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To report the follow-up findings of 7 children with severe epilepsy as a result of thiamine deficiency in infancy caused by a defective soy-based formula.

By assigning complex values to the source coordinates and pulse-initiation time of the time-dependent Green function in free space, one may generate a field solution that behaves like a propagating pulsed beam. Although the conventional pulsed line source response is known in closed form, the complex extension cannot be performed directly thereon because of the nonanalytic behavior of the causal field. The analytic continuation is carried, out here by spectral analysis and synthesis, utilizing the recently formulated spectral theory of transients. This approach not only guarantees uniqueness but also elucidates the spectral content of the resulting waveform, which is composed of contributions from singularities in the complex spectral wave-number plane. By similar analytic extension of time-dependent Green functions for more complicated environments, one may construct directly the transient field produced in these environments by the incident pulsed beam.

A moving window finite difference time domain method is developed to simulate the propagation of electromagnetic pulses over large distances. Both Eulerian and Lagrangian approaches to solving Maxwell's equations in a moving window are obtained and contrasted. The Lagrangian approach is shown to be superior for electromagnetic pulse propagation; it is demonstrated that dispersion-free numerical propagation can be achieved with the Lagrangian approach. Examples of propagation in homogeneous and inhomogeneous media, and scattering from a interface between two media are considered. The scattering results are achieved with a window splitting approach in which the original incident pulse window is frozen at the interface and new windows are generated after the interface interactions occur that move with the reflected and transmitted pulses. The simulation results are shown to be accurate and physically appealing.

Acute intussusception has different clinical features in various parts of the world. The goal of this study was to determine the clinical presentation in different ethnic groups in Israel.

In this second part in a three part sequence, the hybrid wavefront-resonance scheme developed in Part I is applied and explored numerically for the transient field scattered by a plane parallel waveguide cavity configuration. Emphasis is on validating the effectiveness of this representation and on explaining the observed features in the scattered signal at early, intermediate, and at late observation times. Utilizing results reported earlier for the complex resonances [3], it is shown that the late-time observables carry the signature of a cluster of high-Q internal resonances that occurs near modal cutoff frequency, in the form of a slowly decaying typical waveform which is independent of the incident angle or the excitation pulse but is related to the cavity dimensions. The early-time field is expressed as a rapidly decaying series of external wavefront interactions, while at intermediate times the internal resonances synthesize the dispersive guided mode return. The convergence of the resonance series, and its role in establishing the early-time causal wavefront are explored. By properly selecting the incident angle and pulse-shape, one may de-emphasize the early-time contributions and enhance the magnitude of the late time typical waveform.

Short pulse scattering signals furnish valuable information for classification or identification. The aim in this paper is toward defining a strategy for parameterization of the field in terms of "physical observables" which are distinct features that show up in the radar signature at early or late time windows. For targets comprising of open-ended enclosures with interior-exterior coupling, distinct late time observables may be found in the form of high-Q resonances. An effective parameterization is therefore provided by a hybrid representation wherein the internal fields are expressed as resonances while the wave interactions around the exterior boundaries, which are important essentially at early times, are expressed in terms of rapidly decaying series of rays (or wavefronts). This hybrid concept is illustrated here for the prototype configuration of an open-ended perfectly conducting parallel plate waveguide cavity. The hybrid formulation utilizes a systematic matrix procedure in which all the scattering coefficients are expressed in a generic form so that it may be generalized to other open cavity configurations; the specific coefficients for the present configuration are summarized in an appendix. The properties of the hybrid parameterization are contrasted with those of the global SEM representation. Numerical calculations of the time-dependent field and approximate models for the late time observables are considered in Parts II and III of this sequence.

The numerical results of the second portion of this three part sequence dealing with transient scattering by an open ended plane-parallel waveguide cavity, clearly reveal the existence of a distinct late-time observable in the form of a slowly decaying, aspect-independent typical waveform that carries the signature of a cluster of high-Q resonances that occur near the cavity's mode cutoff frequencies. In this paper, we derive analytic approximations for the resonance frequencies, for the late-time waveform, and for the low-frequency "beats" that appear in this late-time waveform. These observables are related to the cavity dimensions. It is shown that the late-time waveform is essentially independent of the incidence angle and of the excitation pulse.

