Landau-Kleffner syndrome. Treatment with subpial intracortical transection

Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia occurring in childhood and associated with a generally poor prognosis for recovery of speech. It is thought to be the result of an epileptogenic lesion arising in speech cortex during a critical period of development. Utilizing a new surgical technique designed to eliminate the capacity of cortical tissue to generate seizures while preserving the normal cortical physiological function, we have treated 14 children with aphasia, seizures and a severely abnormal EEG by multiple subpial transection of the epileptogenic cortex. Seven of the 14 patients (50%) have recovered age-appropriate speech, are in regular classes in school and no longer require speech therapy. Four of the 14 (29%) have shown marked improvement, are speaking and understanding verbal instruction but are still receiving speech therapy. Thus, 11 of the 14 (79%), none of whom had used language to communicate for at least 2 years, are now speaking--a rate of sustained improvement considered unusual in this disorder. This study documents the value of a treatment modality not previously used in LKS. Success depends on selection of cases having severe epileptogenic abnormality that can be demonstrated to be unilateral in origin despite a bilateral electrographic manifestation.

East and west of main street: racism in rural America

This article describes the presence in three rural communities of racism uncovered during recent community-analysis projects. The roots of racism are viewed and analyzed from three theoretical perspectives. Based upon theoretical concepts, intervention strategies are described, and suggested methods of implementation are offered that can guide the community health nurse in the legitimation and empowerment of the various oppressed groups in the communities served.

An integrative review and meta-analysis of oncology nursing research: 1981-1990

The systematic accumulation of widely scattered research results is essential to developing a scientific basis for clinical practice. The purposes of this study were to describe 10 years of patient-related oncology nursing research in the United States, assess effectiveness of interventions, and test a prototype for research synthesis projects. Using a nursing framework and strategies of integrative research review and meta-analysis, 428 studies were selected for the study. The studies were found to be predominantly descriptive (90%), with convenience samples (79%), and a median sample size of 48. Subjects were predominantly in treatment or rehabilitation (52%), with demographic and stage of disease characteristics largely unreported. Of the 428 studies, 42 met the criteria for meta-analytic treatment. Interventions were found to be significantly effective, with membership in the intervention group improving success rate by 22%. The prototype was judged highly for adherence to standards and usefulness for adaptation to other research syntheses. Because of wide diversity in topics studied, missing information on subjects, and lack of replication, implications for research-based practice are premature at this time. Recommendations for future research include new studies, replications, and new research syntheses with an international scope for nurses studying and providing cancer care.

Growth patterns in selected organs of the miniature swine as determined by gross macromolecular composition

As part of a larger study designed to characterize the early developmental stages of the Hormel-Hanford strain miniature pig, the brain, kidney, liver, pancreas, and spleen from male animals were examined for changes in RNA, DNA, and protein contents from 1 to 196 d after birth. Distinct patterns were found for changes with age in macromolecular levels. Protein levels increased from d 1 to 56 in all organs except spleen, in which little change was noted. Gel electrophoresis showed little qualitative change in the liver protein profile during this period. A fat-free, non-nucleic acid, protein-containing fraction, insoluble in hot alkali, appeared in the brain after approximately 1 wk following birth. DNA concentrations decreased markedly from d 1 to d 196 for brain, kidney, and spleen but decreased more gradually for liver and pancreas. RNA levels declined slightly or remained the same in all organs except pancreas, where a large increase occurred from d 1 to weaning (56 d). Growth proceeded in all organs by increases in cell number (hyperplasia), as evidenced by increases in total (level or concentration x organ weight) DNA, or by hypertrophy, as evidenced by increases in the ratio of protein to DNA or by a combination of both processes. Hypertrophic growth was attained by d 56 and continued to sexual maturity in all organs except spleen. Hyperplastic growth continued to sexual maturity in all organs except brain.

