One and one-half syndrome with supranuclear facial weakness: magnetic resonance imaging localization

OBJECTIVE

To provide clinicoanatomical correlation for a small pontine tegmental ischemic stroke producing the one and one-half syndrome associated with supranuclear facial weakness.

DESIGN

Case report.

SETTING

Tertiary care center.

PATIENT

A 70-year-old man developed left-sided facial weakness sparing the forehead, a left internuclear ophthalmoplegia, and a complete left horizontal gaze palsy immediately after percutaneous transluminal coronary angioplasty. Magnetic resonance imaging demonstrated a small lesion in the left paramedian aspect of the dorsal pontine tegmentum.

MAIN OUTCOME AND RESULTS

Electromyographic findings were consistent with supranuclear facial involvement. The patient had nearly complete recovery after 1 year.

CONCLUSIONS

To our knowledge, this is the first report of supranuclear facial weakness in association with the one and one-half syndrome. The location of the lesion provides evidence of the existence of corticofugal fibers that extend to the facial nucleus in the dorsal paramedian pontine tegmentum.

Social evaluation influence on cardiovascular response to a fixed behavioral challenge: effects across a range of difficulty levels

Participants performed five memory tasks--ranging in difficulty from very low to very high--under public or private conditions. The publicity and difficulty variables interacted to determine systolic pressure and heart rate responses during performance. Where performance was public, responsiveness on the parameters increased with difficulty to a point and then dropped; where performance was private, responsiveness was relatively low at all difficulty levels. Diastolic pressure responses were configured similarly, although in that case the interaction was not reliable. Findings corroborate and extend results from a previous study, argue against some explanations of those results, and strengthen the case for a recent active coping analysis of cardiovascular audience effects. Findings also strengthen the case for a broader model of effort and cardiovascular response, which has potential for advancing our understanding of a range of phenomena and processes related to behavior and health.

Problems Associated with Crop Rotation for Management of Pratylenchus penetrans on Easter Lily

In Humboldt and Del Norte counties of California and Curry County, Oregon, Easter lilies (Lilium longiflotum) are grown commercially in a 3- to 6-year rotation with pasture for cattle and sheep. Bulbs are sold to greenhouse operations to produce flowering plants. The lesion nematode, Pratylenchus penetrans, is a serious detriment to Easter lily production. Both soil and planting stock are often infested; typically, a dual nematicide application is used consisting of a preplant soil fumigation followed by an at-planting application of an organophosphate or carbamate. Nematicide usage has resulted in ground-water contamination. Several factors that could lead to an improved crop rotation program were examined in five field trials in Oregon. Examining the relative nematode host status of crops for feeding cattle and sheep indicated differences in host suitability among clovers and fescues that could prove useful in development of pasture mixes. Populations of P. penetrans under continuous fallow and pasture were monitored for 4 years following harvest of Easter lilies. Populations fluctuated in both situations but generally increased on pasture plants and decreased under fallow. Nematodes were still detectable at the end of 4 years of weed-free fallow. Populations of P. penetrans on Easter lilies were followed over two successive crops. Numbers in soil peaked in July and then decreased while numbers within roots continued to increase until harvest in October.

Characterization of pneumococcal specific antibodies in healthy unvaccinated adults

Unlike the elderly, healthy middle aged adults are at relatively low risk of acquiring serious pneumococcal disease. An explanation that has been proposed is that people in this age group have significant amounts of serum antibody (primarily IgG2) that react with any pneumococcal capsular polysaccharide serotypes. The level of antibody can be as high as several hundred micrograms per milliliter of blood for some serotypes. A significant component of this reactivity is directed toward the conserved C-polysaccharide depletion. Even after C-polysaccharide depletion, which is included as a routine part of the assay to determine antibody levels, resting antibody levels in a normal healthy adult population can vary widely. We have analyzed the reactivity of serum from 76 people to 16 pneumococcal capsular polysaccharide serotypes. The antibody reactivities to 13 of 16 serotypes are highly correlated with one another. Depletion of serum with C-polysaccharide and purified capsular polysaccharide inhibited antibody binding to type specific capsular polysaccharide. Cross-serotype inhibition of antibody binding was also observed. This indicates that there are materials contained within the pneumococcal polysaccharides that contribute to the cross-reactivity of serum antibodies in people that have not been vaccinated with the pneumococcal vaccine.

Mycotic renal artery degeneration and systemic sepsis caused by infected renal artery stent

A case of Staphylococcus aureus renal artery stent infection was studied. Fourteen days after the procedure, the patient had a fever, hypotension, and an elevated white blood cell (WBC) count. Blood cultures were positive for S. aureus on admission and during the patient's hospitalization, despite intravenous vancomycin therapy. Evaluation included serial CT scans, revealing increasing persistent inflammation with development of multiple renal intraparenchymal abscesses, and arteriography, showing marked degeneration of the renal artery. Therapy required resection of the renal artery/stent and nephrectomy. This case confirms the severe nature of S. aureus stent infection; we recommend prophylactic antibiotics before these procedures, as well as expeditious evaluation and consideration for aggressive surgical therapy if this complication is suspected.

