Strain control of a bandwidth-driven spin reorientation in Ca3Ru2O7

The layered-ruthenate family of materials possess an intricate interplay of structural, electronic and magnetic degrees of freedom that yields a plethora of delicately balanced ground states. This is exemplified by Ca3Ru2O7, which hosts a coupled transition in which the lattice parameters jump, the Fermi surface partially gaps and the spins undergo a 90∘ in-plane reorientation. Here, we show how the transition is driven by a lattice strain that tunes the electronic bandwidth. We apply uniaxial stress to single crystals of Ca3Ru2O7, using neutron and resonant x-ray scattering to simultaneously probe the structural and magnetic responses. These measurements demonstrate that the transition can be driven by externally induced strain, stimulating the development of a theoretical model in which an internal strain is generated self-consistently to lower the electronic energy. We understand the strain to act by modifying tilts and rotations of the RuO6 octahedra, which directly influences the nearest-neighbour hopping. Our results offer a blueprint for uncovering the driving force behind coupled phase transitions, as well as a route to controlling them.

z+: Neutron cross section separation from wide-angle uniaxial polarization analysis

We introduce a simple method to extract the nuclear coherent and isotope incoherent, spin incoherent, and magnetic neutron scattering cross section components from powder scattering data measured using a single neutron beam polarization direction and a position-sensitive detector with large out-of-plane coverage. The method draws inspiration from polarized small-angle neutron scattering and contrasts with conventional so-called "xyz" polarization analysis on wide-angle instruments, which requires measurements with three orthogonal polarization directions. The viability of the method is demonstrated on both simulated and experimental data for the classical "spin ice" system Ho₂Ti₂O₇, the latter from the LET direct geometry spectrometer at the ISIS facility. The cross section components can be reproduced with good fidelity by either fitting the out-of-plane angle dependence around a Debye-Scherrer cone or grouping the data by angle and performing a matrix inversion. The limitations of the method and its practical uses are discussed.

Magnetic-field-controlled spin fluctuations and quantum critically in Sr3Ru2O7

When the transition temperature of a continuous phase transition is tuned to absolute zero, new ordered phases and physical behaviour emerge in the vicinity of the resulting quantum critical point. Sr₃Ru₂O₇ can be tuned through quantum criticality with magnetic field at low temperature. Near its critical field B_c it displays the hallmark T-linear resistivity and a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T\,{{{{{{\mathrm{log}}}}}}}\,(1/T)$$\end{document}Tlog(1/T) electronic heat capacity behaviour of strange metals. However, these behaviours have not been related to any critical fluctuations. Here we use inelastic neutron scattering to reveal the presence of collective spin fluctuations whose relaxation time and strength show a nearly singular variation with magnetic field as B_c is approached. The large increase in the electronic heat capacity and entropy near B_c can be understood quantitatively in terms of the scattering of conduction electrons by these spin-fluctuations. On entering the spin-density-wave ordered phase present near B_c, the fluctuations become stronger suggesting that the order is stabilised through an “order-by-disorder” mechanism.

Sr₃Ru₂O₇ exhibits a quantum critical point tunable by magnetic field and has been widely used in the study of criticality. Here, by using inelastic neutron scattering, the authors measure collective magnetic excitations near the quantum critical point and relate them to thermodynamic properties and spin density wave order.

Selective probing of magnetic order on Tb and Ir sites in stuffed Tb2Ir2O7 using resonant x-ray scattering

