1.15 PW-850 J compressed beam demonstration using the PETAL facility.

The Petawatt Aquitaine Laser (PETAL) facility was designed and constructed by the French Commissariat à l'énergie atomique et aux énergies alternatives (CEA) as an additional PW beamline to the Laser MegaJoule (LMJ) facility. PETAL energy is limited to 1 kJ at the beginning due to the damage threshold of the final optics. In this paper, we present the commissioning of the PW PETAL beamline. The first kJ shots in the amplifier section with a large spectrum front end, the alignment of the synthetic aperture compression stage and the initial demonstration of the 1.15 PW @ 850 J operations in the compression stage are detailed. Issues encountered relating to damage to optics are also addressed.

Tunable orbital angular momentum in high-harmonic generation.

Optical vortices are currently one of the most intensively studied topics in optics. These light beams, which carry orbital angular momentum (OAM), have been successfully utilized in the visible and infrared in a wide variety of applications. Moving to shorter wavelengths may open up completely new research directions in the areas of optical physics and material characterization. Here, we report on the generation of extreme-ultraviolet optical vortices with femtosecond duration carrying a controllable amount of OAM. From a basic physics viewpoint, our results help to resolve key questions such as the conservation of angular momentum in highly nonlinear light-matter interactions, and the disentanglement and independent control of the intrinsic and extrinsic components of the photon's angular momentum at short-wavelengths. The methods developed here will allow testing some of the recently proposed concepts such as OAM-induced dichroism, magnetic switching in organic molecules and violation of dipolar selection rules in atoms.

Experimental demonstration of a synthetic aperture compression scheme for multi-Petawatt high-energy lasers.

We present the experimental demonstration of a subaperture compression scheme achieved in the PETAL (PETawatt Aquitaine Laser) facility. We evidence that by dividing the beam into small subapertures fitting the available grating size, the sub-beam can be individually compressed below 1 ps, synchronized below 50 fs and then coherently added thanks to a segmented mirror.

[Autonomy and human dignity--fiction and reality]. / Autonomie und menschliche Würde--Fiktion und Realität.

Definition and lived-in reality of "autonomy" an "human-dignity" may differ as can be shown by means of a patient's situation: it varies whether patient, relatives, general practitioner or hospital doctor are involved. It is most important to assure these terms not only to be fiction but to become a lived reality.

Prospective, multicenter study of laparoscopic ventral hernioplasty. Preliminary results.

BACKGROUND: A standard technique for laparoscopic ventral hernioplasty (peritoneal onlay using an expanded polytetrafluoroethylene [ePTFE] patch for hernias >/=4 cm2) is being used in a prospective, multicenter, long-term study. METHODS: Demographic, operative, and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted 7-10 days, 4 weeks, 6 months, 1 year, and then annually after surgery in all patients. RESULTS: In the first 2 years of the study, 144 patients were enrolled; nine were lost to follow-up. The mean operating time was 120 min. The mean follow-up was 222 days (range 5-731). Postoperative complications were five infections, three cases of prolonged ileus, one bowel obstruction, 23 seromas (15 resolved without intervention), and six hernia recurrences. Hospital discharge occurred a mean of 2.3 days after surgery and return to normal activity a mean of 15 days postoperatively. CONCLUSIONS: Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty, the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery.

[Prevention of accidental falls in the elderly]. / Prävention von Stürzen im Alter.

A variety of effective methods to prevent falls of the elderly are presented for everyday practice.

Shoulder pain due to suprascapular nerve compression during general anesthesia.

Suprascapular nerve entrapment is an uncommon but often under-recognized entity caused by a variety of mechanisms and injuries to the shoulder area. The case presented is of a patient with neuropathy after a bilateral hernia repair. This is a previously undocumented association not closely adhering to the usually proposed mechanisms of injury. These mechanisms and the diagnosis and treatment of suprascapular nerve compression are reviewed.

[Rehabilitation of hemiplegia patients]. / Die Rehabilitation des Hemiplegiepatienten.

The indications for a specific rehabilitation training programme for elderly stroke patients are discussed. Special symptomatology, such as hemi-anesthesia as a result of a damaged perceptual process, apraxia including apraxia of dressing, communication disorders and affective disorders are presented. The measures to be taken for effective rehabilitation in hospital, in an institution for the elderly or in the home care situation are indicated. In addition, the physician has to have marked ability for empathic comportment.

Laparoscopic cholecystectomy: the procedure of choice for gallbladder disease.

In an attempt to decrease patient discomfort and hasten recovery after gallbladder surgery, a laparoscopic approach to cholecystectomy has been developed. The procedure decreases hospital stay and affords a rapid return to normal activities. A large experience with laparoscopic cholecystectomy is rapidly accumulating. Our first 100 laparoscopic cholecystectomies are reviewed. Laparoscopic cholecystectomy is now the procedure of choice for the treatment of gallbladder disease.