Control of lytic development in the Streptomyces temperate phage phi C31

The repressor gene, c, is required for maintenance of lysogeny in the Streptomyces phage phi C31. The c gene expresses three in-frame N-terminally different protein isoforms at least one of which is thought to bind to a 17bp highly conserved inverted repeat (CIR) sequence found at 18 (or more) loci throughout the phi C31 genome. Here we present evidence that one of these loci, CIR6, and its interaction with the products of the repressor gene are critical in the control of the lytic pathway in phi C31. To the right of CIR6, according to the standard map of phi C31, an 'immediate-early' promoter, ap1, was discovered after insertion of a fragment containing CIR6 upstream of a promoterless kanamycin-resistance gene, aphII, to form pCIA2. pCIA2 conferred kanamycin resistance upon Streptomyces coelicolor A3(2) but not upon a phi C31 lysogen of S. coelicolor. Operator-constitutive (Oc) mutants of pCIA2 were isolated and the mutations lay in CIR6, i.e. CIR6:G14T and CIR6:C2A. Primer extension analysis of RNA prepared from an induced, temperature-sensitive lysogen of S. coelicolor localized a mRNA 5' endpoint 21 bp to the right of CIR6. The importance of the ap1/CIR6 region in the regulation of lytic growth was demonstrated by the analysis of a virulent mutant, phi C31 vir1, capable of forming plaques on an S. coelicolor phi C31 lysogen. phi C31vir1 contained a DNA inversion with the breakpoints lying within the integrase gene (which lies approximately 7 kbp to the right of CIR6) and in the essential early region between CIR6 and the -10 sequence for ap1. The separation of ap1 from its operator was thought to be the basis for the virulent phenotype in phi C31 vir1. Band-shift assays and DNase I footprinting experiments using purified 42 kDa repressor isoform confirmed that CIRs 5 and 6 were indeed the targets for binding of this protein. The 42 kDa repressor bound to CIR6 with higher affinity than to CIR5 in spite of their identical core sequences. Repressor bound at CIR6 facilitated binding at CIR5. The high-affinity binding to CIR6 was abolished with the Oc mutant, CIR6:G14T. Hydroxyl radical footprinting and dimethyl sulphate methylation protection of the 42 kDa repressor-CIR6 interaction suggested that the protein bound in the major groove and to one face of the DNA.

Effect of binge eating on the prediction of weight loss in obese women

Factors that may be associated with successful weight loss in the obese are of clinical and theoretical significance. Although perceived behavioral control (PBC) had been shown to predict weight loss in a nonclinical population, it had not been used to predict weight loss in the obese. We studied obese women enrolled in a 15-week structured weight loss program and hypothesized that PBC would predict weight loss for low binge eaters better than for high binge eaters. Results indicated that the ability of PBC to predict weight loss immediately posttreatment and 6 months posttreatment depended on binge eating severity, whereas prediction of group attendance was independent of binge eating status.

Fragmentation of the neuronal cytoskeleton in the Lewy body variant of Alzheimer's disease

We studied neuronal alterations in the Lewy body variant of Alzheimer's disease (LBV) with a monoclonal antibody (SMI32) against non-phosphorylated neurofilament proteins, and compared them with the alterations found in pure Alzheimer's disease (AD). A characteristic granular and fragmented appearance of SMI32-immunolabeled pyramidal neurons in layers 3 and 5 of the neocortex occurred in 78% of the LBV cases and was not found in the pure AD cases. Lewy bodies (LBs) in pyramidal neurons in layers 5 and 6 immunoreacted with SMI32 in 44% of the LBV cases. These alterations may be associated with the cognitive deficits found in LBV and are suggestive of an underlying, widespread pathology that includes both disruption of the neurofilamentous cytoskeleton and formation of LBs.