We study the magnetic structure of the 'stuffed' (Tb-rich) pyrochlore iridate Tb_2+x Ir_2-x O_7-y (x ∼ 0.18), using resonant elastic x-ray scattering (REXS). In order to disentangle contributions from Tb and Ir magnetic sublattices, experiments were performed at the Ir L ₃ and Tb M ₅ edges, which provide selective sensitivity to Ir 5d and Tb 4f  magnetic moments, respectively. At the Ir L ₃ edge, we found the onset of long-range [Formula: see text] magnetic order below [Formula: see text] K, consistent with the expected signal of all-in all-out (AIAO) magnetic order. Using a single-ion model to calculate REXS cross-sections, we estimate an ordered magnetic moment of [Formula: see text] at 5 K. At the Tb M ₅ edge, long-range [Formula: see text] magnetic order appeared below  ∼[Formula: see text] K, also consistent with an AIAO magnetic structure on the Tb site. Additional insight into the magnetism of the Tb sublattice is gleaned from measurements at the M ₅ edge in applied magnetic fields up to 6 T, which is found to completely suppress the Tb AIAO magnetic order. In zero applied field, the observed gradual onset of the Tb sublattice magnetisation with temperature suggests that it is induced by the magnetic order on the Ir site. The persistence of AIAO magnetic order, despite the greatly reduced ordering temperature and moment size compared to stoichiometric Tb₂Ir₂O₇, for which [Formula: see text] K and [Formula: see text], indicates that stuffing could be a viable means of tuning the strength of electronic correlations, thereby potentially offering a new strategy to achieve topologically non-trivial band crossings in pyrochlore iridates.

Critical fluctuations in the spin-orbit Mott insulator Sr3Ir2O7

X-ray magnetic critical scattering measurements and specific heat measurements were performed on the perovskite iridate [Formula: see text]. We find that the magnetic interactions close to the Néel temperature [Formula: see text] are three-dimensional. This contrasts with previous studies which suggest two-dimensional behaviour like Sr₂IrO₄. Violation of the Harris criterion ([Formula: see text]) means that weak disorder becomes relevant. This leads a rounding of the antiferromagnetic phase transition at [Formula: see text], and modifies the critical exponents relative to the clean system. Specifically, we determine that the critical behaviour of [Formula: see text] is representative of the diluted 3D Ising universality class.

Multiple Metamagnetic Quantum Criticality in Sr_{3}Ru_{2}O_{7}

Bilayer strontium ruthenate Sr_{3}Ru_{2}O_{7} displays pronounced non-Fermi liquid behavior at magnetic fields around 8 T, applied perpendicular to the ruthenate planes, which previously has been associated with an itinerant metamagnetic quantum critical end point (QCEP). We focus on the magnetic Grüneisen parameter Γ_{H}, which is the most direct probe to characterize field-induced quantum criticality. We confirm quantum critical scaling due to a putative two-dimensional QCEP near 7.845(5) T, which is masked by two ordered phases A and B, identified previously by neutron scattering. In addition, we find evidence for a QCEP at 7.53(2) T and determine the quantum critical regimes of both instabilities and the effect of their superposition.

Collapse of the Mott Gap and Emergence of a Nodal Liquid in Lightly Doped Sr(2)IrO(4)

We report angle resolved photoemission experiments on the electron doped Heisenberg antiferromagnet (Sr(1-x)La(x))(2)IrO(4). For a doping level of x=0.05, we find an unusual metallic state with coherent nodal excitations and an antinodal pseudogap bearing strong similarities with underdoped cuprates. This state emerges from a rapid collapse of the Mott gap with doping resulting in a large underlying Fermi surface that is backfolded by a (π,π) reciprocal lattice vector which we attribute to the intrinsic structural distortion of Sr(2)IrO(4).

Field-tunable spin-density-wave phases in Sr3Ru2O7

The conduction electrons in a metal experience competing interactions with each other and the atomic nuclei. This competition can lead to many types of magnetic order in metals. For example, in chromium the electrons order to form a spin-density-wave (SDW) antiferromagnetic state. A magnetic field may be used to perturb or tune materials with delicately balanced electronic interactions. Here, we show that the application of a magnetic field can induce SDW magnetic order in a quasi-2D metamagnetic metal, where none exists in the absence of the field. We use magnetic neutron scattering to show that the application of a large (B ≈ 8 T) magnetic field to the perovskite metal Sr3Ru2O7 (refs 3-7) can be used to tune the material through two magnetically ordered SDW states. The ordered states exist over relatively small ranges in field (≲0.4 T), suggesting that their origin is due to a new mechanism related to the electronic fine structure near the Fermi energy, possibly combined with the stabilizing effect of magnetic fluctuations. The magnetic field direction is shown to control the SDW domain populations, which naturally explains the strong resistivity anisotropy or 'electronic nematic' behaviour observed in this material.