[Malnutrition in old age: the importance of multi-dimensional evaluation]. / Mangelernährung im Alter: die Bedeutung der multidimensionalen Evaluation.

Protein-energy malnutrition is a frequent, but often overlooked problem in geriatric patients. To prevent malnutrition and its severe complications, a systematic strategy for identifying signs, symptoms and risk factors of malnutrition is required. In this review we present a plan for a multidimensional nutritional workup, including functional nutritional assessment. Special aspects of malnutrition management in geriatric patients are discussed (e.g. dementia, tube-feeding, environmental aspects). Use of available diagnostic and therapeutic measures for preventing malnutrition may lead to improved quality of life in many geriatric patients.

Management of penetrating colon injuries. A prospective randomized trial.

Fifty-six patients with penetrating colon injuries were entered into a randomized prospective study. Management of the colon injury was not dependent on the number of associated injuries, amount of fecal contamination, shock, or blood requirements. Twenty-eight patients were treated with primary repair or resection and anastomosis and 28 patients were treated by diversion (24 colostomy, 3 ileostomy, 1 jejunostomy). The average Penetrating Abdominal Trauma Index score was 23.9 for the diversion group and 26 for the primary repair group. There were five (17.9%) septic-related complications in the diversion group. This included four intra-abdominal abscesses and one subcutaneous wound infection. There were six (21.4%) septic-related complications in the primary repair group. This included one wound infection, two positive blood cultures, and three intra-abdominal abscesses. There were no episodes of suture line failure in the primary repair/anastomosis group. The authors conclude that, independent of associated risk factors, primary repair or resection and anastomosis should be considered for treatment of all patients in the civilian population with penetrating colon wounds.

Adenocarcinoma of the stomach: a review of 35 years and 1,710 cases.

The records of 1,710 patients with adenocarcinoma of the stomach treated at Charity Hospital over a 35-year period were reviewed to note any trends which might help in understanding the decreasing incidence and poor prognosis of the disease. The yearly number of gastric cancer patients has dropped from 234/100,000 in the 1950's to 195/100,000 in the 1960's to 108/100,000 patients in the last decade. The percentage of affected white males is decreasing at a rate equal to the increasing frequency of black female patients, while the ratios for black males and white females remain constant. The median age rose from 61.5 years to 66 years over the study period. The operability rate decreased from 82.4% to 72.8% and the resectability rate was 49%. Subtotal gastrectomy was the most common procedure, but radical subtotal gastrectomy gave the best 5-year survival. There are fewer lesions of the antrum today, but the highest number of 5-year survivors had antral lesions. Long-term survival of patients with lesions of the cardia improved from zero in the first 25 years to 14% in the last decade. For the last 2 decades, patients with stage III and IV lesions comprised one-half of the 5-year survivors. Our overall 5-year survival was 7.9%, but in the last decade it was 8.9%. Our 5-year survival for all patients who underwent a resection was 17.9%, but increased to 24.8% for the last decade. These improvements, in combination with a decrease in incidence, have dropped the overall mortality from gastric cancer.

Hepatic low density lipoprotein receptors, HMG-CoA reductase, and plasma lipids and apolipoproteins in high- and low-responding rhesus monkeys: effect of cholestyramine treatment.

Plasma lipids and apolipoproteins, and hepatic LDL receptor and HMG-CoA reductase activities in biopsy samples were measured in high- and low-responding rhesus monkeys maintained on a cholesterol-rich and regular diets. The effect of a 30-day cholestyramine treatment on the above parameters under both dietary conditions was also determined. On the cholesterol-rich diet the high-responders, when compared to the low-responders, had several-fold increased plasma cholesterol and apoB concentrations and significantly lower HDL apoA-I and cholesterol concentrations. Hepatic LDL receptor and HMG-CoA reductase activities were not detectable in the high-responders, while the low-responders expressed a reduced number of LDL receptors of normal affinity. Administration of cholestyramine resulted in a rapid induction of the hepatic LDL receptors in the high-responders and a small additional increase in the low-responders. Cholestyramine treatment also stimulated the expression of the hepatic HMG-CoA reductase in both groups of monkeys. These changes were accompanied by a dramatic drop in plasma cholesterol and apoB concentrations in the high-responders and, to a lesser extent, in the low-responders. Plasma HDL concentrations in the high-responders rose to levels higher than those seen in the low-responders. The affinity and receptor number were similar in both groups of monkeys on the control diet, but the low-responders had significantly higher HMG-CoA reductase activities. Administration of cholestyramine during the control diet had a small but significant additional effect on the hepatic LDL receptors of the low-responders but not of the high-responders.(ABSTRACT TRUNCATED AT 250 WORDS)

[General medicine criteria for the determination of dental care needs of geriatric patients]. / Allgemeinmedizinische Kriterien zur Erfassung des zahnärztlichen Behandlungsbedarfs geriatrischer Patienten.

