Intracerebral schwannoma of the angular gyrus: case report.

We report an intracerebral schwannoma originating in the angular gyrus of a 20-year-old female that was incidentally diagnosed after she presented with a post-traumatic seizure. After comprehensive investigations, including functional magnetic resonance imaging, she underwent a computed tomography-guided stereotactic resection of the lesion. Pathological examination confirmed features of a schwannoma. After six years of follow-up, she remains well, without any evidence of recurrence. Intracerebral schwannomas are extremely uncommon: fewer than 90 cases have been reported. We present a comprehensive summary of the literature and a discussion of novel theories on the pathogenesis of intracerebral schwannomas.

Second surgery for progressive glioblastoma: a multi-centre questionnaire and cohort-based review of clinical decision-making and patient outcomes in current practice.

PURPOSE: Glioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. METHODS: Current practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. RESULTS: 234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p = 0.874). CONCLUSIONS: This is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

Epidural abscess with associated spondylodiscitis following prostatic biopsy.

Spondylodiscitis is often iatrogenic in nature. We report the case of a 69-year-old man presenting with spondylodiscitis and associated epidural abscess following transrectal ultrasonography guided prostate biopsy despite ciprofloxacin cover. To our knowledge, this is the first case of spondylodiscitis secondary to fluoroquinolone resistant Escherichia coli.

Chiari malformation in female monozygotic twins.

We describe the cases of female monozygotic twins who presented almost synchronously with symptomatic Chiari malformation type I. Both were successfully treated with foramen magnum decompression. We analyse these findings in the context of previously reported cases and discuss the genetic implications.

Effect of high-pressure processing on strains of Enterobacter sakazakii.

Four strains of Enterobacter sakazakii were inoculated into tryptic soy broth and reconstituted powdered infant formula and exposed to high-pressure processing. Pressures of 200, 400, and 600 MPa were used for each medium for 1 min. E. sakazakii was reduced by more than 6 log (strains A and B) in both media at 600 MPa. Strain B was significantly (P < or = 0.05) more pressure resistant than the other strains, with just more than a 3-log reduction at 600 MPa in both media. The reconstituted infant formula has a significant (P < or = 0.05) protective effect for certain strains and pressures (strain B at 400 MPa and strain D at 400 and 600 MPa). Differences in log reductions between media (milk and broth) were also observed for certain strains and specific pressures (strain B at 400 MPa and strain D at 400 and 600 MPa; P < or = 0.05). This research showed that E. sakazakii, when present in reconstituted powdered infant formula, can be submitted to high-pressure processing (600 MPa for 1 min) and achieve log reductions ranging from 3 to 6.84, depending on the strain.

Discharge planning and social work practice.

Current health care practice discharge planning has emerged as a major professional function in hospital settings. To examine the tasks involved in discharge planning and how frequently they are being performed, 124 Alabama hospitals were contacted with a 72% rcsponse rate. Of the 178 surveys returned by discharge planners the core tasks were identified and ranked in terms of performance frequency. The results revealed that the tasks performed typically resembled that of generalist social workers. When specialization occurred, it was related to the populations served and not the specialized tasks or methods utilized. From this data recommendations are made for linking advanced generalist social work practice to discharge planning activities.

Development of physical selection procedures for the British Army. Phase 2: relationship between physical performance tests and criterion tasks.

