Non-typhoid Salmonella meningitis complicated by a infarction of basal ganglia.

A previously healthy 16-month-old Korean girl with symptoms of fever, vomiting, and generalized tonic seizure was diagnosed to have Group D non-typhoid Salmonella meningitis. The patient was treated with ceftriaxone (100 mg/kg/day) and amikin (22.5 mg/kg/day) initially and ciprofloxacin (30 mg/kg/day) was added later because of clinical deterioration and disseminated intravascular coagulation. Brain CT performed on the second day showed a well-demarcated low density lesion in the right lentiform nucleus and both caudate nuclei, without evidence of increased intracranial pressure. MRI performed on the 11th day confirmed CT scan findings as well as right subdural fluid collection, brain atrophy, and ventriculomegaly. She underwent subdural drainage and later ventriculo-peritoneal shunt operation. Despite receiving intensive treatment, she still has severe neurologic sequelae. Our case shows that infarctions of basal ganglia and thalami are not specific for tuberculous meningitis and that meningitis complicated by infarction is indicative of grave prognosis.     

Vertically integrated,three-dimensional nanowire complementary metal-oxide-semiconductor circuits

Three-dimensional (3D), multi-transistor-layer, integrated circuits represent an important technological pursuit promising advantages in integration density, operation speed, and power consumption compared with 2D circuits. We report fully functional, 3D integrated complementary metal-oxide-semiconductor (CMOS) circuits based on separate interconnected layers of high-mobility n-type indium arsenide (n-InAs) and p-type germanium/silicon core/shell (p-Ge/Si) nanowire (NW) field-effect transistors (FETs). The DC voltage output (V_out) versus input (V_in) response of vertically interconnected CMOS inverters showed sharp switching at close to the ideal value of one-half the supply voltage and, moreover, exhibited substantial DC gain of ≈45. The gain and the rail-to-rail output switching are consistent with the large noise margin and minimal static power consumption of CMOS. Vertically interconnected, three-stage CMOS ring oscillators were also fabricated by using layer-1 InAs NW n-FETs and layer-2 Ge/Si NW p-FETs. Significantly, measurements of these circuits demonstrated stable, self-sustained oscillations with a maximum frequency of 108 MHz, which represents the highest-frequency integrated circuit based on chemically synthesized nanoscale materials. These results highlight the flexibility of bottom-up assembly of distinct nanoscale materials and suggest substantial promise for 3D integrated circuits.     

Perception of Osteoporosis by Belgian Women Who Work in a University Hospital

Campaigns to increase ‘awareness’ of osteoporosis have been organized. The aim of this study was to assess how Belgian women who benefit from superior conditions favoring ‘awareness’ perceive osteoporosis as being an important disease. A survey sent to the private home of all the women working in a university hospital in Brussels (n= 1154). From a list of 13 diseases the women were asked to rank, by order of importance, the five which they found to be the most important for a woman of their age. They were also asked about visits to physicians, and screening procedures. The response rate was 55.4%. A high uptake of medical visits and screening procedures was reported: 89% of the women had seen a general practitioner or a gynecologist and 81.6% had undergone at least one gynecologic examination during the previous year. Three times more women had ever undergone mammography than a bone mineral density (BMD) measurement. Overall, 18.1% reported having had a BMD measurement in the past. In women over 50 years, 61% reported having had a BMD measurement and 92.7% having had a mammogram. Osteoporosis was ranked among the five most important diseases by 19.4% of women before the age of 50 years and by 39.3% after that age, far behind breast cancer (respectively 86.3% and 77.7%) and uterine cancer (respectively 74.2% and 58.0%). Thus even among a population of women who benefit from superior conditions for information and screening, the perception of osteoporosis remains low, as does the uptake of osteoporosis screening. Received: 5 November 1998 / Accepted: 29 March 1999     

Gait and function in patients with a femoral endoprosthesis after tumor resection

We performed gait analysis in 18 patients with a femoral endoprosthesis: 12 distal, 3 proximal and 3 total. Follow-up after surgery was mean 12 (0.6-19) years. The gait parameters measured were walking velocity, step length, duration of stance phase and swing phase. Goniometry of the hip, knee and ankle in both legs was determined during free-paced walking. The functional outcome score of the Musculoskeletal Tumor Society (MSTS) and the Ambulation score were also assessed in all patients.

