Z = 50 shell gap near 100Sn from intermediate-energy Coulomb excitations in even-mass 106-112Sn isotopes.

Rare isotope beams of neutron-deficient 106,108,110Sn from the fragmentation of 124Xe were employed in an intermediate-energy Coulomb excitation experiment. The measured B(E2,0(1)(+)-->2(1)(+)) values for 108Sn and 110Sn and the results obtained for the 106Sn show that the transition strengths for these nuclei are larger than predicted by current state-of-the-art shell-model calculations. This discrepancy might be explained by contributions of the protons from within the Z = 50 shell to the structure of low-energy excited states in this region.

Measurement of excited states in (40)Si and evidence for weakening of the N=28 shell gap.

Excited states in (40)Si have been established by detecting gamma rays coincident with inelastic scattering and nucleon removal reactions on a liquid hydrogen target. The low excitation energy, 986(5) keV, of the 2(1)(+) state provides evidence of a weakening in the N=28 shell closure in a neutron-rich nucleus devoid of deformation-driving proton collectivity.

Probing shell structure and shape changes in neutron-rich sulfur isotopes through transient-field g-factor measurements on fast radioactive beams of 38S and 40S.

The shell structure underlying shape changes in neutron-rich nuclei near N = 28 has been investigated by a novel application of the transient-field technique to measure the first-excited-state g factors in 38S and 40S produced as fast radioactive beams. There is a fine balance between proton and neutron contributions to the magnetic moments in both nuclei. The g factor of deformed 40S does not resemble that of a conventional collective nucleus because spin contributions are more important than usual.

Vancomycin-induced hypersensitivity reaction with acute renal failure: resolution following cyclosporine treatment.

Drug rash with eosinophilia and systemic symptoms or DRESS syndrome is a distinct severe drug-induced hypersensitivity reaction characterized by skin rash, fever, eosinophilia and visceral involvement. The latter leads to a 10% mortality rate, with interstitial nephritis occurring in about 10% of the cases. The outcome is usually favorable after withdrawal of drug therapy; systemic corticosteroid therapy may hasten the recovery, although there are no data from prospective, randomized trials evaluating the efficacy of this approach. Administration of other immunosuppressive agents (cyclophosphamide, cyclosporine) has also been suggested. We report on a patient with vancomycin-induced DRESS syndrome with acute interstitial nephritis and hepatitis. There was no improvement after withdrawal of the offending agent and empiric corticosteroid use. After tapering the steroids, a five-day course of cyclosporine was followed by quick resolution of the skin rash and recovery of renal function. Cyclosporine could represent a treatment option in cases of severe visceral involvement such as persistent renal insufficiency that do not improve after discontinuation of the offending agent and administration of high doses of steroids.

Methodologic challenges of randomized controlled studies on in-home comprehensive geriatric assessment: the EIGER project. Evaluation of In-Home Geriatric Health Visits in Elderly Residents.

Previous controlled studies have shown that preventive home visits are a promising method for disability prevention in elderly persons; however, due to the lack of data on cost effectiveness and optimal intervention methods, there is still debate on their usefulness. Therefore, additional controlled studies must use new methods to resolve these unanswered issues. We present a novel approach used in the project EIGER (Evaluation of In-Home Geriatric Health Visits in Elderly Residents), an ongoing randomized controlled trial of preventive home visits in community-residing persons aged 75 years and older in Bern, Switzerland. The intervention consists of in-home visits with structured comprehensive geriatric assessment and follow-up by specially trained nurses who collaborate with geriatricians and an interdisciplinary team. Special methods were used to optimize the sample size, to improve the health care cost analysis, to minimize and explore refusal to participate, to apply stratified randomization for subgroup analysis, and to evaluate the intervention process with a tracer method. Selected baseline findings (N = 791, mean age 82 years, 73% female) include uncontrolled systolic hypertension (54%), balance/gait disorder (9%), cognitive impairment (7%), 6 or more medications (21%), depressive symptoms (10%), and impaired basic ADL (15%). Baseline findings demonstrate that this study is likely to contribute to some of the unresolved issues of in-home prevention for older persons.

Efficacy and pharmacokinetics of piretanide in patients with congestive heart failure.

The efficacy and pharmacokinetics of the diuretic piretanide were studied in two groups of six patients hospitalized for congestive heart failure. A dosage of 2 x 6 mg day-1 to 2 x 12 mg day-1 of intravenous piretanide for 7 days was sufficient to abrogate most symptoms of cardiac insufficiency. When compared with another group of healthy volunteers, patients with congestive heart failure had reduced total body clearance of piretanide of about 50% which was attributable to a diminished renal but not non-renal clearance. The analysis of the interrelationship between urinary piretanide excretion and diuresis by means of a linearized Emax-model revealed a maximal diuresis of 231 ml h-1 and a urinary piretanide excretion to induce half-maximal diuresis of 245 micrograms h-1. Thus patients with congestive heart failure exhibit a decreased renal clearance of piretanide and a good response to this high ceiling diuretic after intravenous dosing.

[Plasmapheresis therapy in Guillain-Barré polyneuroradiculitis]. / Plasmapheresetherapie bei Polyneuroradikulitis Guillain-Barré.

The outcome of Guillain-Barré polyneuritis is not always benign. Since no therapy of proven effectiveness is available and an immunologic etiology is presumed, plasma exchange treatment has been repeatedly used. We report on three patients with severe polyneuritis who were unable to walk. Two were also in acute respiratory failure. All the cases exhibited surprisingly good improvement correlating in time with plasma exchange. A review of the literature suggests that plasma exchange can at least be recommended in severe cases of Guillain-Barré acute polyneuritis with inability to walk. Treatment should be started within 1-2 weeks of onset of the disease.

Effects of low-dose 'factor VIII inhibitor bypassing activity (FEIBA)' in resistant haemophilia.

Possible effects and side-effects of 'factor VIII inhibitor bypassing activity (FEIBA)' were tested on 7 haemophiliacs with high-titre antibody to factor VIII (resistant haemophilia). FEIBA was administered both to hospitalised patients and as part of a home therapy programme. Serious side-effects, attributable to FEIBA, were one episode of hypersensitivity and, possibly, hepatitis. Our preliminary data suggest that early injection of FEIBA, using considerably lower doses than suggested by the manufacturer, may shorten the duration of immobilisation of haemophiliacs with inhibitor against factor VIII in comparison with infusion of factor VIII and/or supportive care alone, at least following musculoskeletal bleeding. A decrease or complete disappearance of the inhibitor was observed in all patients receiving FEIBA alone.