Subacute combined spinal degeneration caused by cobalamin deficiency.

A 51-year-old woman consulted the department of neurology with a 5 month-history of progressive numbness and tingling in a glove and stocking distribution. The problems started in both feet, resulting in unsteadiness and difficulty walking. Motor weakness and impairment of sensation of fine touch were also noticed

A method for the reconstruction of unknown non-monotonic growth functions in the chemostat

We propose an adaptive control law that allows one to identify unstable steady states of the open-loop system in the single-species chemostat model without the knowledge of the growth function. We then show how one can use this control law to trace out (reconstruct) the whole graph of the growth function. The process of tracing out the graph can be performed either continuously or step-wise. We present and compare both approaches. Even in the case of two species in competition, which is not directly accessible with our approach due to lack of controllability, feedback control improves identifiability of the non-dominant growth rate.Comment: expansion of ideas from proceedings paper (17 pages, 8 figures), proceedings paper is version v

WITCH: a recoil spectrometer for weak interaction and nuclear physics studies

An experimental set-up is described for the precise measurement of the recoil energy spectrum of the daughter ions from nuclear beta decay. The experiment is called WITCH, short for Weak Interaction Trap for CHarged particles, and is set up at the ISOLDE facility at CERN. The principle of the experiment and its realization are explained as well as the main physics goal. A cloud of radioactive ions stored in a Penning trap serves as the source for the WITCH experiment, leading to the minimization of scattering and energy loss of the decay products. The energy spectrum of the recoiling daughter ions from the $\beta$--decays in this ion cloud will be measured with a retardation spectrometer. The principal aim of the WITCH experiment is to study the electroweak interaction by determining the beta--neutrino angular correlation in nuclear $\beta$--decay from the shape of this recoil energy spectrum. This will be the first time that the recoil energy spectrum of the daughter ions from $\beta$--decay can be measured for a wide variety of isotopes, independent of their specific properties

Progress at the WITCH experiment

The WITCH-experiment will measure the energy spectrum of the recoiling daughter ions in $\beta$-decay to search for non-standard scalar and tensor type interaction. To facilitate this a Penning trap is used to store the radioactive ions. Thus the recoil ions can leave the source without any energy loss and their energy can be probed by the subsequent retardation spectrometer. The experiment is being set up at present at ISOLDE/CERN. The principle and the status of the WITCH-experiment will be presented. (12 refs)

Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis

Surgery is the primary therapeutic intervention for breast cancer and can result in significant postoperative pain. We searched the current literature and performed a meta-analysis in order to compare the analgesic efficacy of the pectoral type-2 (Pecs II) block with systemic analgesia alone and with a thoracic paravertebral block for breast cancer surgery. Primary outcome was postoperative opioid consumption in the first 24 h after surgery. Secondary outcomes were pain scores at 0, 3, 6, 9 and 24 h after surgery, intra-operative opioid consumption, time to first analgesic request and incidence of postoperative nausea and vomiting. We identified 13 randomised controlled trials that included 815 patients. The Pecs II block significantly reduced postoperative opioid consumption (standardised difference in means: -13.64 mg oral morphine equivalents; 95%CI: -21.22 to -6.05; p < 0.01) and acute postoperative pain at all intervals in the first 24 h after surgery compared with systemic analgesia alone. Compared with the thoracic paravertebral block, the Pecs II block resulted in similar postoperative opioid consumption (standardised difference in means: -8.73 mg oral morphine equivalents; 95%CI: -18.16 to 0.69; p = 0.07) and postoperative pain scores after first measurement. In conclusion, the Pecs II block offers improved analgesic efficacy compared with systemic analgesia alone and comparable analgesic efficacy to a thoracic paravertebral block for breast cancer surgery

Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II

STUDY OBJECTIVE: The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery. DESIGN: A prospective randomized double blind placebo-controlled study. SETTING: A secondary hospital. PATIENTS: 140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection. INTERVENTIONS: Patients were randomized to receive either a Pecs block with levobupivacaine 0.25% (n=70) or placebo block with saline (n=70). MEASUREMENTS: The pain levels were evaluated by Numeric Rating Scale (NRS) pain scores at 15-minute intervals during the post anesthesia care unit stay time (PACU), at 2-hour intervals for the first 24h on the ward and at 4-hour intervals for the next 24h. Intraoperative and postoperative opioid consumption were recorded during the full stay. Patient satisfaction was evaluated upon discharge using a 10-point scale. MAIN RESULTS: Intraoperative sufentanil requirements were comparable for the Pecs and placebo group (8.0+/-3.5mug and 7.8+/-3.0mug, P=0.730). Patients in the Pecs group experienced significantly less pain than patients in the control group (P=0.048) during their PACU stay. Furthermore, patients in the Pecs group required significant less postoperative opioids (9.16+/-10.15mg and 14.97+/-14.38mg morphine equivalent, P=0.037) and required significant fewer postsurgical opioid administration interventions than patients in the control group (P=0.045). Both patient-groups were very satisfied about their management (9.6+/-0.6 and 9.1+/-1.8 on a 10-point scale, P=0.211). CONCLUSIONS: The Pecs block reduces postsurgical opioid consumption during the PACU stay time for patients undergoing breast surgery

Isospin mixing in the ground state of sup 5 sup 2 Mn

The presence of isospin mixing into the ground state of sup 5 sup 2 Mn was studied via anisotropic positron emission from nuclei. With this method the isospin forbidden Fermi-component in the Gamow-Teller dominated beta decay was determined. It is shown that sample purity and the control of positron scattering is of vital importance. Comparison between theory and experiment shows that shell model calculations of the isospin mixing probability deviate by a factor three to seven from experiment. For more recent Hartree-Fock-RPA based calculations the difference is over two orders of magnitude

Pectoral Nerve Block Type II as the Sole Anesthetic for Removal of a Large Axillary Tumor: A Case Report

The pectoral nerve block type II (Pecs II block) combined with general anesthesia provides analgesia during breast and axillary surgery. This report describes the first use of the Pecs II block as the sole anesthetic for axillary surgery. A patient needed resection of axillary masses. She was not only very reluctant to have general anesthesia but also considered high risk because of multiple comorbidities. An ultrasound-guided Pecs II block was performed. Both masses were resected without additional sedation or analgesia. This case report suggests that, in selected cases, the Pecs II block can be used as the sole anesthetic for axillary surgery