[Antithyroid agents related agranulocytosis: Literature review]. / Agranulocytoses aux antithyroïdiens de synthèse : revue de la littérature.

The antithyroid agents (carbimazole, methimazole, thiamazole, propylthiouracil and benzylthiouracile) are the drug class that is associated with a high risk of agranulocytosis. Acute and profound (<0.5×10(9)/L) isolated neutropenia occurring in a subject treated with antithyroid agents should be considered as a drug-induced agranulocytosis, until proven otherwise. The clinical spectrum ranges from discovery of acute severe but asymptomatic neutropenia, to isolated fever, localized infections (especially ear, nose and throat, or pulmonary) or septicemia. With an optimal management (discontinuation of antithyroid agents, antibiotics in the presence of fever or a documented infection, or use of hematopoietic growth factor) the current mortality is close to 2%.

[Experimentation of an e-platform to detect situations at risk of cardiac impairment (platform E-care) in an internal medicine unit]. / Expérimentation d'une plateforme de détection automatisée des situations à risque de décompensation cardiaque (plateforme E-care) dans une unité de médecine interne.

INTRODUCTION: Monitoring patients with heart failure by telemedicine systems is a potential means susceptible to optimize the management of these patients and avoid life-threatening emergencies. In this context, we experimented in internal medicine unit an e-platform E-care dedicated to automated, intelligent detection of situations at risk of heart failure. METHODS: The E-care platform based on medical sensors (blood pressure, heart rate, O2, weight), communicating (Bluetooth), to go up, in real time, to an intelligent physiological information and an analysis of the ontology medical, leading ultimately to the generation of alerts. After a development phase (proof of concept), the E-care platform has been deployed and tested by health professionals and patients in an internal medicine unit with 20 beds, opened on emergencies to the Strasbourg University Hospitals. RESULTS: One hundred and eighty patients were included and 1500 measurements were obtained. The patient profile included in this experiment was an elderly patient, with comorbidity in 90% of cases, with a loss of autonomy in 25%. Health professionals were using E-care platform every day to their great satisfaction. This experiment made it possible to validate the technology choices, to consolidate the system, and to test the robustness of the platform E-care. The collection continuously allowed us to have the critical number of patients for more detailed analysis of the relevance of alerts related to heart impairment. A preliminary analysis showed the relevance of the generated alerts. CONCLUSION: Preliminary results following the deployment of E-care platform in hospitals appear to show the relevance of technological choices, tools and solutions developed and adopted. This telemedicine system allows automatic, non-intrusive, generate alerts related to the detection of situations at risk for heart failure. Ultimately, E-care was capable of preventing hospitalization. A home deployment is currently underway.

Spontaneous regression of metastatic melanoma after inoculation with tetanus-diphtheria-pertussis vaccine.

Spontaneous regression of metastatic melanoma is an exceedingly rare event, with only 76 well-documented cases in the literature since 1866. Here, we present the case of a patient who developed metastatic melanoma despite interferon therapy and who then achieved spontaneous regression shortly after a reaction to tetanus-diphtheria-pertussis vaccination. A common theme among these cases is the development of febrile illness before remission of the malignant disease. A brief overview of proposed mechanisms for these miraculous recoveries is presented, including a highlight on the potential role of the herv-k-mel viral marker, a nona- or decapeptide that appears in most melanomas, with homologies to peptides in pathogenic microorganisms.

Peripheral neuropathy in Whipples disease: a case report.

Whipples disease is a chronic multisystem inflammatory disease with predominantly gastrointestinal manifestations due to Tropheryma whipplei infection. Typical neurological abnormalities include dementia, eye movement abnormalities, hypothalamic dysfunction and oculomasticatory myorhythmias. The literature on peripheral neuropathy in Whipples disease is sparse and the involvement of peripheral nerves in Whipples disease has not been documented convincingly so far. We present a case of Whipples disease presenting by axonal peripheral neuropathy without gastrointestinal involvement. The diagnosis was confirmed by a sural nerve biopsy and consequent PCR of the sample. All clinical signs disappeared progressively during the antibiotic therapy. Two years after the T. whipplei infection, the patient developed dopa-sensitive Parkinson's disease, although these two events seem to be unrelated. This case illustrates the value of peripheral nerve biopsy in cases of axonal neuropathy of unexplained origin and extends the clinical spectrum of Whipples disease to a new modality.

Cerebrospinal fluid and serum antibodies against neurofilaments in patients with amyotrophic lateral sclerosis.

