Cessation Of Attacks Research Articles

E48 Thinking about auto inflammatory diseases in front of a periodicity of fever in children: a case report

Abstract Introduction Auto-inflammatory diseases (AIDs) are caused by mutations in genes involved in the regulation of innate immunity. The prototypical diseases are the hereditary recurrent fevers (HRFs), whose intermittent inflammatory manifestations are similar between the different diseases; they preferentially affect the serous membranes, skin, eyes, joints, muscles and sometimes the central nervous system. Their onset is often early in life. Objectives To think of an auto inflammatory disease in front of a periodic fever in children Method We report the case of a child with periodic fever. Results A 4-year-old boy with no particular family or personal history, who presented at the age of 1 year with episodes of high fever without evident cause lasting from 7 to 14 days, with a monthly recurrence. There was associated pharyngitis, bilateral cervical lymphadenopathy, oral aphthosis, abdominal pain, sometimes with arthralgia, vomiting, diarrhoea and skin rash. During the fever episode the inflammatory work-up is frankly positive with neutrophilic hyperleukocytosis and an elevated C-reactive protein. The duration and characteristics of the episodes are not modified by the usual antibiotic and antipyretic therapy. Viral serologies for CMV, EBV, parvovirus B19 and HIV are negative. Recurrent bacterial infections of the upper airways were ruled out in view of the periodic character, the negativity of the procalcitonin and throat swabs and the inefficiency of the antibiotic therapy during the attacks. The immune deficiency test came back normal. Autoinflammatory diseases in the absence of autoimmune signs were strongly suggested. Urinary mevalonate kinase/mevalonic acid during the episode was normal. Cyclic neutropenia was eliminated in the presence of PNN hyperleukocytosis at each episode. Genetic study of familial Mediterranean fever syndrome, cryopyrin-caps associated periodic syndrome and TRAPS syndrome came back normal. Our patient met al.l the Vanoni criteria for Marshall's syndrome. He received a single dose of prednisone 1 mg/kg which resulted in a spectacular defervescence in < 24 h and disappearance of other symptoms in a few days and their absence between attacks. This corticosteroid therapy was subsequently prescribed at each attack, which allowed rapid control and a reduction in the duration of the attacks. Discussion and conclusion The exact etiopathogenesis and diagnostic biomarkers of Marshall's disease are still unknown. It is rather a diagnosis of exclusion based mainly on clinical criteria. It is retained in our patient in view of the presence of all diagnostic criteria and the therapeutic test. There is no consensus on the treatment of Marshall's at present. Antipyretics can be used but are only partially effective. Single dose corticosteroids result in cessation of attacks; tonsillectomy is a secondary treatment option. Colchicine is promising for preventing or reducing the frequency of attacks. Marshall's syndrome is a self-limiting autoinflammatory disease of early childhood with spontaneous resolution without impact on the child's growth and development and without major sequelae in most cases within 3–5 years of onset.

Exploring the immunological basis of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome: immunohistochemical staining features of palatine tonsils.

Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is the most common periodic fever syndrome during early childhood period with regular febrile attacks of sterile upper airway inflammation. The cessation of attacks following tonsillectomy points to fundamental role of tonsil tissue on etiopathogenesis of disease, which is not clarified satisfactorily. The aim of this study is to explore the immunological basis of PFAPA by evaluating the cellular properties of tonsils, and microbial exposition such as Helicobacter pylori on tonsillectomy materials. The paraffinized tonsil samples of 26 PFAPA and 29 control patients with obstructive upper airway disorder were compared in terms of immunohistochemical staining features including CD4, CD8, CD123, CD1a, CD20, and H. pylori. The median number of CD8+ cells was 1485 (1218-1287) in PFAPA while it was 1003 (852-1261.5) in control group and the difference was statistically significant (p=0.001). Similarly, CD4+ cell counts were statistically higher in PFAPA group than control (833.5 vs 622). The ratio of CD4/CD8 did not differ between two groups; also, there was no statistically difference in terms of the other immunohistochemical staining results, such as CD20, CD1a, CD123 and H. pylori. This is the largest number of pediatric tonsillar tissue study of PFAPA patients in current literature and we emphasized the triggering effects of CD8+ and CD4+ T-cells on PFAPA tonsils. • The cessation of attacks following tonsillectomy points to fundamental role of tonsil tissue on etiopathogenesis of disease, which is not clarified satisfactorily. • In current study, 92.3% of our patients did not experience any attacks following operation similarly with literature. • We observed the increased number of CD4+ and CD8+ T cell counts on PFAPA tonsils compared to control group and emphasized the active role of both CD4+ and CD8+ cells localized on PFAPA tonsils in immune dysregulation. • Some other cell types evaluated in this study such as CD19+ (B cells), CD1a (dendritic cells), and CD123 (IL-3 receptors, for pluripotent stem cells) and H. pylori did not differ in PFAPA patients compared to the control group.

