Recurrent post‐partum seizures after epidural blood patch

There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre‐eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late‐onset pre‐eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report. Br J Anaesth 2003; 90: 247-5

Exudative pharyngitis possibly due to Corynebacterium pseudodiphtheriticum, a new challenge in the differential diagnosis of diphtheria.

Corynebacterium pseudodiphtheriticum has rarely been reported to cause disease in humans, despite its common presence in the flora of the upper respiratory tract. We report here a case of exudative pharyngitis with pseudomembrane possibly caused by C. pseudodiphtheriticum in a 4-year-old girl. The case initially triggered clinical and laboratory suspicion of diphtheria. Because C. pseudodiphtheriticum can be easily confused with Corynebacterium diphtheriae in Gram stain, clarification of its role in the pathogenesis of exudative pharyngitis in otherwise healthy persons is of public health importance. Simple and rapid screening tests to differentiate C. pseudodiphtheriticum from C. diphtheriae should be performed to prevent unnecessary concern in the community and unnecessary outbreak control measures

Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation

Background Age is an important risk factor for perioperative cerebral complications such as stroke, postoperative cognitive dysfunction, and delirium. We explored the hypothesis that intraoperative cerebrovascular autoregulation is less efficient and brain tissue oxygenation lower in elderly patients, thus, increasing the vulnerability of elderly brains to systemic insults such as hypotension. Methods We monitored intraoperative cerebral perfusion in 50 patients aged 18-40 and 77 patients >65 yr at two Swiss university hospitals. Mean arterial pressure (MAP) was measured continuously using a plethysmographic method. An index of cerebrovascular autoregulation (Mx) was calculated based on changes in transcranial Doppler flow velocity due to changes in MAP. Cerebral oxygenation was assessed by the tissue oxygenation index (TOI) using near-infrared spectroscopy. End-tidal CO2, O2, and sevoflurane concentrations and peripheral oxygen saturation were recorded continuously. Standardized anaesthesia was administered in all patients (thiopental, sevoflurane, fentanyl, atracurium). Results Autoregulation was less efficient in patients aged >65 yr [by 0.10 (se 0.04; P=0.020)] in a multivariable linear regression analysis. This difference was not attributable to differences in MAP, end-tidal CO2, or higher doses of sevoflurane. TOI was not significantly associated with age, sevoflurane dose, or Mx but increased with increasing flow velocity [by 0.09 (se 0.04; P=0.028)] and increasing MAP [by 0.11 (se 0.05; P=0.043)]. Conclusions Our results do not support the hypothesis that older patients' brains are more vulnerable to systemic insults. The difference of autoregulation between the two groups was small and most likely clinically insignifican

On field theory quantization around instantons

With the perspective of looking for experimentally detectable physical applications of the so-called topological embedding, a procedure recently proposed by the author for quantizing a field theory around a non-discrete space of classical minima (instantons, for example), the physical implications are discussed in a ``theoretical'' framework, the ideas are collected in a simple logical scheme and the topological version of the Ginzburg-Landau theory of superconductivity is solved in the intermediate situation between type I and type II superconductors.Comment: 27 pages, 5 figures, LaTe

The modular geometry of Random Regge Triangulations

We show that the introduction of triangulations with variable connectivity and fluctuating egde-lengths (Random Regge Triangulations) allows for a relatively simple and direct analyisis of the modular properties of 2 dimensional simplicial quantum gravity. In particular, we discuss in detail an explicit bijection between the space of possible random Regge triangulations (of given genus g and with N vertices) and a suitable decorated version of the (compactified) moduli space of genus g Riemann surfaces with N punctures. Such an analysis allows us to associate a Weil-Petersson metric with the set of random Regge triangulations and prove that the corresponding volume provides the dynamical triangulation partition function for pure gravity.Comment: 36 pages corrected typos, enhanced introductio

Triangulated Surfaces in Twistor Space: A Kinematical Set up for Open/Closed String Duality

We exploit the properties of the three-dimensional hyperbolic space to discuss a simplicial setting for open/closed string duality based on (random) Regge triangulations decorated with null twistorial fields. We explicitly show that the twistorial N-points function, describing Dirichlet correlations over the moduli space of open N-bordered genus g surfaces, is naturally mapped into the Witten-Kontsevich intersection theory over the moduli space of N-pointed closed Riemann surfaces of the same genus. We also discuss various aspects of the geometrical setting which connects this model to PSL(2,C) Chern-Simons theory.Comment: 35 pages, references added, slightly revised introductio

Molecular Dynamics Simulation of Semiflexible Polyampholyte Brushes - The Effect of Charged Monomers Sequence

Planar brushes formed by end-grafted semiflexible polyampholyte chains, each chain containing equal number of positively and negatively charged monomers is studied using molecular dynamics simulations. Keeping the length of the chains fixed, dependence of the average brush thickness and equilibrium statistics of the brush conformations on the grafting density and the salt concentration are obtained with various sequences of charged monomers. When similarly charged monomers of the chains are arranged in longer blocks, the average brush thickness is smaller and dependence of brush properties on the grafting density and the salt concentration is stronger. With such long blocks of similarly charged monomers, the anchored chains bond to each other in the vicinity of the grafting surface at low grafting densities and buckle toward the grafting surface at high grafting densities.Comment: 8 pages,7 figure