Rho-independent terminators without 3' poly-U tails from the early region of actinophage øC31

Previous work has identified three intergenic regions from the early region of actinophage øC31 where transcription was either terminated or the mRNA was processed. Here we show using in vivo and in vitro approaches that these regions contain rho-independent terminators designated eta, etb and etc. Transcripts through eta-c would be expected to form stable RNA stem-loops but would lack poly-U tails. Eta-c contained part or all of the conserved sequences 5' AGCCCC and 5' GGGGCTT. A Streptomyces 'terminator probe' vector, pUGT1, was constructed and used to assay the efficiency of termination of transcription by eta-c from the thiostrepton-inducible tipA promoter by measuring the expression of a downstream reporter gene (aphII). In pUGT1 etb was at best a minor terminator in vivo whilst eta and etc exhibited strong termination activity. In vitro termination was assayed using templates containing a synthetic promoter recognised by E.coli RNA polymerase and fragments containing eta-c inserted downstream. All three terminators stimulated the formation of 3' ends in the promoter-distal arm of the inverted repeats with efficiencies eta > etc > etb. As all three terminators either overlap with or lie close to sequences which interact with phage repressor proteins (conserved inverted repeats, CIRs) and these can potentially form stem-loop structures in RNA, the effect of CIRs on termination was also investigated. Termination at etb was unaffected by the presence or absence on the transcription template of CIR3. CIR4 forms the central 17 bp of etc and a 37 nt deletion which eliminated this stem-loop abolished termination in vivo and in vitro. Eta was investigated using an antisense oligonucleotide interference assay; an oligo designed to bind the 5' arm of eta inhibited termination whilst an oligo antisense to CIR5 was ineffective and an oligo targeted further upstream enhanced termination. Taken together these data show that eta-c are intrinsic, rho-independent terminators of varying efficiencies despite the absence of a poly-U tail.

Tailored anterior temporal lobectomy. Relation between extent of resection of mesial structures and postsurgical seizure outcome

OBJECTIVE

The purpose of this study was to assess the relationship between the extent of resection of mesial temporal structures and postsurgical seizure outcome in a group of patients who had undergone a tailored anterior temporal lobectomy.

METHODS

Twenty-four patients with unilateral interictal and ictal foci restricted to anterior/mesial temporal regions underwent resection of mesial and temporal lateral structures, the extent of which was tailored by intraoperative electrocorticographic findings and functional mapping of eloquent cortex. The extent of resection was determined with postoperative magnetic resonance imaging scans, using a semiquantitative method, based on a 20-compartment model of the temporal lobe. The magnetic resonance imaging scans were rated by three investigators blinded to seizure outcome. Follow-up period ranged between 18 months and 5 years.

RESULTS

Amygdala and hippocampus were spared in six patients; nine patients had a partial to total resection of amygdala, eight patients had a resection of amygdala and the anterior third of the hippocampus, and one patient underwent resection of amygdala and anterior two thirds of hippocampus. Twenty-one of the 24 patients were seizure free (Engel's class I) and three had rare seizures (Engel's class II). Among these three patients, one had a resection of amygdala; one had resection of amygdala and anterior third of hippocampus; while in the third patient, mesial structures were spared.

CONCLUSION

These data suggest that in patients with an anterotemporal seizure focus, the sparing or limited resection of amygdala and/or hippocampus is not necessarily associated with a poor seizure outcome, as had been previously suggested, provided that the decision not to resect is based on the absence of epileptiform activity during intraoperative electrocorticography or during recordings with depth electrodes.

Significance of unilateral ear extinction on the dichotic listening test

The association between unilateral ear extinction on the dichotic listening test and the lateralization of epileptogenic foci was examined in a sample of 49 seizure patients undergoing preoperative evaluation for epilepsy surgery. Results from patients who were left hemisphere dominant for speech indicated that right ear impairment was always predictive of a unilateral left hemisphere focus, but left ear extinction was associated with unilateral lesions of either hemisphere. In this patient sample, dichotic listening performance reflected an interaction of both lateralized foci and hemispheric preference of language processing. Implications concerning clinical use of the dichotic listening test are discussed.