BACKGROUND: The aim of the study was to assess autoimmune involvement in amyotrophic lateral sclerosis (ALS). METHODS: We measured IgG antibodies against light (NFL) and medium (NFM) subunits of neurofilaments using ELISA in paired cerebrospinal fluid (CSF) and serum samples from 38 ALS patients and 20 controls. RESULTS: Serum levels of anti-NFL were higher in ALS patients than in controls (P < 0.005). Serum anti-NFL antibodies and intrathecal anti-NFM antibodies were related to patient disability (serum anti-NFL: P < 0.05; intrathecal anti-NFM: P < 0.05). Anti-NFL levels were significantly correlated with anti-NFM levels in ALS (P < 0.001) and the control group (P < 0.0001) in the CSF, but not in serum. Anti-NFL and anti-NFM antibodies significantly correlated between serum and CSF in the ALS group (anti-NFL: P < 0.0001; anti-NFM: P < 0.001) and in the control group (anti-NFL: P < 0.05; anti-NFM: P < 0.05). CONCLUSIONS: Autoimmune humoral response to neurocytoskeletal proteins is associated with ALS.

Relationship between ALS and the degree of cognitive impairment, markers of neurodegeneration and predictors for poor outcome. A prospective study.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a common neurodegenerative disease affecting motor neurons and may be associated with impaired cognition. Reliable prognostic factors for ALS patients are still missing. METHODS: We prospectively included 67 patients, 42 women and 25 men, with clinically defined ALS. The disease severity was assessed and the patients underwent SPECT, lumbar puncture with determination of tau, hyperphosporylated tau (p-tau) and beta-amyloid and a detailed neuropsychological assessment using a standardized test battery. In patients who died, a detailed neuropathologic evaluation was performed. RESULTS: The mean survival duration was 26.8 months. The delay between the first signs and confirmation of the diagnosis was 12.75 months. Cognitive impairment did not have an impact on the evolution of the disease. There was no correlation between neuropsychological and SPECT findings. Higher age at onset, more pronounced handicap and elevated beta-amyloid in the CSF were associated with shorter survival times. In brain tissue from nine of the deceased patients with ALS and dementia, all showed signs of comorbidity, six had hallmarks of frontotemporal lobar degeneration (FTLD) and three showed Alzheimer disease pathology. Brain tissues form 11 deceased ALS patients who did not show signs of dementia, had only changes compatible with a diagnosis of motor neuron disease. CONCLUSION: In our prospective study, age, disease severity and CSF beta-amyloid levels taken together were a risk factor suggesting shorter survival times. Dementia is relatively frequent in ALS and may be a consequence of either FTLD or result from co-existing Alzheimer disease.

Hamilton-Jacobi approach to photon wave mechanics: near-field aspects.

After having briefly reviewed the Hamilton-Jacobi theory of classical point-particle mechanics, its extension to the quantum regime and the formal identity between the Hamilton-Jacobi equation for Hamilton's characteristic function and the eikonal equation of geometrical optics, an eikonal theory for free photons is established. The space-time dynamics of the photon is described on the basis of the six-component Riemann-Silberstein energy wave function. Form-identical eikonal equations are obtained for the positive and negative helicity dynamics. Microscopic response theory is used to describe the linear photon-matter interaction. In the presence of matter the free-photon concept is replaced by a quasi-photon concept, and there is a quasi-photon for each of the two helicity states. After having established integro-differential equations for the wave functions of the two quasi-photons, the eikonal conditions for the quasi-photons are determined. It appears that the eikonal condition contains complicated space integrals of the gradient of the eikonal over volumes of near-field domain size. In these space integrals the dynamics of the electrons (matter particles) appears via transverse transition current densities between pairs of many-body states. Generalized microscopic polarization and magnetization fields are introduced to establish the connection between the quasi-photon and macroscopic eikonal theories.

[Recommendations for the treatment of tobacco dependence]. / Doporucení pro lécbu závislosti na tabáku.

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of tobacco dependence at any level: during any contact with the smoking patient (short intervention), in specialised centres or for the health care providers or health system itself.

Hearing loss as the first feature of late-onset axonal CMT disease due to a novel P0 mutation.

A Czech family with three individuals carrying a novel mutation, 290 A-->T (Glu97Val), in the myelin protein zero gene (P0) is reported. The two eldest carriers developed progressive sensorineural hearing loss and abnormal pupillary reaction at age 18. These preceded the onset of the classic signs of Charcot-Marie-Tooth disease (CMT) by more than a decade. Sural nerve biopsy and nerve conduction studies were compatible with the axonal type of CMT. The authors show that progressive hearing loss can be the first symptom in P0 mutation carriers.

Electrodynamic interaction between two atoms in near-field contact.