Strong asymptotics for Jacobi polynomials with varying nonstandard parameters

Strong asymptotics on the whole complex plane of a sequence of monic Jacobi polynomials $P_n^{(\alpha_n, \beta_n)}$ is studied, assuming that $$\lim_{n\to\infty} \frac{\alpha_n}{n}=A, \qquad \lim_{n\to\infty} \frac{\beta _n}{n}=B,$$ with $A$ and $B$ satisfying $A > -1$, $B>-1$, $A+B < -1$. The asymptotic analysis is based on the non-Hermitian orthogonality of these polynomials, and uses the Deift/Zhou steepest descent analysis for matrix Riemann-Hilbert problems. As a corollary, asymptotic zero behavior is derived. We show that in a generic case the zeros distribute on the set of critical trajectories $\Gamma$ of a certain quadratic differential according to the equilibrium measure on $\Gamma$ in an external field. However, when either $\alpha_n$, $\beta_n$ or $\alpha_n+\beta_n$ are geometrically close to $\Z$, part of the zeros accumulate along a different trajectory of the same quadratic differential.Comment: 31 pages, 12 figures. Some references added. To appear in Journal D'Analyse Mathematiqu

Evaluation of a prostate cancer e-health-tutorial

Hintergrund: Angesichts verschiedener Behandlungsoptionen ist die Information und Therapieentscheidung beim lokalisierten Prostatakarzinom eine Herausforderung. Die digitale Informationstechnologie bietet im Vergleich zu gedruckten Informationen mehr Möglichkeiten, die Information und die Patientenkommunikation bedarfsgerecht zu gestalten. Ziele: Zur Unterstützung der Therapieentscheidung und der Kommunikation mit Patienten ist in der deutschsprachigen Schweiz ein Online-Tutorial in einem systematischen Prozess entwickelt und in einer Pilotstudie getestet worden. In der Evaluation interessierten die Nutzerzufriedenheit, die Erfüllung der Informationsbedürfnisse, die Vorbereitung auf die Therapieentscheidung und deren subjektive Qualität. Material und Methoden: Die Plattform wurde in einem iterativen Prozess mittels Fokusgruppen mit Ärzten und Patienten auf der Grundlage von Informationen aus bestehenden Broschüren entwickelt. Für den Test der Plattform wurden in 8 urologischen Kliniken 87 Patienten zur Teilnahme eingeladen. Die 56 Nutzer wurden 4 Wochen nach dem Login und 3 Monate nach dem Therapieentscheid online befragt, 48 Nutzer füllten beide Befragungen aus. Eingesetzte Instrumente waren die Preparation for Decision Making Scale (PDMS), die Decisional Conflict Scale (DCS) und die Decisional Regret Scale (DRS). Ergebnisse und Diskussion: Die Nutzenden sind mit der Plattform sehr zufrieden und finden ihre Informationsbedürfnisse gut erfüllt. Sie zeigen 3 Monate nach dem Entscheid eine gute Vorbereitung auf die Entscheidung (MW PDMS 75, SD 23) und berichten über niedrigen Entscheidungskonflikt (MW DCS 9.6, SD 11) und kaum Bedauern über die Entscheidung (MW DRS 6.4, SD 9.6). Basierend auf diesen Erkenntnissen kann die Plattform zur weiteren Nutzung empfohlen werden.Background: Due to the multitude of therapy options the treatment decision after diagnosis of a localised prostate cancer is challenging. Compared to printed booklets, web based information technology offers more possibilities to tailor information to patients’ individual needs. Objectives: To support the decision making process as well as the communication with patients we developed an online tutorial in a systematic process in the German speaking part of Switzerland and then tested it in a pilot study. The study investigated users’ satisfaction, the coverage of information needs, the preparation for decision making and the subjective quality of the decision. Materials and methods: Based on already existing information material the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. From these patients 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS). Results and Conclusion: Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (Mean PDMS 75, SD 23), they had low decisional conflict (Mean DCS 9.6, SD 11) and almost no decisional regret (Mean DRS 6.4, SD 9.6). Based on these findings the further use of the tutorial can be recommended

On the worldsheet theories of strings dual to free large N gauge theories

We analyze in detail some properties of the worldsheet of the closed string theories suggested by Gopakumar to be dual to free large N SU(N) gauge theories (with adjoint matter fields). We use Gopakumar's prescription to translate the computation of space-time correlation functions to worldsheet correlation functions for several classes of Feynman diagrams, by explicit computations of Strebel differentials. We compute the worldsheet operator product expansion in several cases and find that it is consistent with general worldsheet conformal field theory expectations. A peculiar property of the construction is that in several cases the resulting worldsheet correlation functions are non-vanishing only on a sub-space of the moduli space (say, for specific relations between vertex positions). Another strange property we find is that for a conformally invariant space-time theory, the mapping to the worldsheet does not preserve the special conformal symmetries, so that the full conformal group is not realized as a global symmetry on the worldsheet (even though it is, by construction, a symmetry of all integrated correlation functions).Comment: 60 pages, 17 figures, latex. v2: Added references and a minor correctio