Coherent quasiparticles with a small fermi surface in lightly doped Sr(3)Ir(2)O(7)

We characterize the electron doping evolution of (Sr_{1-x}La_{x})_{3}Ir_{2}O_{7} by means of angle-resolved photoemission. Concomitant with the metal insulator transition around x≈0.05 we find the emergence of coherent quasiparticle states forming a closed small Fermi surface of volume 3x/2, where x is the independently measured La concentration. The quasiparticle weight Z remains large along the entire Fermi surface, consistent with the moderate renormalization of the low-energy dispersion, and no pseudogap is observed. This indicates a conventional, weakly correlated Fermi liquid state with a momentum independent residue Z≈0.5 in lightly doped Sr_{3}Ir_{2}O_{7}.

Spin-wave spectrum of the quantum ferromagnet on the pyrochlore lattice Lu2V2O7

Neutron inelastic scattering has been used to probe the spin dynamics of the quantum (S=1/2) ferromagnet on the pyrochlore lattice Lu(2)V(2)O(7). Well-defined spin waves are observed at all energies and wave vectors, allowing us to determine the parameters of the Hamiltonian of the system. The data are found to be in excellent overall agreement with a minimal model that includes a nearest-neighbor Heisenberg exchange J = 8.22(2) meV and a Dzyaloshinskii-Moriya interaction (DMI) D = 1.5(1) meV. The large DMI term revealed by our study is broadly consistent with the model originally used to explain the magnon Hall effect in this compound [Onose et al., Science 329, 297 (2010) and Ideue et al., Phys. Rev. B 85, 134411 (2012)]. However, our ratio of D/J = 0.18(1) is roughly half of their value, and is much larger than those found in other theoretical studies [Xiang et al., Phys. Rev. B 83, 174402 (2011) and Mook et al., Phys. Rev. B 89,134409 (2014)].

Locking of iridium magnetic moments to the correlated rotation of oxygen octahedra in Sr₂IrO₄ revealed by x-ray resonant scattering

Sr2IrO4 is a prototype of the class of Mott insulators in the strong spin-orbit interaction (SOI) limit described by a Jeff = 1/2 ground state. In Sr2IrO4, the strong SOI is predicted to manifest itself in the locking of the canting of the magnetic moments to the correlated rotation by 11.8(1)° of the oxygen octahedra that characterizes its distorted layered perovskite structure. Using x-ray resonant scattering at the Ir L3 edge we have measured accurately the intensities of Bragg peaks arising from different components of the magnetic structure. From a careful comparison of integrated intensities of peaks due to basal-plane antiferromagnetism, with those due to b-axis ferromagnetism, we deduce a canting of the magnetic moments of 12.2(8)°. We thus confirm that in Sr2IrO4 the magnetic moments rigidly follow the rotation of the oxygen octahedra, indicating that, even in the presence of significant non-cubic structural distortions, it is a close realization of the Jeff = 1/2 state.

Robustness of basal-plane antiferromagnetic order and the J(eff)=1/2 state in single-layer iridate spin-orbit Mott insulators

The magnetic structure and electronic ground state of the layered perovskite Ba(2)IrO(4) have been investigated using x-ray resonant magnetic scattering. Our results are compared with those for Sr(2)IrO(4), for which we provide supplementary data on its magnetic structure. We find that the dominant, long-range antiferromagnetic order is remarkably similar in the two compounds and that the electronic ground state in Ba(2)IrO(4), deduced from an investigation of the x-ray resonant magnetic scattering L(3)/L(2) intensity ratio, is consistent with a J(eff)=1/2 description. The robustness of these two key electronic properties to the considerable structural differences between the Ba and Sr analogues is discussed in terms of the enhanced role of the spin-orbit interaction in 5d transition metal oxides.