A theoretical study of elements of the quantum electrodynamic interaction between two single-electron atoms in near-field contact is presented. The framework of the study is an electromagnetic propagator formalism that allows one to describe the near-field space-time interaction in such a manner that the Einstein causality and lack of photon localizability are manifest. First we set up the atom-field Hamiltonian in the so-called G-gauge, starting from the Coulomb Hamiltonian, and thereafter we show that this leads to a correct propagator description for the retarded part of the transverse electromagnetic field (operator). In the G-gauge approach, renormalization of the two-particle energy level structure stemming from the transverse self-field occurs. The intraparticle renormalization is calculated for a three-level atom (it is trivial for a two-level atom), and the interparticle renormalization, which depends on the atomic separation, is determined for two two-level atoms. The magnitude of the energy renormalization is always finite in our theory because we do not consider the atoms to be point-like objects from an electromagnetic point of view. Throughout, we relate our G-gauge formalism to the multipole theory often used in studies of interatomic electrodynamics.

Near-field optics and quantum optics: an assignation arranged by four kinds of photons.

In the process of emergence a photon emitted from an atom (or a molecule) is usually no better localized in space than to the near-field zone of the source. Near-field optics therefore is of central importance for understanding fundamental statistical aspects related to single-photon tunnelling, the space-time description of photon dynamics, and the photon position-operator problem. In the present work an attempt is made to study the microscopic near-field optical interaction from a quantum statistical point of view. In near-field quantum electrodynamics (QED) scalar and longitudinal photons always are involved and this makes the covariant formulation of QED attractive also in the low-energy regime. We show that the Lorenz gauge condition on the global state vector relates to the near-field electrodynamics of the d-photons. The gauge photon is shown to be of no importance in near-field interactions. To understand the role of the lack of photon localizability we finally study near-field quantum optical correlations in a new so-called propagator gauge.

Laser-induced temperature changes in dentine.

OBJECTIVE: The purpose of this work is to study the temperature rise and potential thermal damage caused during ablation of human dentine using a super pulsed carbon dioxide laser of 9.6-microm wavelength, equipped with a water-cooling spray and scanner system. BACKGROUND DATA: There have been no reports on thermal effects of super pulsed CO2 laser of 9.6 microm wavelength on human dentine recently. MATERIALS AND METHODS: Two different types of samples were investigated to yield data most consistent with a typical clinical situation. Human dentine slices and crown segments were studied at a drilling depth of 1.0 +/- 0.1 mm and 2.5 +/- 0.5 mm, respectively. A control group treated with a conventional hand piece was compared to four laser groups with settings varying from 2 to 8 W. RESULTS: In the laser group demonstrating the highest elevation in temperature of the four studied, dentine slices lased at 2 W for 15 sec showed a mean temperature rise of less than 1.68 degrees C at an ablation rate of 0.86 +/- 0.08 mm. Conventional drilling with a comparable ablation rate of 0.76 +/- 0.59 mm resulted in a mean rise of 2.87 degrees C. The laser groups of crown segments revealed a constant decrease in temperature. SEM observations were lacking the typical morphological changes seen in earlier studies, specifically extensive melting, charring or cracking. CONCLUSION: A maximum rise of mean temperature to 1.68 degrees C in closest vicinity to the pulpal chamber and the morphological unaltered dentine surfaces demonstrate the safe and tissue preserving character of the superpulsed 9.6 microm CO2 laser. The laser caused an even lower temperature rise than conventional drilling. Moreover, the laser showed acceptable efficacy with ablation rates that did not significantly differ from the conventional dental drill.

On the quantum physical relation between photon tunnelling and near-field optics.

The standard theory of optical tunnelling based on a mathematical analogy between the time-independent one-particle Schrödinger equation describing electron tunnelling and the Helmholtz equation for the macroscopic electric field is criticized. In a classical perspective photons are related to the dynamics of the transverse part of the electromagnetic field, and with the assumption that the electrons in a coupled photon-atom system are driven in a linear fashion by the field, a rigorous integro-differential equation for the transverse field is established. In the near-field zone of matter a transverse self-field exists and this may cause the appearance of superluminality in optical tunnelling. In the wake of a brief review of the space-time dynamics of free photons, a first-quantized description of the birth process of a single polychromatic photon in the near-field region of an active atom (molecule, mesoscopic particle) is presented, and afterwards the link between photon localizability, Einstein causality and near-field photon tunnelling is discussed. On the basis of a new one-photon quantum theory of near-field scattering from a microscopic (or mesoscopic) object, it is shown that photon tunnelling always appears in photon-atom scattering. A first-order Born approximation cannot capture the phenomenon, however. The emergence of the energy wave function of the scattered photon is followed in space and time.

Superluminal interactions in near-field optics.