P12.10 Treatment of pharmacoresistent epilepsy by combining stereotactic destruction and authologous mesenchymal stem cells

Abstract BACKGROUND Existing anti-epileptic drugs (AED) have limited efficiency in many patients, necessitating the search for alternative approaches such as stereotactic radiosurgery (SRS) and followed by stem cell therapy to improve results of previous treatment. MATERIAL AND METHODS From 2016 to 2017, a prospective study included 6 patients with a combined pathology, a median of 56 years of age, in the past TBI - 3 patients, a solitary metastatic focus in the brain (GM) - 2 patients. The indications for stereotactic intervention were both the presence of a metastatic lesion of the GM, and the bitemporal epilepsy with generalized convulsive, complex and simple partial attacks, regardless of the presence of an organic focus on CT or MRI GM. SRS was undertaken in patients undergoing a course of anticonvulsant drug therapy in combination with other types of symptomatic therapy in the absence of therapeutic effect. The frequency of generalized convulsive seizures ranged from 2–3 to 7–10 per month, complex partial from daily to 2–3 per month. SRS was performed on a stereotactic irradiation system with conical “BrainLab” collimators mounted on a linear CLINAC accelerator and allowing the session of SRS arc arches. Total dose was 12–30 Gy in isocenter, 1 fraction. After 2–3 monthes from SRS the patients received AED supplemented with single intravenous administration of undifferentiated autologous MSC (target dose of 1 × 106 cells/kg), followed by a single intrathecal injection of neurally induced autologous MSC (target dose of 0.1 × 106 cells/kg). RESULTS duration of epilepsy at the time of surgery ranged from 3 to 42 years. Cessation of attacks after 2–3 months after SRS with followed MSC therapy in 2 out of 6 patients was achieved remission (no seizures for one year and more), and 3 patients became responders to AEDs additionally, reduction of the pathological EEG pattern (disappearance of beta focusing, reduction of theta2-index to 23.6). Persistent clinical onco- and neurological remission 18 months. Reduction of the dose of enkorata-chrono - 3 patients, complete abolition of anticonvulsant therapy - 2 patients. MSC injections were well tolerated and did not cause any severe adverse effects. CONCLUSION MSC possess unique immunomodulatory properties and are a safe and promising candidate for cell therapy in AED resistant epilepsy patients in the frame of combined treatment.

Diagnostics and treatment the deficiency of biotinidase in practice of the children’s neurologist

Biotinidase deficiency is a hereditary metabolic disease from the group of organic acidurias with an autosomal recessive type of inheritance. The disease is caused by mutations in the BTD gene, which encodes an enzyme biotinidase. Deficiency of biotinidase leads to insufficiency of intracellular Biotin, which is the coenzyme of four carboxylases involved in gluconeogenesis, leucine metabolism and biosynthesis of fatty acids. At infringement of function of carboxylase accumulate substrates that are toxic to the human body. Deficiency of biotinidase is manifested primarily by neurocutaneous disorders. The Central nervous system is particularly vulnerable, since the activity of biotinidase in the human brain is very low and therefore, for the normal functioning of neurons, it is necessary to receive enough biotin through the blood-brain barrier. With its deficiency, neurological disorders for a certain period may be the only sign of the disease. Symptoms can be successfully cured or prevented by the introduction of pharmacological doses of biotin. The article presents two clinical observations of young children with biotinidase deficiency, the main manifestation of which in the first clinical case were neurological disorders, in the second – respiratory disorders. To confirm the diagnosis, an enzyme diagnosis was carried out, which revealed a low level of biotinidase. The rapid and pronounced efficacy of biotin therapy with cessation of attacks, the possibility of cancellation of anticonvulsants, regression of neurological, skin and respiratory disorders.

