Time trends, frequency, characteristics and prognosis of short-duration transient global amnesia.

BACKGROUND AND PURPOSE: Transient global amnesia (TGA) is characterized by a sudden onset of anterograde amnesia lasting up to 24 h. One major differential for TGA is transient epileptic amnesia, which typically lasts < 1 h. However, TGA can also be short in duration and little is known about the time trends, characteristics and prognosis of TGA cases lasting < 1 h. METHODS: We compared the clinical features of TGA ascertained in two independent cohort studies in Oxfordshire, UK [Oxford cohort 1977-1987 versus Oxford Vascular Study (OXVASC) 2002-2018] to determine the time trends of clinical features of TGA. Results were validated in another independent contemporary TGA cohort in Italy [Northern Umbria TGA registry (NU) 2002-2018]. We compared the risk factors, clinical features and long-term prognosis (major cardiovascular events, recurrent TGA and seizure/epilepsy) of patients presenting with episodes lasting < 1 h versus those lasting ≥ 1 h. RESULTS: Overall, 639 patients with TGA were included (114 Oxford cohort, 100 OXVASC, 425 NU). Compared with the original Oxford cohort, there were more cases with TGA lasting < 1 h in OXVASC [32 (32.0%) vs. 9 (8.8%)] and NU (11.8% vs. 8.8% in Oxford cohort). In both OXVASC and NU, patient age, vascular risk factors and clinical features were largely similar between those with TGA lasting < 1 h versus those lasting ≥ 1 h. Moreover, there was no difference in the long-term risk of seizure/epilepsy or major cardiovascular events between TGA lasting < 1 h versus TGA lasting ≥ 1 h. CONCLUSIONS: Short-duration TGA episodes (<1 h) were not uncommon and were more frequent than in earlier studies. The clinical features and long-term prognosis of short-duration TGA did not differ from more typical episodes lasting ≥ 1 h.

Nature of spatiotemporal light bullets in bulk Kerr media.

We present a detailed experimental investigation which uncovers the nature of light bullets generated from self-focusing in a bulk dielectric medium with Kerr nonlinearity in the anomalous group velocity dispersion regime. By high dynamic range measurements of three-dimensional intensity profiles, we demonstrate that the light bullets consist of a sharply localized high-intensity core, which carries the self-compressed pulse and contains approximately 25% of the total energy, and a ring-shaped spatiotemporal periphery. Subdiffractive propagation along with dispersive broadening of the light bullets in free space after they exit the nonlinear medium indicate a strong space-time coupling within the bullet. This finding is confirmed by measurements of a spatiotemporal energy density flux that exhibits the same features as a stationary, polychromatic Bessel beam, thus highlighting the nature of the light bullets.

Space-time focusing of Bessel-like pulses.

We report on a space-time compression technique allowing for complete and independent control of the longitudinal dynamics and of the transverse pulse localization by means of spatial beam shaping. We experimentally observe both strong temporal compression and high transverse localization, of the order of a few wavelengths, along free-space propagation.

Spontaneous emergence of pulses with constant carrier-envelope phase in femtosecond filamentation.

We study the possibility to obtain high-intensity pulses that maintain a constant Carrier Envelope Phase (CEP) during propagation in dispersive media, i.e. pulses such that the carrier-wave offset with respect to the main intensity peak remains fixed. Our numerical experiments strongly suggest that pulse splitting and X-wave formation within femtosecond laser pulse filamentation leads to the formation of "constant-CEP" within well-defined regions inside the filament. We study the creation of "constant- CEP" pulses in both gasseous and condensed media showing that this is a generic feature of filaments.

Finite-energy, accelerating Bessel pulses.

We numerically investigate the possibility to generate freely accelerating or decelerating pulses. In particular it is shown that acceleration along the propagation direction z may be obtained by a purely spatial modulation of an input Gaussian pulse in the form of finite-energy Bessel pulses with a cone angle that varies along the radial coordinate.We discuss simple practical implementations of such accelerating Bessel beams.

Less invasive cardiac operations through a median sternotomy: 100 consecutive cases.