Recently it has been shown that there is a high prevalence of treatable dental conditions in elderly subjects in Switzerland. The purpose of the present prospective study was to assess the value of an oral screening examination intended to help the primary care physician to determine which patients should be referred to a dental service for specialized treatment. Of 219 patients aged over 65 referred consecutively to a geriatric hospital, 58.4% were objectively in need of dental treatment according to the data obtained by a dentist. In a multiple logistic analysis, 4 oral screening criteria (presence of residual teeth of the patient's own, no prosthetic replacement of an edentulous arch, subjective dental treatment requirement, subjective chewing impairment) were found to predict the objectively assessed dental need with a sensitivity of 93.0% and a specificity of 82.4%. Among the patients with objective dental treatment requirement not predicted by the screening examination, 3 had ulcerations of the oral mucosa. An intraoral soft-tissue examination should therefore be included in the screening examination. In conclusion, simple oral screening may serve to identify patients needing dental care with a high degree of diagnostic accuracy. This enables the primary care physicians to screen for oral and dental problems and to refer patients in the same way as for other special treatment problems.

Dental treatment needs in an elderly population referred to a geriatric hospital in Switzerland.

Of 219 elderly patients admitted consecutively to a geriatric hospital in Switzerland, 59.4% were edentulous. A high proportion of the dentate patients exhibited tooth loss patterns requiring free-end partial dentures in the maxilla (36.0%) or the mandible (69.7%). Of the remaining teeth, 29.3% were decayed, and 45.1% had severe periodontitis. Virtually all (97.8%) dentate and 31.5% of the edentulous subjects were judged to need some kind of dental treatment. In contrast, the subjective need for dental treatment was low in dentate (30.4%) and edentulous (13.1%) subjects. Prosthesis hygiene was poor in 73.8% of the 191 denture wearers whether they needed assistance with oral hygiene or not. The objectively-assessed need for a new prosthesis in edentulous patients was determined by income, marital status, and patient mobility, whereas the need for a prosthesis alteration was related to cognitive function. These findings should help to plan future dental prophylactic and therapeutic services in geriatric hospitals.

Villous tumors of the duodenum.

Five cases of villous tumors of the duodenum are reported, all of which involve the ampulla of Vater. Three of the five lesions contained either infiltrating carcinoma or carcinoma in situ. Although preoperative endoscopic biopsy was performed on all tumors no malignancy was identified. Frozen sections done at the time of operation on the three patients with carcinoma also failed to identify malignancy. One patient underwent pancreaticoduodenectomy and four patients had local excision of the tumor. Three of the patients treated with local excision developed recurrence and two subsequently had pancreaticoduodenectomy. Because of the difficulty in making an accurate diagnosis and the chance of recurrence when local excision is employed, strong consideration should be given to pancreaticoduodenectomy as the initial form of treatment of these lesions.

[The time requirements for the dental treatment of independent and handicapped geriatric patients. An epidemiological study]. / Zeitbedarf für die zahnmedizinische Behandlung bei selbständigen und behinderten geriatrischen Patienten. Eine epidemiologische Untersuchung.

To plan a dental care program for geriatric patients, the dental treatment needs of 219 elderly patients consecutively admitted to a geriatric hospital were quantitatively assessed. Of 89 patients with residual teeth, 97.8% were assessed as needing dental treatment of a mean projected duration of about 312 min per patient. Of the 130 edentulous patients, 30.8% needed dental treatment of a mean projected duration of about 194 min per patient. Patients exhibiting high (greater than 60 min) dental treatment needs were more frequently impaired in activities of daily living than patients with low (less than or equal to 60 min) dental treatment needs (e.g. impaired transfer function 60.2% vs. 28.0%). There was no difference in the oral hygiene or in the cleanliness of removable dentures between patients needing and not needing help in activities of daily living. In conclusion, the present results show a high amount of dental treatment needed in elderly patients. For the planning of an effective dental care program, special attention has to be paid to the interdisciplinary treatment of patients with limitations in activities of daily living. Furthermore, the improvement of the oral hygiene status is of paramount importance in most elderly patients.

[The relation of hospital and outpatient care: an important factor in geriatric practice]. / Die Verbindung Spital-ambulante Betreuung: ein wichtiger Faktor in der geriatrischen Praxis.

An example of a way to establish contact between hospital and outpatient care was demonstrated by the method of working at a clinic for geriatrics and rehabilitation. The basis for evaluation of the working method concerning the patient is optimal information about his situation at the time of hospitalisation. An objective for the hospitalisation can be determined together with the patient. The progress achieved during hospitalisation is judged at regular intervals by the patient and the staff taking care of him. This makes an estimation of the length of required hospitalisation possible. About 40% of the patients returning to family practitioner care require outpatient care. The division between the different services involved is demonstrated. The working method was judged, based on an inquiry at the family practitioners.