The mean free-paced walking velocity was 88% of normal. The step length of the uninvolved leg was longer than that of the involved one. The swing phase of the involved leg was longer than that of the uninvolved leg, and the stance phase of the involved leg was shorter than that of the uninvolved leg. Goniometry showed three abnormal patterns in the involved leg: a stiff knee gait in 10 patients, a flexed knee gait in 6, and an abnormal flexion-extension pattern in the hip in 9. Goniometry of the uninvolved leg was normal. The mean MSTS score was 22 points (72%). This showed a significant positive correlation to the Ambulation score, but no correlation to any of the temporal variables.

Our findings indicate that the time of load on the involved leg, whether conscious or not, is reduced. Follow-up studies are needed to evaluate the effects of the asymmetrical gait pattern observed and the abnormal goniometric results on the development of endoprosthesis-related complications.     

Prolonged exposure to N-methyl-D-aspartate increases intracellular and secreted somatostatin in rat cortical cells.

Somatostatin (SRIF) release from fetal rat cortical cells was stimulated by exposure to 10(-5) M N-methyl-D-aspartate (NMDA) (250 +/- 20% of basal at 96 h). A similar but much less potent effect was seen with kainate (KA) but not with quisqualate (Q) which inhibited SRIF release (KA 150 +/- 13%, Q 65 +/- 18% of basal at 96 h). Similar data were obtained for intracellular levels of SRIF. Dose-dependent experiments showed that the EC50 for the stimulatory action of NMDA was 2-3 x 10(-6) M with a Bmax of around 10(-5) M. At 10(-4) M KA and Q but not NMDA reduced tissue content and release of SRIF (KA: 47 +/- 14, 67 +/- 17%; Q: 36 +/- 13, 42 +/- 6% of basal for content and release, respectively). These findings indicate that cortical SRIF content and release is enhanced by exposure to NMDA but not by KA or Q. We suggest that SRIF-containing neurones are sensitive to glutamate damage through the activation of non-NMDA rather than NMDA receptors.     

Technetium 99m mercaptoacetyltriglycine gamma camera clearance calculations: methodological problems

Major sources of errors in the gamma-camera methods for the calculation of renal clearance are the accuracy of background correction for obtaining the true renal time-activity curve and the validity of the externally recorded pre-cordial activity as an estimate of the plasmatic time-activity curve. With technetium 99m mercaptoacetyltriglycine (^99mTc-MAG3), because of its high protein plasma binding, one could expect minimal extravascular diffusion and hence a more accurate externally detected plasmatic curve. The high extraction rate should reduce the influence of the background, but, on the other hand, the effect of hepatobiliary excretion on the calculation of renal clearance might be significant. Our results suggest that the hepatobiliary excretion of^99mTc-MAG3 does not influence the gamma-camera renal clearance determination, even in patients with low renal function. However, the pre-cordial curve does not reflect accurately the plasmatic disappearance curve; its calibration with a single plasma sample taken at the 20th min is responsible for significant errors, probably because of an unfavourable ratio between the intravascular and extravascular activities at the 20th min. Offprint requests to: M. TondeurParts of this work have been presented at the 17th Annual Meeting of the British Nuclear Medicine Society, London, in April 1989.     

Radiosurgery: a nursing perspective

The term radiosurgery, originally applied to three-dimensional stereotactic irradiation of small intracranial targets with low-energy x-rays, has more recently been applied to widely differing techniques and radiation sources. These include gamma units using cobalt-60; beams of protons, helium ions and neutrons; and modified cobalt-60 or linear accelerator units. These techniques allow delivery of a high dose of radiation in a single fraction to a small and well-defined intracranial volume, without delivering significant radiation to adjacent normal tissue. The most usual targets for radiosurgery are arteriovenous malformations. It is occasionally used for acoustic neuromas and primary or metastatic brain malignancies as well. Although radiosurgery is not a new procedure, its use is becoming more widespread. Nurses, as critical members of radiosurgery teams, must be informed about all aspects of the procedures and associated nursing care skills.