Similarity of scattering rates in metals showing T-linear resistivity

Many exotic compounds, such as cuprate superconductors and heavy fermion materials, exhibit a linear in temperature (T) resistivity, the origin of which is not well understood. We found that the resistivity of the quantum critical metal Sr(3)Ru(2)O(7) is also T-linear at the critical magnetic field of 7.9 T. Using the precise existing data for the Fermi surface topography and quasiparticle velocities of Sr(3)Ru(2)O(7), we show that in the region of the T-linear resistivity, the scattering rate per kelvin is well approximated by the ratio of the Boltzmann constant to the Planck constant divided by 2π. Extending the analysis to a number of other materials reveals similar results in the T-linear region, in spite of large differences in the microscopic origins of the scattering.

Symmetry-breaking lattice distortion in Sr₃Ru₂O₇

The electronic nematic phase of Sr₃Ru₂O₇ is investigated by high-resolution in-plane thermal expansion measurements in magnetic fields close to 8 T applied at various angles Θ off the c axis. At Θ < 10° we observe a very small (10⁻⁷) lattice distortion which breaks the fourfold in-plane symmetry, resulting in nematic domains with interchanged a and b axis. At Θ ≳ 10° the domains are almost fully aligned and thermal expansion indicates an area-preserving lattice distortion of order 2 × 10⁻⁶ which is likely related to orbital ordering. Since the system is located in the immediate vicinity of a metamagnetic quantum critical end point, the results represent the first observation of a structural relaxation driven by quantum criticality.

Quantum oscillations in the anomalous phase in Sr3Ru2O7

We report measurements of quantum oscillations detected in the putative nematic phase of Sr3Ru2O7. Improvements in sample purity enabled the resolution of small amplitude de Haas-van Alphen (dHvA) oscillations between two first order metamagnetic transitions delimiting the phase. Two distinct frequencies were observed, whose amplitudes follow the normal Lifshitz-Kosevich profile. Variations of the dHvA frequencies are explained in terms of a chemical potential shift produced by reaching a peak in the density of states, and an anomalous field dependence of the oscillatory amplitude provides information on domains.

Fermi surface and van Hove singularities in the itinerant Metamagnet Sr3Ru2O7

The low-energy electronic structure of the itinerant metamagnet Sr3Ru2O7 is investigated by angle-resolved photoemission and density-functional calculations. We find well-defined quasiparticle bands with resolution-limited linewidths and Fermi velocities up to an order of magnitude lower than in single layer Sr2RuO4. The complete topography, the cyclotron masses, and the orbital character of the Fermi surface are determined, in agreement with bulk sensitive de Haas-van Alphen measurements. An analysis of the dxy band dispersion reveals a complex density of states with van Hove singularities near the Fermi level, a situation which is favorable for magnetic instabilities.

Formation of a Nematic Fluid at High Fields in Sr3Ru2O7

In principle, a complex assembly of strongly interacting electrons can self-organize into a wide variety of collective states, but relatively few such states have been identified in practice. We report that, in the close vicinity of a metamagnetic quantum critical point, high-purity strontium ruthenate Sr3Ru2O7 possesses a large magnetoresistive anisotropy, consistent with the existence of an electronic nematic fluid. We discuss a striking phenomenological similarity between our observations and those made in high-purity two-dimensional electron fluids in gallium arsenide devices.