A variable pitch oxygen saturation indicator designed for use in the magnetic resonance environment

Many commercially available pulse oximeters have a variable pitch blood oxygen saturation indicator, which emits a 'beep' between 175 Hz and 675 Hz with each heart beat. The frequency of this beep is dependent on the blood oxygenation measured by the oximeter, higher frequencies corresponding to higher blood saturation percentages. This is a useful feature for an anaesthetist, rapidly communicating potentially life-threatening situations in an easily detectable manner. Most available oximeters with an audio output feature are vulnerable to the effects of magnetic resonance scanning. In this article an add-on module is described for generating a beep to indicate the blood oxygen saturation which has been specifically designed to operate in the MR environment.

Age and skill differences in adaptive competence

Previous research has documented qualitative changes in certain cognitive abilities during the older adult years, such as in short-term memory, perceptual and motor skills, and attentional capacities. Other work has suggested that a number of significant age-related changes, across a variety of cognitive abilities, are based on social experiences, such as occupational or recreational activities. The current study is based on earlier research by Perlmutter and her colleagues (1990) and examines age and skill-related differences among adults engaged in a social-recreational activity. BINGO players, ranging in age from nineteen to seventy-four, and having from less than two months to over twenty years of playing experience, were given a variety of psychometric, cognitive, and experimental measures. The participants were also observed as they played real BINGO games. No age-related differences were found on the psychometric or memory measures, suggesting that BINGO playing experience may have positive benefits for many older adults. Skilled players at all age levels were found to be more efficient in their game-playing actions. The oldest and most experienced players did not differ from the younger, equally experienced, players on the cognitive and skill-based tasks. These findings demonstrate the need to investigate adaptive competence in those situations in which social-environmental factors play a role in enhancing older adults' cognitive skills.

Quinine-associated acute interstitial nephritis

Quinine-induced acute renal failure attributed to the hemolytic-uremic syndrome has been infrequently reported. A case of acute renal failure due to acute interstitial nephritis associated with ingestion of quinine and the subsequent response to steroid therapy is described.

Effect of corticosteroid therapy on human immunodeficiency virus-associated nephropathy

PURPOSE

Human immunodeficiency virus-associated nephropathy (HIV-AN) occurs predominantly in blacks and is characterized histologically by focal segmental glomerulosclerosis or mesangial proliferation and a lymphohistiocytic tubulointerstitial infiltrate. Patients manifest heavy proteinuria and, once azotemia occurs, progress rapidly to end-stage renal disease within 2 to 6 months. No treatment has been shown to be useful for HIV-AN. The purpose of this study was to determine the effect of corticosteroid agents on the progression of HIV-AN.

PATIENTS AND METHODS

Four consecutive HIV-infected adults with fewer than 200 CD4 cells/microL, moderate to severe renal insufficiency, proteinuria greater than 2 g per 24 hours, and HIV-AN demonstrated by renal biopsy were treated with 60 mg of prednisone daily for 2 to 6 weeks. Patients were followed with respect to serum creatinine level, 24-hour protein excretion, adverse drug reactions, and the occurrence of opportunistic infections.

RESULTS

CD4 counts ranged from 30 to 80 cells/microL before therapy with steroids. The mean (+/- SD) pretreatment serum creatine concentration was 9.1 +/- 5.7 mg/dL and decreased to 3.3 +/- 1.8 mg/dL (P < 0.05) after 2 to 6 weeks of corticosteroid therapy. Twenty-four hour protein excretion did not change (5.2 +/- 2.4 g pretreatment versus 4.6 +/- 4.1 g posttreatment). One patient was able to discontinue dialysis after 10 days. Two patients developed Mycobacterium avium-complex infections and steroid-associated psychosis. One of these patients developed a recurrence of genital herpes, and the other developed dermatomal zoster. None of the four required dialysis during a 1.5- to 5.5-month period of follow-up after cessation of steroid treatment.

CONCLUSION

In selected patients with HIV-AN, short-term treatment with corticosteroid agents improves renal function and prevents the development of end-stage renal disease during a 1.5- to 5.5-month period of observation, but may be associated with an increased risk of opportunistic infection.

A meta-analysis of intervention effectiveness for symptom management in oncology nursing research

PURPOSE

To describe intervention effectiveness for symptom management in oncology nursing research.