This paper is the second in a series of three to describe the development of physical selection standards for the British Army. The first paper defined criterion tasks (single lift, carry, repetitive lift and carry, and loaded march tasks) and set standards on the criterion tasks for all British Army trades. The principal objective was to determine which combination of physical performance tests could be best used to predict criterion task performance. Secondary objectives included developing so-called 'gender-free' and 'gender-unbiased' models. The objectives were met by analysing performance data on the criterion tasks and a large battery of physical performance tests collected from 379 trained soldiers (mean age 23.5 (SD 4.45) years, stature 1734 (SD 79.5) mm, body mass 71.4 (SD 10.58) kg). Objective 1 was met: the most predictive physical performance tests were identified for all criterion tasks. Both single lift tasks were successfully modelled using muscle strength and fat free mass scores. The carry model incorporated muscle endurance and body size data, but the errors of prediction were large. The repetitive lift models included measures of muscle strength and endurance, and body size, but errors of prediction were also large. The loaded march tasks were successfully modelled incorporating indices of aerobic fitness, supplemented by measures of strength, endurance or body size and composition. The secondary objectives were partially fulfilled, though limitations in the data hampered the process. Although only one model (a loaded march) was gender-free, three models were gender-related (i.e. contained 'gender' explicitly in the model). The remaining six were gender-specific (i.e. were appropriate for men or for women). Owing to both a lower accuracy of prediction in women's scores and a greater tendency for the women's scores to be distributed around the pass standards, a greater percentage of women than men were misclassified as passing or failing, resulting in indirect discrimination. A validation of the models in a separate sample of the user population of recruits is reported in the third paper in this series.

DRGs and hospital social work: when policy guides practice.

Since the early 1980s cost containment policies have changed the practice of hospital social work. Diagnosis Related Groups (DRGs), a cost containment mechanism, have increased the caseloads of hospital social workers, and placed a greater emphasis on discharge planning. In this article DRGs are described, and their function is discussed from a social work perspective. The literature surrounding DRGs and the role of the hospital social worker is addressed. Recommendations are made for social workers to evaluate the policies affecting their practice. It is proposed that if social workers understand policies, their origins, and how policies affect practice, then they can have greater influence as advocates and policy makers.

Exploring the relationship between purpose in life and African American adolescents' use of prenatal care services.

This article presents findings of a study that explored the relationship between purpose in life and African American adolescents' use of prenatal care services. The findings revealed no statistically significant relationship, thus suggesting that purpose in life may not be a crucial factor in determining whether African American adolescents use prenatal care services. The need to explore the influence of other variables on service use and the importance of considering such findings for appropriate health care and social work intervention are discussed.

PIP: Although prenatal care can prevent or minimize many of the risks associated with adolescent pregnancy, most young people either underutilize or avoid this service. This study investigated the hypothesis that adolescents who have a sound sense of life's meaning and purpose will have higher levels of participation in prenatal care than those without such direction. Respondents included 30 African-American adolescent females (mean age, 17 years) referred by a local health center. The mean score on Crumbaugh's Purpose-in-Life test was 97.3 out of a maximum of 140 (high purpose). Other studies utilizing this measure have yielded mean scores ranging from 108.5 for college undergraduates to 118.9 among successful businessmen and professionals. Correlation analysis failed to reveal any significant association between use of prenatal services and purpose in life scores. Overall, these findings suggest that health and social service providers should not place a major emphasis on such philosophical issues when attempting to encourage use of prenatal services among Black youth. It should be considered, however, that this particular measure may lack validity in a sample of very young African-Americans. Recommended are further studies to assess the impact of factors such as agency staffing patterns, modes of service information dissemination, physical environment of service facilities, and instructional content on prenatal care utilization.

Effect of oral creatine supplementation on respiratory gas exchange and blood lactate accumulation during steady-state incremental treadmill exercise and recovery in man.

1. Oral creatine supplementation has been shown to increase muscle creatine and phosphocreatine concentrations with consequent benefits on performance during short-term maximal exercise. However, recently there have been anecdotal reports that creatine supplementation can also influence the pattern of substrate utilization and improve performance during more prolonged, submaximal exercise, which, based on recent experimental evidence, may have some scientific justification. 2. Eight men performed a continuous incremental exercise test running at 10 km/h on a motorized treadmill at predetermined workloads from 50% to 90% of maximal oxygen uptake, before and after 5 days of creatine supplementation (4 x 5 g daily). Exercise was performed for 6 min at each workload to achieve a steady state, and respiratory gas exchange and blood lactate concentrations were measured during the last 30 s at each workload. Measurements were also made at 5-min intervals for the first 15 min of recovery. 3. The results showed no measurable effect of creatine supplementation on respiratory gas exchange and blood lactate concentrations during either incremental submaximal exercise or recovery. This suggests that creatine supplementation does not influence substrate utilization during and after this type of exercise.