Erotomania after aneurysmal subarachnoid hemorrhage: case report and literature review

A woman developed the delusional syndrome of erotomania 4 years after subarachnoid hemorrhage from a ruptured basilar artery aneurysm. The authors review the literature on erotomania in association with neurologic and medical conditions. Although no cause-and-effect relationship can be established between the neurologic event and erotomania in this patient, the possible neuropsychiatric correlates of this syndrome highlight the need for careful attention to neurologic and medical factors in future cases. Available information suggests that diffuse brain dysfunction may contribute to erotomania, perhaps by interfering with the operations of cerebral regions subserving complex emotional function.

QS-21 and QS-7: purified saponin adjuvants

QS-21 and QS-7 are two adjuvant-active saponins that can be obtained in high purity from Quillaja saponaria Molina extracts. QS-21 is a highly characterized compound and is known to be a potent adjuvant for antibody and CD8+ CTL response to subunit antigens. Less is known about the activity and structure of the hydrophilic saponin QS-7. Hence, we have carried out a detailed structural and immunological characterization. As with QS-21, QS-7 was shown to be a 3,28-O-bisglycoside quillaic acid, with some differences being a higher degree of glycosylation and a considerably shorter fatty acyl unit in QS-7. These differences were correlated to a lower lytic activity against sheep red blood cells. Different doses of QS-7 were evaluated for stimulation of immune response to the antigen ovalbumin, given three times by subcutaneous route to C57BL/6 mice. QS-7 doses of 40 micrograms or higher were shown to induce a strong CD8+ CTL response reproducibly against E. G7-OVA targets (similar to that induced by a 5-10 micrograms dose of QS-21). QS-7 (at doses above 5 micrograms) was also shown to stimulate CTL against peptide 18 of HIV-1IIIB gp120 after three immunizations of Balb/c mice with recombinant gp120 and different doses of QS-7. These data suggest that a hydrophilic saponin with low lytic activity can stimulate MHC Class I CTL responses although a higher minimum dose may be required for some antigens.

Axonal spheroids in the cochlear nucleus of normal beagle dogs

In the course of drug evaluation studies, sporadic axonal spheroids were identified in the cochlear nucleus of 8-15-month-old Beagle dogs. These structures were identified by Bielschowski histochemical and anti-neurofilament immunohistochemical stains and by ultrastructural examination. No cellular reaction or significant neuropil alterations were associated with the presence of the spheroids. Their presence was unrelated to treatment and were considered to be an incidental background finding.

Funding nursing education: the Medicare dilemma. Interview by Cheryl Slagle King

Comprehensive analysis of current Medicare funding for hospital-based diploma programs is multi-factorial, and must incorporate a market of constrained costs, impending Medicare Reform and emerging opportunities for APNs. In addition, consideration must be given to fundamental issues surrounding all aspects of nursing education. APNQ interviews Dr. Carol A. Anderson and Dr. Gail Wolf who make thought-provoking points in arguments covering a spectrum of nursing issues.

Hot years and serious and deadly assault: empirical tests of the heat hypothesis

Two archival studies examined the relation between year-to-year shifts in temperature and violent and property crime rates in the United States. Study 1 examined the relation between annual average temperature and crime rate in the years 1950-1995. As expected, a positive relation between temperature and serious and deadly assault was observed, even after time series, linear year, poverty, and population age effects were statistically controlled. Property crime was unrelated to annual average temperature. Study 2 examined the relation between the average number of hot days (> or = 90 degrees F) and the size of the usual summer increase in violence for the years 1950-1995. As expected, a positive relation was observed between number of hot days and magnitude of the summer effect, even after time series and linear year effects were statistically controlled. For property crime, the summer effect was unrelated to number of hot days.

Contrast radiography in small bowel obstruction: a prospective, randomized trial

Small bowel obstruction is a common cause of acute abdominal distress, accounting for up to 20% of emergency admissions to surgical services. Although the majority of obstructions will resolve with conservative therapy alone, there are currently no reliable tests for identifying the patients who will require operation. Barium contrast studies have the potential to rapidly identify patients with complete small bowel obstruction, but many surgeons are hesitant to use them for fear of inducing complications. We report the results of a randomized, prospective trial comparing immediate oral barium contrast studies with plain abdominal X-rays in patients presenting with signs and symptoms of small bowel obstruction. End points included time to resolution of the symptoms or operation, total number of hospital days, and morbidity. Sixty-four patients completed the study; of these, 23 received contrast studies and 41 had plain radiographs only. Six of the contrast group (26%) and 11 of the plain radiograph group (27%) ultimately went to operation. Barium contrast studies had a sensitivity of 100% for diagnosing complete obstruction, whereas the sensitivity of serial plain radiographs was only 82%. Among those going to operation, the time from admission to operation was 8.2 hours in the contrast group and 12.4 hours in the plain radiograph group, but this result did not reach statistical significance (p = 0.25). Total hospital days were similar between the two groups (8 vs. 12 days, p = 0.40). There were no complications resulting from the oral administration of barium. Small bowel contrast studies using barium are safe and may shorten the time to operation in patients presenting with signs and symptoms of small bowel obstruction.