DESIGN

Integrative research review and meta-analysis.

SAMPLE

28 randomized experimental and control group studies of symptom management that were identified from 428 published and unpublished oncology nursing research reports authored by nurses from 1981-1990.

METHODS

Experimental studies identified and coded by four oncology nurse specialists; findings transformed into effect sizes; effect sizes combined into overall effect for 28 studies; and effects clustered by symptoms, interventions, and outcomes.

MAIN OUTCOME MEASURE

Combined effect for 28 symptom management study outcomes.

FINDINGS

For 28 study outcomes tested for symptom management, weighted average effect was d = 0.47, the 95% confidence interval ranged from 0.31 to 0.61, statistical significance was p = 5.17 x 10(-12) with wide variability of effect (chi 2 = 66.574, df = 27, p = 3.41 x 10(-5), and success rate improved from 39% to 62% for subjects in the treatment group.

CONCLUSION

Interventions were effective in relieving symptoms in the collection of studies and in the clusters for managing nausea and vomiting, pain, anxiety, alopecia, infection, and side effects of chemotherapy.

IMPLICATIONS FOR NURSING PRACTICE

Missing data related to subject characteristics and need for replications prior to use in practice preclude making specific recommendations at this time for research-based nursing interventions for symptom management in patients with cancer.

Recurrent intracranial epithelioid hemangioendothelioma associated with multicentric disease of liver and heart: case report

Epithelioid hemangioendothelioma is an unusual vascular neoplasm with prominent cytoplasmic vacuolization representing primitive lumen formation. A case is presented of this unique vascular neoplasm in a woman with a seizure disorder who had cardiac, hepatic, and recurrent nervous system lesions. To our knowledge, this is the third known case of intracranial epithelioid hemangioendothelioma. Emphasis is placed on the indolent course of this rare neoplasm, with a recommendation for aggressive surgical treatment and diligent follow-up.

Febrile seizures. Recognition and management

The majority of all febrile seizures represent a benign syndrome that does not require extensive testing or long term medication. A careful history of the febrile seizure, family history, developmental history and physical examination can identify those infants and children with this syndrome. While one-third of this group will experience additional febrile seizures, there is no significant increase in the incidence of later epilepsy or neurological sequelae. The parents of these children need to be reassured and educated about this syndrome. They should understand the emergency treatment of seizures and aggressively treat fever. The more difficult task for the physician is to correctly identify those children who experience nonbenign seizures. Careful history and physical examination can accurately identify this group. Further evaluation including neuroimaging, electroencephalogram and developmental assessment may be necessary. In those children with a high risk of later epilepsy, treatment with an antiepileptic drug should be considered.

Diagnosis and epidemiological association of Listeria monocytogenes strains in two outbreaks of listerial encephalitis in small ruminants

Two outbreaks of epizootic listerial encephalitis, one in sheep and one in goats, were investigated through pathology, microbiology, and DNA amplification-based techniques. Efforts were made to survey the diversity of Listeria monocytogenes strains in the silage consumed by affected animals and to verify the causal relationship between silage and disease outbreak. In both outbreaks, L. monocytogenes was isolated from silage and brain tissue samples. Random amplified polymorphic DNA patterns revealed two distinct L. monocytogenes strains, one of which was identical to the sheep brain isolate, in the silage associated with the outbreak in sheep. Three brain isolates and one silage isolate, all of which had different random amplified polymorphic DNA patterns, were found in the outbreak involving goats. All isolates from both outbreaks were indistinguishable in an in vitro assay for cell-to-cell spread and growth in macrophages. All brain isolates from the goat outbreak had identical intracellular ActA patterns, which were different from the pattern for the silage isolate. While the sheep brain isolate had an ActA pattern different from that of the corresponding silage isolate, the patterns for the brain isolates from the two outbreaks were not identical. This survey demonstrates the diversity of L. monocytogenes in silage and suggests the existence of one or more selective processes by which certain strains are more prone to give rise to disease.