The fact that photons emitted from an electric-dipole active atom cannot be spatially localized better than to the near-field zone of the atom is seen as the origin of genuine superluminality. By means of a simple model dipole current density the general theory is used to demonstrate numerically how superluminality enters the near-field dynamics, and how from a measurement one could be tempted to believe that superluminal propagation effects occur. Furthermore, it is shown how for source-detector distances larger than a pulse length one should be able to divide the pulse into two separate parts: one purely superluminal part arising solely in the non-local generation process of the field, and another part seemingly propagating with superluminal speed. We comment on different velocity analyses, and we argue that the only fundamental velocity entering the problem is the vacuum velocity of light, which in a measurement would appear as the velocity of the trailing edge of the pulse.

[Reduced visual capacity increases the risk of accidents in street traffic]. / Reduziertes Sehvermögen führt zu erhöhtem Unfallrisiko im Strassenverkehr.

BACKGROUND: This study was carried out to investigate the relationship between the frequency of traffic accidents and impaired vision. MATERIALS AND METHODS: Seven hundred and fifty-four drivers involved in accidents were recruited, in addition to 250 accident-free drivers similar in age and driving experience as an control group. The age distribution of the persons involved in traffic accidents (mean 56.3 years) was similar to that of the control group (mean 57.7 years), the difference was not statistically significant. Both groups underwent a complete ophthalmological examination. RESULTS: All three types of accidents (night-time accidents, violations of right of way, accidents during an overtaking manoeuvre) had a statistically significantly higher incidence of reduced photopic visual acuity, mesopic vision and an increased sensitivity to glare. Some other visual functions were also abnormal, with differences according to the type of accident. In particular, there were noticeable differences between the control group and those who were involved in night-time accidents regarding mesopic vision and sensitivity to glare. Concerning mesopic vision, 15% of the 261 persons involved in night-time accidents did not reach the contrast limit of 1:5; with glare, 20.7% failed. In comparison 4% of the control group reached this critical limit without glare and 7.6% with glare. These differences are highly statistically significant. In contrast to these findings, many of the drivers involved in accidents assessed their own visual capability as "excellent". CONCLUSIONS: The results of this study show that reduced mesopic vision and increased sensitivity to glare are accompanied by an increased risk of night-time accidents (for example, collisions with a non-illuminated obstacle). This emphasizes the importance of regular ophthalmological check-ups including visual functions such as mesopic vision and sensitivity to glare, which currently are not required by the traffic laws in Germany.

[Diagnostic costs for ambulatory care patients]. / Diagnosekosten bei ambulanten Patienten.

Few analyses of the costs of diagnostic plans have been published. We have determined and analyzed the diagnostic costs of 1000 consecutively evaluated patients at the medical outpatient clinic. A data base was developed for this purpose. Based on the itemized tarif the total costs amounted to 622,553.25 SFR. Medical services (consultations) required 20 per cent of this sum, laboratory services and technical investigations 40 per cent each. The average number of consultations per patient was 2.83 +/- 1.85. As expected the first consultation was the most expensive. It amounted on the average to 350.-SFR, 54% of which were used for laboratory and 27% for technical procedures. Chest X-ray, ECG, abdominal ultrasound and upper gastrointestinal endoscopy caused about 20% of the total diagnostic costs. Cost reduction could probably be achieved by using more stringent indications for laboratory and technical services.

[Colorectal carcinoma. Which factors are decisive for development of postoperative complications?]. / Kolorektales Karzinom. Welche Faktoren sind für das Auftreten postoperativer Komplikationen entscheidend?

This retrospective study analyses the prognostic effect of different factors on morbidity and lethality based on selected, primarily resecting colon carcinoma operations (n = 222). In all, 12.2% of our operations were performed under emergency conditions. The total complication rate was 31.5%, the lethality rate 7.7%. The left hemicolectomy cases showed the highest morbidity (48.4%), the rectum amputation the highest lethality (11.8%). Tumour staging tumour differentiation and the sex of the patient showed no significant influence on the postoperative morbidity and lethality. However, a correlation was proved between the age of the patient, tumour localisation, co-morbidity, duration of operation and the conditions under which the operation was performed (emergency or elective), on the one hand, and morbidity and lethality on the other.

Recovery from rhabdomyolysis after allogeneic BMT: report of a case with speculation on causation.

A case of fulminant rhabdomyolysis occurring 4 months after allogeneic BMT for CML is reported. The patient developed rhabdomyolysis following the empiric institution of antibacterial and anti-tuberculous medication. His inpatient course was complicated by the development of acute anuric renal failure and a severe myopathy. With aggressive supportive care, both of these complications resolved, making this patient the only reported survivor of rhabdomyolysis occurring after BMT.

Correlation between optical and topographical images from an external reflection near-field microscope with shear force feedback.

An external reflection scanning near-field optical microscope with shear force regulation of the tip-surface distance is described. Near-field optical and shear force topographical images are compared for various samples. It is shown that the most important correlative relationships between these images can be deduced from symmetry considerations. The possibility of extracting additional information from the optical images is demonstrated on images of human blood cells.