Thermal conductivity in the vicinity of the quantum critical end point in Sr3Ru2O7

Thermal conductivity of Sr3Ru2O7 was measured down to 40 mK and at magnetic fields through the quantum critical end point at Hc=7.85 T. A peak in the electrical resistivity as a function of the field was mimicked by the thermal resistivity. In the limit as T-->0 K, we find that the Wiedemann-Franz law is satisfied to within 5% at all fields, implying that there is no breakdown of the electron despite the destruction of the Fermi liquid state at quantum criticality. A significant change in disorder [from rho0(H=0 T)=2.1 to 0.5 microOmega cm] does not influence our conclusions. At finite temperatures, the temperature dependence of the Lorenz number is consistent with ferromagnetic fluctuations causing the non-Fermi liquid behavior as one would expect at a metamagnetic quantum critical end point.

Fermi surface and quasiparticle excitations of Sr2RhO4

The electronic structure of the layered 4d transition metal oxide Sr2RhO4 is investigated by angle resolved photoemission. We find well-defined quasiparticle excitations with a highly anisotropic dispersion, suggesting a quasi-two-dimensional Fermi-liquid-like ground state. Markedly different from the isostructural Sr2RuO4, only two bands with dominant Rh 4dxz,zy character contribute to the Fermi surface. A quantitative analysis of the photoemission quasiparticle band structure is in excellent agreement with bulk data. In contrast, it is found that state-of-the-art density functional calculations in the local density approximation differ significantly from the experimental findings.

Metamagnetic quantum criticality in Sr3Ru2O7 studied by thermal expansion

We report low-temperature thermal expansion measurements on the bilayer ruthenate Sr3Ru2O7 as a function of magnetic field applied perpendicular to the ruthenium-oxide planes. The field dependence of the c-axis expansion coefficient indicates the accumulation of entropy close to 8 T, related to an underlying quantum critical point. The latter is masked by two first-order metamagnetic transitions which bound a regime of enhanced entropy. Outside this region the singular thermal expansion behavior is compatible with the predictions of the itinerant theory for a two-dimensional metamagnetic quantum critical end point.

Nested fermi surface and electronic instability in Ca3Ru2O7

High-resolution angular resolved photoemission data reveal well-defined quasiparticle bands of unusually low weight, emerging in line with the metallic phase of Ca(3)Ru(2)O(7) below approximately 30 K . At the bulk structural phase transition temperature of 48 K, we find clear evidence for an electronic instability, gapping large parts of the underlying Fermi surface that appears to be nested. Metallic pockets are found to survive in the small, non-nested sections, constituting a low-temperature Fermi surface with 2 orders of magnitude smaller volume than in all other metallic ruthenates. The Fermi velocities and volumes of these pockets are in agreement with the results of complementary quantum oscillation measurements on the same crystal batches.

Metamagnetic quantum criticality revealed by 17O-NMR in the itinerant metamagnet Sr3Ru2O7

We have investigated the spin dynamics using 17O-NMR in the bilayered perovskite Sr3Ru2O7, which sits close to a metamagnetic quantum critical point. The nuclear spin-lattice relaxation rate divided by temperature 1/T1T is enhanced on approaching the metamagnetic critical field of approximately 7.9 T, and at the critical field 1/T1T continues to increase and does not show Fermi-liquid behavior down to 0.3 K. The temperature dependence of T1T in this region suggests the critical temperature Theta to be approximately 0 K, which is strong evidence that the spin dynamics possesses a quantum critical character. Comparison between uniform susceptibility and 1/T1T reveals that antiferromagnetic fluctuations instead of two-dimensional ferromagnetic fluctuations dominate the spin fluctuation spectrum at the critical field, which is unexpected for itinerant metamagnetism.

Phase bifurcation and quantum fluctuations in Sr3Ru2O7

The bilayer ruthenate Sr3Ru2O7 has been cited as a textbook example of itinerant metamagnetic quantum criticality. However, recent studies of the ultrapure system have revealed striking anomalies in magnetism and transport in the vicinity of the quantum critical point. Drawing on fresh experimental data, we show that the complex phase behavior reported here can be fully accommodated within the framework of a simple Landau theory. We discuss the potential physical mechanisms that underpin the phenomenology, and assess the capacity of the ruthenate system to realize quantum tricritial behavior.