One hundred sixteen patients who had undergone partial arthroscopic meniscectomy were reviewed in a short-term follow-up study (mean follow-up: 16 months). Their results were compared with those of a group of 402 patients who had been treated previously by conventional open meniscectomy in the same hospital. Average age in the arthroscopic group was 40 years, in the open group 34. Average sick leave was 4 weeks in the arthroscopic group, 10 weeks in the arthrotomy group. In the endoscopic group, there was virtually no sick leave for self-employed people, but 7 weeks if the lesion was sustained at work. Top-class sportsmen resumed competition 5 weeks after arthroscopy, 8 weeks after conventional meniscectomy. Still, most of them complained of prolonged synovial reaction resulting in a period of poor physical condition and performance. Of the patients treated by arthroscopy, 7.5% presented minor problems related to the approach (anteromedial-transpatellar), while 21.5% had similar problems after routine anteromedial incision in the open meniscectomy group. The overall results after arthroscopy were excellent in 49 cases (41.5%), good in 51 (43%), fair in 14 (12%), and poor in four (3.5%). These short-term results are comparable to those of the open meniscectomy group. The short-term results in the older patients confirm our belief that (partial) meniscectomy is useful for the older patient with a history of mechanical meniscal problems, with or without cartilage degeneration, provided one is not dealing with frank osteoarthrosis and secondary varus or valgus deformity.

Analytical modeling of high-frequency time-harmonic and transient radiation from extended aperture sources and of propagation of the resulting fields through perturbing environments is facilitated by simultaneous use of configurational (space-time) and spectral (wave number–frequency) information for suitably defined synthesizing wave objects. Such a bilateral approach can be embodied within a configuration-spectrum phase space. The present investigation deals with radiation from extended aperture sources, with emphasis on alternative uses of the phase space at high frequencies, on promising wave objects as basis elements for field synthesis, and on extraction of physical information from exact wave solutions by asymptotic methods. Of special interest are beam-type wave objects that exhibit localization in the phase space because localized wave fields have favorable propagation characteristics in complex external environments. In this paper, alternative phase-space parameterizations are applied to time-harmonic plane aperture distributions and to the corresponding fields radiated into a homogeneous half-space. The parameterizations include nonwindowed continuum versions, in which localization occurs asymptotically through constructive interference; windowed continuum versions, in which localization is embedded inherently; and windowed discretized versions, in which the basis elements are situated on a self-consistent configuration–wave number lattice. By analysis and illustrative examples, it is shown how these alternative formulations are interrelated, how the localization around well-defined regions in the phase space takes place in each formulation, and how these localization properties, through the beam propagators, influence the synthesis of the radiation field. Transient phenomena will be addressed in separate publications.

Acute intussusception has different clinical features in various parts of the world. The goal of this study was to determine the clinical presentation in different ethnic groups in Israel. A retrospective chart review of a 9‐year period (1985‐1995) was carried out at a university medical center. Data extracted included age, sex, ethnic origin, presenting symptoms and signs, the type of enema (barium or air), and the success rate of non‐surgical reduction of the intussusception. Ninety patients suffering from intestinal obstruction due to acute intussusception were admitted. The triad of intermittent screaming attacks, lethargy, and vomiting was observed in 37.5% of study subjects. The majority of patients were admitted during the warmer months of the year. The average age of the patients was 7.8 ± 3.7 months; 70% of them were between the ages of 4 and 9 months and 92.5% under 1 year of age. The female‐to‐male ratio was 1:2.1. Air enema was superior to the barium enema in achieving reduction (p < 0.01). The incidence in the Jewish population was similar to that observed in other surveys, and twice that found in the Arab population in our region (p < 0.05). The overall clinical presentation of acute intussusception found in our study does not differ from other studies. The lower incidence of acute intussusception found in the Arab population can be explained by ethnic, genetic, or nutritional factors.