BACKGROUND: In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy. A limited (6 to 9 cm) median skin incision followed by a subcomplete (manubrium and body) median sternotomy makes opening and closing of the chest easier; conventional central cardiopulmonary bypass is instituted, and no modifications to the surgical techniques are necessary. METHODS: In 100 consecutive patients (mean age, 62.04 years; range, 9 to 92 years), 70 aortic, 13 mitral, and 17 other cardiac procedures were performed. Surgical technique required many self-made instruments; anesthetic "fast-tracking" management was performed. RESULTS: Four patients died. One conversion to a standard sternotomy and five reoperations for bleeding were necessary. Cross-clamp time ranged from 33 to 140 minutes (mean +/- standard deviation, 69.23 +/- 20.99 minutes) and total drainage loss ranged from 120 to 1,800 mL x m(-2) x 24 h(-1) (mean, 288 mL x m(-2) x 24 h(-1)). The postoperative course was shorter than usual, and one complication in the healing wound was observed. The scar was shorter than 9 cm in all patients. CONCLUSIONS: Our work shows that a less invasive approach to many cardiac operations is possible through a modified median sternotomy. This technique provides many potential and practical advantages: there is less trauma and pain reported by patients, and the small wound reduces the risk of infection and blood loss. Patients are extubated and discharged from the hospital earlier.

Less-invasive heart surgery: the preservation of median approach.

OBJECTIVE: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations. METHODS: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6-9 cm) median incision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a conventional central CPB was instituted and valve surgery and most of intracardiac procedures were performed without modification of the standard technique. RESULTS: No mortality was observed; morbidity was minimal. Cardiopulmonary bypass time and aortic cross-clamp time averaged 84+/-9 and 61+/-11 min, respectively. The majority of patients were extubated and discharged from the ICU early. Chest drainage lost on average 290+/-180 ml/m2. CONCLUSIONS: Despite our limited initial experience, this technique seems to provide several potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patients are extubated and discharged from the hospital earlier with lower overall costs.

Urinary excretion of ethylenethiourea in five volunteers on a controlled diet (multicentric study).

Urinary excretion of ethylenethiourea (ETU) was monitored for 8 days in a group of five male non-smoker volunteers on a diet, the items of which were assayed for ETU and carbon sulphide. Urinary excretion of ETU reflected the consumption of wine, fruit and vegetables. Urinary ETU concentrations ranged from 0.6 to 6.7 micrograms/g creatinine. ETU concentrations in the food eaten by the volunteers were generally below the detection limit whereas in wine 8.8 micrograms/l ETU was detected. Evolution of carbon sulphide by food samples ranged from 0.03 to 0.17 mg/kg. Mean (+/- S.D.) daily intake of ETU in wine was 3.5 +/- 0.2% of the acceptable daily intake (ADI): 0.070 +/- 0.004 micrograms/kg body wt. During the 8 days of the study, an average of 48.3% of the ETU ingested in wine was excreted unmodified by the kidneys. Twenty-four hour urinary excretion of ETU was significantly correlated with daily intake of ETU (r = 0.768) and CS2 evolved by the daily food items (r = 0.414).

Reference values of urinary ethylenethiourea in four regions of Italy (multicentric study).

The results of a study in which urinary ethylenethiourea (ETU) was assayed in the general population (167 subjects) of four Regions of Italy (Veneto, Lombardy, Piedmont and Trentino Alto Adige) are reported. The results are compared with those in a population of 97 subjects from Rovescala, a hillside wine-producing town a few kilometers from Pavia, where ethylenebisdithiocarbamates are sprayed by helicopter. It was found that an average of 24% of the populations of the four regions, taken together, had urinary ETU levels above detection limits (1.0 microgram 1(-1)) as compared to 37% of the population of Rovescala. The ranges of concentration were 0.8-8.3 micrograms 1(-1) for the four regions and 0.9-61.4 micrograms 1(-1) for Rovescala. Statistically significant variables for urinary ETU levels were smoking and wine drinking.

A study of the semeiological reliability of dorsalis pedis artery and posterior tibial artery in the diagnosis of lower limb arterial occlusive disease.

Routine diagnosis of suspected occlusive arterial disease of the lower limbs are often based on the pulse absence at the dorsalis pedis artery. However many of these diagnoses are not confirmed after more thorough tests, and this fact arises the problem of the semeiological reliability of the above mentioned artery. Researches carried out by several authors in normal individuals on the dorsalis pedis artery yielded controversial results. Three hundred-sixty subjects free of occlusive arterial disease were then examined by means of clinical and Doppler investigation in order to assess the semeiological reliability of the dorsalis pedis artery in the diagnosis of occlusive arteriopathy of lower limbs, when compared to the posterior tibial one. The conclusion is drawn that a greater semeiological reliability must be attributed to the latter, due to its lesser "absence" incidence.

Reference values of urinary 3,5,6-trichloro-2-pyridinol in the Italian population--validation of analytical method and preliminary results (multicentric study).

