin in any case of alimentary bleeding of obscure origin.

Apnoea following suxamethonium: the genetic study of four generations of a family.

Nineteen subjects were investigated as a result of apnoea following the administration of suxamethonium occurring in one member of the family. Examination of the blood for cholinesterase activity, dibucaine number, and fluoride number was carried out and the appropriate genotype determined. The significance of the genetic variation of plasma cholinesterase in relation to suxamethonium apnoea is discussed. Five subject had the genotype Eu1Eu1, seven were of genotype Eu1E1a, three were Eu1Es1, and four Ea1Es1. Nine members of the family were considered to be at risk for the administration of suxamethonium. The appropriate action to safeguard other members of the family following a case of apnoea is outlined. By routine preoperative blood examination, 92 of 100 cases of suxamethonium apnoea resulting from a genetic abnormality of plasma cholinesterase can be anticipated.

Left vocal cord paralysis and dysphagia in mitral valve disease.

Two cases of severe mitral stenosis with both hoarseness, caused by left vocal cord palsy, and dysphagia are described. This combination in the same patient has not, to our knowledge, been previously described. Previous studies have firmly established that vocal cord paralysis in mitral stenosis is a result of compression of the left recurrent laryngeal nerve as it passes around the aortic arch. It is suggested that dysphagia may also develop as a result of neurological damage, in this case to autonomic nerve plexuses supplying the oesophagus, leading to abnormal peristalsis and enabling external compression by a tense left atrium sufficient to cause symptoms