Disorder-Sensitive Phase Formation Linked to Metamagnetic Quantum Criticality

Condensed systems of strongly interacting electrons are ideal for the study of quantum complexity. It has become possible to promote the formation of new quantum phases by explicitly tuning systems toward special low-temperature quantum critical points. So far, the clearest examples have been appearances of superconductivity near pressure-tuned antiferromagnetic quantum critical points. We present experimental evidence for the formation of a nonsuperconducting phase in the vicinity of a magnetic field-tuned quantum critical point in ultrapure crystals of the ruthenate metal Sr3Ru2O7, and we discuss the possibility that the observed phase is due to a spin-dependent symmetry-breaking Fermi surface distortion.

de Haas-van Alphen effect across the metamagnetic transition in Sr3Ru2O7

We report a study of the de Haas-van Alphen (dHvA) effect on the itinerant metamagnet Sr3Ru2O7. Extremely high sample purity allows the observation of dHvA oscillations both above and below the metamagnetic transition field of 7.9 T. The quasiparticle masses are fairly large away from the transition, and are enhanced by up to an extra factor of 3 as the transition is approached, but the Fermi surface topography change is quite small. The results are qualitatively consistent with a field-induced Stoner transition in which the mass enhancement is the result of critical fluctuations.

Multiple first-order metamagnetic transitions and quantum oscillations in ultrapure Sr3Ru2O7

We present measurements on ultraclean single crystals of the bilayered ruthenate metal Sr3Ru2O7, which has a magnetic-field-tuned quantum critical point. Quantum oscillations of differing frequencies can be seen in the resistivity both below and above its metamagnetic transition. This frequency shift corresponds to a small change in the Fermi surface volume that is qualitatively consistent with the small moment change in the magnetization across the metamagnetic transition. Very near the metamagnetic field, unusual behavior is seen. There is a strong enhancement of the resistivity in a narrow field window, with a minimum in the resistivity as a function of temperature below 1 K that becomes more pronounced as the disorder level decreases. The region of anomalous behavior is bounded at low temperatures by two first-order phase transitions. The implications of the results are discussed.

Sensitivity to disorder of the metallic state in the ruthenates

We report the results of transport measurements on SrRuO3, Sr3Ru2O7, and CaRuO3. In SrRuO3 and Sr3Ru2O7, our findings are consistent with the predictions of Fermi liquid theory, in contrast to previous reports based on samples with much shorter mean free paths. In CaRuO3, however, a T1.5 power law is seen in the resistivity in the high purity samples studied here. Our work gives concrete evidence that even the metallic state of the ruthenates is highly sensitive to disorder.

Magnetic field-tuned quantum criticality in the metallic ruthenate Sr3Ru2O7

The concept of quantum criticality is proving to be central to attempts to understand the physics of strongly correlated electrons. Here, we argue that observations on the itinerant metamagnet Sr3Ru2O7 represent good evidence for a new class of quantum critical point, arising when the critical end point terminating a line of first-order transitions is depressed toward zero temperature. This is of interest both in its own right and because of the convenience of having a quantum critical point for which the tuning parameter is the magnetic field. The relationship between the resultant critical fluctuations and novel behavior very near the critical field is discussed.

Metamagnetism and critical fluctuations in high quality single crystals of the bilayer ruthenate Sr3Ru2O7

We report the results of low temperature transport, specific heat, and magnetization measurements on high quality single crystals of the bilayer perovskite Sr3Ru2O7, which is a close relative of the unconventional superconductor Sr2RuO4. Metamagnetism is observed, and transport and thermodynamic evidence for associated critical fluctuations is presented. These relatively unusual fluctuations might be pictured as variations in the Fermi surface topography itself.