57. Botulinum toxin type-A therapy in cluster headache: Two clinical cases

Cluster headache (CH) is a primary chronic disabling form with autonomic symptoms, that often does not respond satysfactorily to prophylactic treatment. Botulinum toxin type A is an effective therapy for chronic migraine. We describe 2 clinical cases of CH examining the role of Onabotulinum-toxin-A on this form of primary headache. We treated with Onabotulinum-toxin-A two men (46 and 65 years-old) with refractory CH, with a periodicity of 3–4 months, in the muscles of the head and neck following a Blumenfeld treatment paradigm. The first patient has undergone six applications of Onabotulinum-toxin-A (total dosage of 155 U-31 sites) with a follow-up of two years. The second patient has undergone ten applications of Onabotulinum-toxin-A (total dosage between 105 and 195 U-31-39 sites), with a follow-up of three years. Symptoms improvement appeared after the second infiltrative treatment in both case with persistence of effectiveness until seven treatment, with intensity and frequency attack reduction. The first patient reported rare episodes of temporo-mandibular joint tension. The second case showed a total cessation of attacks. Interleukin-1 is a potent prototypical pro-inflammatory cytochine implicated in the pathogenesis of CH, and botulinum toxin inactivate interleukin-1.Onabotulinum-toxin-A can represent a valid alternative prophylactic therapy in CH.

Rotfeld, Adam Daniel and Torkunov, Anatoly V. (eds) White Spots — Black Spots: Difficult Matters in Polish-Russian Relations 1918–2008 (review)

REVIEWS 557 Vasyl Rasevych’s chapter on the Galician Ukrainians shows how reluctant they were to liberate themselves from Habsburg tutelage, even in late 1918. Georgiy Kasianov provides an excellent overview of the ups and downs of the various Ukrainian governments after 1917, ending his account of ‘the Ukrainian Revolution’ in ‘November 1920, when Ukrainian troops engaged in the Soviet-Polish war retreated to Galicia’ (p. 76). There are many excellent maps, particularly in the material on military campaigns. Wolfram Dornik is sceptical that the occupation of Ukraine by the Central Powers in 1918 was anything but ‘a fiasco for all those involved’ (p. 399). He also raises the question of ‘whether the Central Powers were well-advised when they overthrew the Rada’ (p. 400) in April 1918. Peter Lieb and Wolfram Dornik are interesting on why the Habsburgs deferred to the Germans during the occupation (p. 62). ‘A Ukraine under the protection of Vienna was seen as a possibility, but the Austrians were realistic enough to know that it was not very likely. Their real fear was that Kyiv would come under the influence of Russia or Germany, and this would put strategic pressure on the Danube Monarchy’ (p. 403). Hannes Leidinger and Wolfram Dornik provide an excellent analysis of the (lack of) interest shown by the Allied Powers towards Ukraine, particularly after the end of the war in the West in November 1918. Bogdan Musial is very good on the vicissitudes of Poland’s policy, and on Piłsudski’s genuine desire for a ‘cessation of attacks on Petliura’ (p. 377) in 1919 and ‘attempt to restore Ukrainian statehood’ (p. 382) in 1920. This is an ideal book for students, containing as it does both summary chapters and in-depth detail where needed. But there is also much to interest the specialist. UCL SSEES Andrew Wilson Rotfeld, Adam Daniel and Torkunov, Anatoly V. (eds). White Spots — Black Spots: Difficult Matters in Polish-Russian Relations 1918–2008. Pitt Series in Russian and East European Studies. Pittsburgh University Press, Pittsburgh, PA, 2015. xi + 666 pages. Notes. Appendices. Index. $65.00. This is a remarkable book, not so much for its insights drawn from new historical research but as an important document of collaborative PolishRussian efforts to remove from their contemporary political relationship conflicts over ‘difficult matters’ in their common twentieth-century history. The Polish-Russian Group on Difficult Matters was originally formed in 2002 on the initiative of both governments, but suffered a false start due to renewed tensions in their relations. The Group was revived in 2008 and its composition SEER, 94, 3, july 2016 558 significantly altered, bringing together individuals from a variety of academic disciplines, professional fields and government agencies to ‘support state institutions in addressing those problems from the past that hinder mutual relations and inhibited their development’ (p. 5). The 2008 ‘reset’ would produce concrete results, including fifteen paired Polish-Russian perspectives from thirty-one contributors on their bilateral relations over a ninety-year period, of which the English-language edition under review is an abridge version of the Polish and Russian originals. Led by the former Polish foreign minister, Adam Daniel Rotfeld and the Russian academician and former diplomat Anatoly V. Torkunov, the Group could also claim credit for inspiring the joint 70th anniversary commemoration of Polish officers shot and killed in the Katyn Forest by the NKVD in April 1940. To be sure Katyn has been the most difficult of all matters, beginning with the crime itself, followed by decades of denial and obfuscation on the Soviet side and bitterness and resentment from the Poles. An early breakthrough occurred in March 1990 with the publication of an article in Moskovskie Novosti by Natalia S. Lebedeva, one of the contributors to this volume. Lebedeva’s ‘bombshell’ revelation of Katyn documents was followed three weeks later by an official statement in which the highest Soviet authorities admitted the responsibility of the NKVD for the murders. However, the most important materials remained hidden until October 1992, when authorized copies of the top secret folders of the Politburo related to the decision to execute the Poles in captivity were turned over to then Polish President Lech Wa...