The interlaboratory validation of analytical procedures for the assay of urinary 3,5,6-trichloro-2-pyridinol (TCP) in the general Italian population is reported. The determinations were performed by high-resolution gas chromatography (HRGS) with electron capture detection and HRGS with mass spectrometry (MS) in 2 laboratories. The urine samples were from 42 participants from 3 regions of Italy. The results were evaluated by interlaboratory quality control. Urinary TCP concentrations were above the detection limit (1.2 micrograms/L) in 88% of the population, with a mean detectable concentration [GM (GSD)] of 2.8 (1.9) micrograms/g creatinine (creat). (GM, geometric mean; GSD, geometric standard deviation.) The Mann-Whitney U test showed that wine consumption was a statistically significant variable (p < 0.05) for urinary concentrations of TCP. Analysis of variance of the logarithm of urinary TCP versus wine consumption and diet showed a statistically significant fit. The model used explained 30% of the total variance: wine consumption and diet accounted for 37 and 17% respectively of the explained variance.

[A case of primary cardiac tumor in childhood. Echographic and anatomo-pathologic study]. / Un caso di tumore primitivo cardiaco in età pediatrica. Studio ecografico ed anatomo-patologico.

Primary cardiac tumors are rare in children. The benign forms constitute 90% of cases, with often fatal clinical course due to the origin site. Here is reported a case of fibroelastic hamartoma in a four month baby, with multiple malformations, in which the initial signs have been alterations of ECG and of the cardiac profile at Rx chest. Bidimensional echocardiography suggested the correct diagnosis, revealing the mass in the interventricular septum. Cardiac catheterization excluded connections with coronary arteries. The baby died before cardiosurgical operation, probably because of a hyperkinetic ventricular arrhythmia. Anatomo-pathologic examination discusses the diagnosis of this tumor versus other kinds, defining our case as a fibroelastic hamartoma.

Soliton-induced relativistic-scattering and amplification.

Solitons are of fundamental importance in photonics due to applications in optical data transmission and also as a tool for investigating novel phenomena ranging from light generation at new frequencies and wave-trapping to rogue waves. Solitons are also moving scatterers: they generate refractive index perturbations moving at the speed of light. Here we found that such perturbations scatter light in an unusual way: they amplify light by the mixing of positive and negative frequencies, as we describe using a first Born approximation and numerical simulations. The simplest scenario in which these effects may be observed is within the initial stages of optical soliton propagation: a steep shock front develops that may efficiently scatter a second, weaker probe pulse into relatively intense positive and negative frequency modes with amplification at the expense of the soliton. Our results show a novel all-optical amplification scheme that relies on soliton induced scattering.

High throughput analysis of drugs of abuse in hair by combining purposely designed sample extraction compatible with immunometric methods used for drug testing in urine.

Drug testing in hair usually requires a rather complex sample treatment before drugs are amenable to analysis by either immunological and/or chromatographic coupled to mass spectrometry methods. Immunological methods applied are usually dedicated to hair analysis as analytes present in this matrix are not always the same present in urine. Comedical s.a.s. laboratories recently commercialized reagents (VMA-T) purposely designed for hair sample treatment which are compatible with current immunometric methods used for urine drug testing. This is possible as some analytes (6-MAM and cocaine) present in hair after sample treatment are converted to those detected in urine (morphine and benzoylecgonine). A correlation study for several drug classes performed in two laboratories with 32 clinical and 12 spiked drug free (controls) hair samples shows that implementation of the method on clinical chemistry analyzers is easy and that results obtained by different operators and instruments are comparable and reproducible. The main advantage of VMA-T method is the possibility to simultaneously extract from hair main drug classes, in a period of time lower than 2h and its compatibility with immunological methods applied in urine drug testing.

Complete retrieval of the field of ultrashort optical pulses using the angle-frequency spectrum.

We propose an experimental technique that allows for a complete characterization of the amplitude and phase of optical pulses in space and time. By the combination of a spatially resolved spectral measurement in the near and far fields and a frequency-resolved optical gating measurement, the electric field of the pulse is obtained through a fast, error-reduction algorithm.

Internal knee lesions and medial discoid meniscus.

The authors stress the great importance of stability in the normal functioning of the knee and its resistance to injury. They describe a case of multiple internal lesions involving the anterior cruciate ligament, the medial collateral ligament and the lateral meniscus sustained in a knee already affected by a discoid medial meniscus. These lesions were caused by a relatively slight injury and the knee for some time over reacted to the slightest stress. Operation revealed the existance of a discoid medial meniscus and in the view of the authors this was the cause both of the knee's instability and previous episodes as well as the final severe traumatic syndrome revealed at operation. Discoid medial meniscus is extremely rare. Smillie's classification into three groups and the various pathogenetic hypotheses are discussed. The authors analyse the relation between knee instability and meniscal malformation and conclude that discoid medial meniscus plays a primary role in rendering the joint highly vulnerable.