Basic cardiac electrophysiology and mechanisms of antiarrhythmic agents

Basic cardiac electrophysiology and how it applies to antiarrhythmic drug therapy are reviewed. Normal impulse propagation through the heart proceeds in sequence from the sinoatrial (SA) node, through the atrial specialized conducting system, the atrioventricular (AV) node, the His-Pur-kinje system, and into the ventricles. The cardiac cell maintains a resting membrane potential until an electrical stimulus depolarizes the cell and generates an action potential. The action potential is composed of five phases that represent the changing ionic fluxes and membrane potentials of the cardiac cell. The heart contains two types of cardiac conducting fibers. The fast- and slow-current action potentials generated by these fiber types exhibit distinctly different electrophysiologic properties. Cardiac arrhythmias generally result from an abnormality in the rate, rhythm, or conduction of an electrical impulse in the heart. They may be described as disturbances in normal impulse initiation (automaticity), impulse conduction, or both. Various portions of the conduction system are under the control of the autonomic nervous system, which depends on the balance between the activity of the parasympathetic and sympathetic nervous systems. Intracellular and extracellular concentrations of potassium, calcium, and magnesium have important effects on the electrophysiology of the heart. These changes can be critical in the production of various arrhythmias or may affect the efficacy or toxicity of various antiarrhythmic agents. The electrophysiology of quinidine, procainamide, disopyramide, lidocaine, tocainide, phenytoin, flecainide, amiodarone, and bretylium tosylate is discussed to detail the relationship between drug action and antiarrhythmic efficacy. The electrophysiologic effects of beta-blocking agents and calcium-channel antagonists are also presented. This basic primer on cardiac electrophysiology should provide the practitioner with an improved understanding of the effects, indications, and limitations of antiarrhythmic drugs.

Contemporary recommendations for evaluating and treating hyperlipidemia

The biochemistry, etiology, and evaluation of hyperlipidemia and its management, including dietary and drug therapies, are discussed. Strong evidence supports the role of increased cholesterol concentrations as an independent risk factor for coronary artery disease (CAD); however, evidence that elevated triglyceride concentrations are also an independent risk factor remains questionable. The cornerstone of the laboratory diagnosis of hyperlipidemia involves repeated measurement of serum or plasma cholesterol and triglyceride concentrations. The goals of therapy should be to reduce cholesterol or triglyceride concentrations or both to below the 75th percentile, modify co-existing risk factors, individualize the treatment, and minimize any adverse effects. Specific interventions must be determined on the basis of patient age, gender, etiology of hyperlipidemia, presence of other risk factors, and degree of lipid abnormality. The majority of patients may be managed with dietary therapy alone. The three-phase diet developed by the American Heart Association emphasizes a gradual reduction in cholesterol and fats with the substitution of polyunsaturated for saturated fats. Patients at risk for CAD with sustained elevations in plasma cholesterol concentrations above the 95th percentile or a triglyceride concentration above 500 mg/dL after an adequate dietary trial should be considered for drug therapy. The effects of cholestyramine and colestipol hydrochloride, niacin, dextrothyroxine, clofibrate, neomycin sulfate, probucol, gemfibrozil, and mevinolin and compactin on lipids and lipoproteins are reviewed. Hyperlipidemia should be managed systematically using information about the association between increased lipid concentrations and CAD, patient risk factors, and limitations of both diet and drug therapy.

Recognition and management of acute suppurative parotitis

Acute suppurative parotitis (ASP) is a rare infectious process occurring after surgery or in debilitated patients. This case describes a 41-year-old man who was hospitalized initially for acute bacterial endocarditis. Late in the hospital course his recovery was complicated by the development of ASP. Subsequent cultures of blood and parotid-fluid samples grew Pseudomonas aeruginosa. Despite early empiric antibiotic therapy followed by more specific therapy with an aminoglycoside, the patient continued to experience severe pain, swelling, and facial-nerve palsy. Surgical incision and drainage of the parotid gland was accomplished on the ninth day after onset of ASP, and the patient experienced a rapid resolution of the disease process. Acute suppurative parotitis was originally attributed to infection with gram-positive organisms, primarily Staphylococcus aureus and Streptococcus species. More recently, reports of ASP caused by gram-negative and anaerobic bacteria have been published. This review describes the etiology, pathogenesis, microbiology, and clinical features of ASP. Nonpharmacologic, pharmacologic, and surgical management of the disease is discussed. Although ASP is a rare occurrence in the hospital setting, early recognition and appropriate management are important in avoiding serious morbidity and mortality.