BackgroundLacosamide is indicated for various types of refractory epilepsy and as adjunctive therapy to other antiepileptic medications. Data on monitoring serum levels of lacosamide in pediatric patients is scarce.ObjectiveTo evaluate the correlation between serum levels of lacosamide and the tolerability in children with refractory epilepsy.MethodsThe medical records of 22 children with refractory epilepsy treated with lacosamide at Assaf Harofeh Medical Center were reviewed. Trough serum levels of lacosamide was measured using HPLC and correlated with its efficacy and safety.ResultsMean age of the children was 11 ± 4 (3–18) years. Median lacosamide daily dose was 9.3 (6.6–11) mg/kg and median plasma concentration was 7.1 (5.9–11.9) ug/ml. The therapeutic range of lacosamide serum concentration is 10 to 20 ug/ml. No change in seizures frequency was reported in 21.4% of children with lacosamide concentrations below 10 ug/ml. However, in 40% of the children, reduction of the seizures frequency was reported when serum concentration was above 10 ug/ml. No serious adverse events were reported during therapy. The prospective part of the study was initiated, and the first patients were recruited.ConclusionLarge studies, preferably prospective, on lacosamide serum monitoring including information on correlation with efficacy and safety are warranted.Disclosure(s)Nothing to disclose

Introduction: Newborns with thrombocytopenia have a higher incidence of bleeding disorders including IVH, which may increase their risk for mortality and morbidity. In order to identify this high risk population among healthy normal term newborn we obtained a CBC from all the newborn to thrombocytopenic mothers. We divided the infants to 2 groups: the first, those born to mothers with mild thrombocytopenia (100,000-150,000), and the second the ones that were born to mothers with severe thrombocytopenia (< 100,000).Patients and Methods: During the study period we collected samples from 284 healthy term newborns, born at Assaf Harofeh Medical Center in Israel. 22 infants born to severe thrombocytopenic mothers and 176 to mothers with mild thrombocytopenia. All samples were collected within 2 hours after birth.Results: The 2 groups did not defer regarding clinical and demographic data. Neonatal thrombocytopenia was noted among 27.3% in the severe maternal thrombocytopenia group, compared to 3.4% in the mild group (p< 0.0001).Conclusion: Newborns born to severe thrombocytopenic mothers had a higher incidence of thrombocytopenia compared to the one born to mild thrombocytopenia mothers. The pathogenesis of this finding may be of immunologic origin. We recommend that in every case of maternal thrombocytopenia a CBC should be obtained from the offspring in order to identify this high risk population, especially if the mother has severe thrombocytopenia and should be treated accordingly.

OBJECTIVE: The purpose of this study was to test the hypothesis that patients with evidence of left-systolic ventricular dysfunction treated with torsemide would have fewer hospitalizations for heart failure, improved disease-specific quality of life, and lower direct inpatient costs compared to patients treated with fursemide. Pharmacokinetic studies have shown that the bioavailability of torsemide is more complete and predictable than furosemide, especially in patients with heart failure. METHODS: Prospective, randomized trial. This is an interim analysis of 191 hospitalized patients (65 years of age ± 12 SD) who were prescribed torsemide (n = 93) or furosemide (n = 98) for 1 year. Data were analyzed at 15 months as part of a planned interim intention to treat analysis. Duration of follow-up did not differ between treatment groups (233 days ± 134 SD). Dependent variables were the numbers of subsequent hospitalizations for heart failure, other cardiovascular causes, and all causes, their corresponding count of hospital days, and direct costs. Disease-specific quality of life was measured using the Chronic Heart Failure Questionnaire. RESULTS: Patients treated with torsemide had significantly fewer hospitalizations for heart failure (11 vs. 28) and other cardiovascular causes (20 vs. 48). The difference in all cause hospitalizations was not signficant (77 vs. 107). Hospital days were significantly less for patients treated with torsemide for all cardiovascular causes only (91 vs. 222) (p > 0.05). Dyspnea, fatigue, and total disease-specific quality of life were significantly better for patients treated with torsemide. Direct inpatient costs for all cause hospitalizations were $793,460 ($8,532 per patient) for torsemide and $1,161,617 ($11,617 per patient) for furosemide. CONLUSION: Patients treated with torsemide have fewer hospitalizations for heart failure and other cardiovascular causes, improved dyspnea and fatigue, and lower direct inpatient health care costs. These effects are presumably due to the complete and reliable absorption of torsemide.