Dornik, Wolfram; Kasianov, Georgiy; Leidinger, Hannes; Lieb, Peter; Miller, Alexei; Musial, Bogdan, and Rasevych, Vasyl The Emergence of Ukraine: Self-Determination, Occupation and War in Ukraine, 1917–1922 (review)

SEER, 94, 3, july 2016 556 interesting book, but to an extent feels like the first phase of a larger project. Hopefully Kowalsky will pursue her important research further. School of History and Anthropology K. Turton Queen’s University, Belfast Dornik, Wolfram; Kasianov, Georgiy; Leidinger, Hannes; Lieb, Peter; Miller, Alexei; Musial, Bogdan, and Rasevych, Vasyl. The Emergence of Ukraine: Self-Determination, Occupation and War in Ukraine, 1917–1922. CIUS Press, Edmonton, AL and Toronto, ON, 2015. xxx + 441 pp. Maps. Illustrations. Notes. Appendix. Bibliography. Index. $39.95 (paperback). This volume is a (shortened) translation of the book Die Ukraine zwischen Selbstbestimmung und Fremdherrschaft 1917–1922, that came out in German in 2011. Most of the analysis is conventional, though it is invaluable for its wealth of detail. There is nothing, for example, on the Donetsk-Kryvyi Rih Republic of 1918, other than a brief mention in a list of would-be statelets, despite its mythologization by the self-proclaimed Donetsk People’s Republic since 2014; even if this is maybe all it deserves in terms of its actual historical importance. Nevertheless, there are many novel framings. The editors are keen to see ‘developments after the First World War not so much as a break but as a continuity’ (p. xvi). Events in Ukraine did not happen ex nihilo and were part of the general European upheaval that lasted much longer than the official four years of war in the West (hence for some Germans it is the Urkatastrophe). The editors also argue that ‘severe doubt is cast […] on the concept of the “Russian Civil War”’ (p. xvii) — many of its conflicts were between centre and periphery and many of its participants were from outside the empire of 1914. There is an admiral emphasis on ‘transnational history’, following on from Georgiy Kasianov’s excellent edited volume with Phillip Ther (A Laboratory of Transnational History, Budapest and New York, 2009). HighlightsincludeaninterestingessaybyAlexeiMilleron‘Russia’sUkrainian Policy before 1917’. Building on his own earlier work and that of Faith Hillis, he argues that ‘Ukraine, especially Kyiv, […] became a battleground between two nationalisms deeply rooted there’. ‘Ukrainian activists and the Little Russian anti-Ukrainians were both directing their propaganda toward the same group, whose members identified as Malorossy (Little Russians) or Khokhly’ (p. 307). Indeed, for the embryonic Russian nationalist movement, ‘the Little Russian variety of the Russian character was claimed to be even more “solid” than the Great Russian variety, which succumbed all too easily to the temptations of revolutionary ideas and the deceptive imaginings of minority milieus from the periphery of the empire’ (p. 310). REVIEWS 557 Vasyl Rasevych’s chapter on the Galician Ukrainians shows how reluctant they were to liberate themselves from Habsburg tutelage, even in late 1918. Georgiy Kasianov provides an excellent overview of the ups and downs of the various Ukrainian governments after 1917, ending his account of ‘the Ukrainian Revolution’ in ‘November 1920, when Ukrainian troops engaged in the Soviet-Polish war retreated to Galicia’ (p. 76). There are many excellent maps, particularly in the material on military campaigns. Wolfram Dornik is sceptical that the occupation of Ukraine by the Central Powers in 1918 was anything but ‘a fiasco for all those involved’ (p. 399). He also raises the question of ‘whether the Central Powers were well-advised when they overthrew the Rada’ (p. 400) in April 1918. Peter Lieb and Wolfram Dornik are interesting on why the Habsburgs deferred to the Germans during the occupation (p. 62). ‘A Ukraine under the protection of Vienna was seen as a possibility, but the Austrians were realistic enough to know that it was not very likely. Their real fear was that Kyiv would come under the influence of Russia or Germany, and this would put strategic pressure on the Danube Monarchy’ (p. 403). Hannes Leidinger and Wolfram Dornik provide an excellent analysis of the (lack of) interest shown by the Allied Powers towards Ukraine, particularly after the end of the war in the West in November 1918. Bogdan Musial is very good on the vicissitudes of Poland’s policy, and on Piłsudski’s genuine desire for a ‘cessation of attacks on Petliura’ (p. 377) in 1919 and ‘attempt to restore...