Management of maldigestion associated with pancreatic insufficiency

The etiology, pathophysiology, clinical presentation, dietary management, and drug therapy of maldigestion associated with pancreatic insufficiency are reviewed. Maldigestion can occur in a number of conditions that lead to pancreatic insufficiency but is seen most frequently in patients with alcohol-related chronic pancreatitis or cystic fibrosis. Destruction of pancreatic tissue and obstruction of the ducts that lead into the small intestine prevent pancreatic secretions from reaching the small intestine and result in weight loss, anorexia, abdominal distention, and changes in the appearance and frequency of stools. The goal of dietary intervention in patients with maldigestion is to provide sufficient calories and protein to maintain weight while limiting fat intake to an amount tht the patient can tolerate. Medium-chain triglycerides can be substituted for dietary fat in patients whose symptoms continue despite dietary fat restriction. Drug therapy involves supplementing deficient pancreatic enzymes with pancreatin or pancrelipase. Regimens must be individualized for each patient because of problems with gastric inactivation of orally administered enzymes, lack of standardization of commercially available preparations, and large interpatient variation in response. In selecting an enzyme supplement preparation, the amount of available enzyme activity, dosage form, number of dosage units needed per dose, dosage schedule, and product cost must be considered. When enzyme supplementation alone does not adequately control the symptoms of maldigestion, a histamine H2-receptor antagonist or antacids may be added to the therapeutic regimen. Although complete resolution of the symptoms of maldigestion is difficult to achieve, a regimen of dietary modification and pancreatic-enzyme replacement can improve patients' quality of life.

Characterization, distribution, and significance ofMetallogenium in Lake Washington

During summer stratification,Metallogenium personatun was found exclusively in the hypolimnion of Lake Washington where the oxygen tension was below 8 ppm. Numbers of the organism decreased in the lake immediately following turnover in October. Significant concentrations ofMetallogenium microcolonies did not recur until spring, after the lake had stratified. During stratification the distribution of particulate manganese closely followed the distribution ofMetallogenium. EDAX analysis, confirmed by electron microprobe analyses of the encrustation, showed that the primary component was manganese. Iron and some trace elements were also precipitated on the organism but to a lesser degree. In addition, phosphate, the primary substance limiting phytoplankton growth in Lake Washington, was found in the encrustation, indicatingMetallogenium maybe important in limiting algal blooms in the lake. Attempts to growMetallogenium in the laboratory were unsuccessful. This inability, combined with the negative results of thin-sectioning and acridine orange staining ofMetallogenium microcolonies, suggests that the microcolonial structures seen in Lake Washington are not a living form of an organism.

Mechanisms for differential block among single myelinated and non-myelinated axons by procaine

1. The differential sensitivity of saphenous nerve fibres in the cat to block by procaine HCl was re-examined by recording identifiable unit action potentials from small nerve filaments.2. Small myelinated axons were blocked more quickly than large myelinated axons, but this differential effect could not be accounted for by differences in anaesthetic concentration requirements.3. The onset of block in non-myelinated axons was slower than or equal to that of small myelinated axons depending on anaesthetic concentration.4. Absolute differential block of non-myelinated and small myelinated axons was obtained by limiting the length of axons exposed to procaine to 2 mm.5. Differential rates of blocking among myelinated axons appear to depend on differences in the length of axons that must be exposed to blocking concentrations of procaine and to arise from the irregular distribution of such concentrations within an exposed nerve.