Priapisme intermittent chronique chez l'enfant drépanocytaire homozygote au Togo

Aim To describe clinical aspects and outcome of stuttering priapism (SP) in children with sickle cell anemia. Patients and methods We included the 8 children with sickle cell anemia suffering from SP between 1996 and 2004. Results Age at onset of SP ranged from 5 to 14 years (mean 9.75 ± 3.69 years). SP attacks occurred once a day for 6 patients, and 2 and 3 times by week for the others. It happened during deep sleep, especially in the night (all patients) and sometimes in the day (4 patients). The duration of attacks ranged from 10 min to 2 h in 6 patients and 4 to 5 h in 2 patients. Oral étilefrine was administered to all patients until the cessation of attacks, and continued during 1 month. A long remission was obtained in all patients after 7 days to 7 months treatment (follow-up 2 to 7 years) in spite of 1 or many relapses.

Foramen ovale perméable et migraine

Recent epidemiological data suggest a bidirectional link between patent foramen ovale (PFO) and migraine with aura (MA) with a relative risk of 2 for PFO in subjects with MA and for MA in subjects with PFO. There is no evidence for a link between PFO and migraine without aura. This link is not systematic and applies only to subsets of PFO, mostly large ones, and to subsets of patients with MA. Although comorbidity cannot be ruled out, it may be that this link is partly causal and that some large PFOs may favor MA attacks in genetically predisposed subjects, by allowing vasoactive substances, platelet emboli or paradoxical emboli to bypass the lung filter and trigger the cortical spreading depression of the aura. The first double blind randomised trial of PFO closure in refractory MA, "MIST", has failed to show a benefit on the primary efficacy end point: cessation of attacks during the analysis period included between 3 and 6 months after the procedure. There is thus at present no scientific reason to look for PFO or to close PFO in migraine patients.

SUNCT syndrome: estimation of cerebral blood flow velocity with transcranial Doppler ultrasonography.

Four patients with SUNCT syndrome (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) were investigated with Doppler ultrasonography. Blood flow velocity (V) was measured in all intracranial arteries during both normocapnia and voluntary hyperventilation in 4 patients outside attacks (2 during remission; 2 during bout, but outside attacks) and in 8 healthy individuals. Vasomotor reactivity (VMR) was calculated on the basis of the formula of percentage change in V divided by the reduction in end-tidal PCO2 (PETCO2). Under the basal condition, the patients had a slightly, but non-significantly higher V in the middle cerebral artery (MCA) (P > 0.1) and lower V in the basilar artery (P > 0.05) than controls. During hyperventilation, a significant reduction in V was observed in the anterior and posterior cerebral arteries, at a level 1.5-2 SD above that in controls (P < 0.05), but a non-significant difference in VMR in comparison with controls. VMCA was continuously insonated during spontaneous (n = 8) and precipitated (n = 4) attacks in one particular patient on different days. Prior to attack, VMCA was significantly lower on the symptomatic side than on the non-symptomatic side (P < 0.014). VMCA decreased significantly during spontaneous attacks on both sides (P < 0.01) in comparison with the pre-attack stage, and returned to baseline before the cessation of attack. Similar findings were made during precipitated attacks. PETCO2, was rather constant throughout the entire attack study. Our data suggest that abnormal cerebral circulation may be part of the SUNCT syndrome. The vascular changes may have underlying mechanisms differing from those of the pain.

Amiodarone in atrial fibrillation.

Twenty-seven patients with atrial fibrillation without any concomitant conduction abnormality have been treated with oral amiodarone in a daily maintenance dose of 200 mg. The drug has been used for three purposes: 1) to block atrioventricular conduction, thereby decreasing the ventricular rate during atrial fibrillation (9 patients), 2) as prophylaxis against paroxysmal atrial fibrillation (8 patients), 3) as prophylaxis against recurrence of atrial fibrillation after DC conversion to sinus rhythm (13 patients). All patients were considered refractory to other antiarrhythmic drugs in these respects. In the second group, 4 of the 8 patients reported complete cessation of attacks and the others a marked reduction of the attack rate. In the third group, 10 of the 13 patients have maintained sinus rhythm for a longer period on treatment with amiodarone than with other drugs, resulting more than a triple prolongation of the time in sinus rhythm. In 3 patients the drug has been discontinued because of side-effects. In conclusion, amiodarone affords protection from episodes of paroxysmal atrial fibrillation, as well as from recurrence of atrial fibrillation after DC conversion to sinus rhythm. If the drug is ineffective in either of these respects, it may still be useful as a means of moderating the ventricular response in atrial fibrillation.

The nature of posttraumatic epilepsy.

✓ The development, recession, and residua of posttraumatic epilepsy follow natural laws that are imperfectly defined. However, studies from World War I, World War II, the Korean conflict, and the Vietnam War demonstrate the following patterns: 1) The onset of seizures is significantly related to local brain destruction and its location, and to diffuse brain damage, reflected by alteration in consciousness. 2) The incidence of seizures has remained the same from one war to another, in spite of marked improvement in patient transport, surgical techniques, medical management, and the prophylactic use of anticonvulsants in Vietnam. 3) After injuries incurred in combat and support activities, the onset of new cases of epilepsy rises sharply, with approximately 5% having a seizure in the first week, 10% in the first 3 months, 16% in the first 6 months, 23% in the first year, 29% in the first 2 years; after that there is a low, but protracted rate of new cases of epilepsy. 4) Those cases that occur in the first week are less influenced by the agent of injury or local brain damage, thereafter there is a sharp divergence with the more extensive injuries providing the greater number of patients with seizures. 5) In the population at risk, 65% to 75% never have a seizure. In those that do, the development varies in degree, adjudged from frequency of seizures. The latter ranges from a single seizure to a number that defies an accurate count. 6) As new patients with seizures accumulate, earlier patients cease having seizures. Within 5 to 10 years, one-half of the patients have ceased having seizures, with or without therapy. Half of the remainder, about 8% of the injured, have intractable seizures. 7) While there is a clear correlation between severity of injury and onset of seizures, there is no correlation between severity of injury and cessation of attacks. However, there is a correlation between the attack frequency and persistence of seizures. 8) From the preceding, two principal determinants are evident: the constitutional tendency toward seizures (probably a multifactorial genetic trait), and the brain damage. In onset of seizures, both play a part, the constitutional factor apparently determining severity of attacks. In cessation or persistence of seizures, the constitutional factor plays the dominant role.

The Diplomacy of the WXYZ Affair

H HISTORIANS have long recognized the significance of the WXYZ affair of I797-I798. They have emphasized its important effects on domestic politics in the United States-and rightly so, for such matters as the balance between the Republican and Federalist parties, the divisions among the Federalists, the politics of the provisional army, and the passage of the Alien and Sedition acts cannot be understood apart from the WXYZ affair. Less attention has been given, however, to the diplomatic ramifications of the episode. Interest has focused on the break between the United States and France, with its threat of armed hostilities. Yet the QuasiWar did not expand into a general conflict, neutrality was preserved, and a second mission to France was soon dispatched. To explain this outcome, the inner history of the WXYZ affair must be freshly explored. President John Adams inherited a growing problem arising from French hostility to the ratification of the Jay Treaty with Great Britain in I796. By the time he assumed office French privateers had captured hundreds of American vessels in the West Indies, and the French government had expelled Charles C. Pinckney, the United States minister to France. During Adams's term the abortive negotiations conducted by the commission consisting of Pinckney, John Marshall, and Elbridge Gerry, together with the publication of the WXYZ dispatches, led to a near-rupture between the two nations. Federalists portrayed the WXYZ affair as grounds for severing French-American relations, and Republicans feared that it was. Adams, however, detected limited but solid progress toward his foreign policy aims. A close study of the WXYZ negotiations themselves will confirm Adams's judgment. The tentative, precarious diplomacy between the two republics was not fruitless. ByJuly I798 the French had dropped their bribery and loan demands, and an order had been issued calling for cessation of attacks on American vessels. Nor were the French diplomats as hostile to United States interests as many contemporary Americans and later historians concluded. The WXYZ agents and the less familiar second-line emissaries

Cessation of Attacks of Auricular Paroxysmal Tachycardia by the Use of Calcium

Excerpt The object of this paper is to report a series of five cases of auricular paroxysmal tachycardia, three of which were successfully arrested by the use of calcium intravenously. In all three...