Pediatric hemifacial spasm: the efficacy of microvascular decompression

Hemifacial spasm (HFS), generally a disease of the elderly, is caused by vascular compression of the seventh nerve. Vascular compression is thought to result from atherosclerotic changes within the vessels of the posterior fossa, and therefore rarely presents in childhood. Here we describe our experience with 12 patients with onset of HFS during childhood (age 18 or less) and who had surgical exploration of the cerebellopontine angle. These patients represent less than 1.2% of the patient population with HFS operated upon at this institution during the study period. Nine patients had follow-up data extending over 83 months. All 12 patients were found to have microvascular compression of the seventh nerve at the time of surgery. The most common operative finding was compression of the seventh nerve by a vein, alone or in combination with a branch of the anterior inferior cerebellar artery. At the time of discharge and after a mean follow-up period of 125 months, microvascular decompression resulted in complete relief of spasm in 67% of the patients.     

The spiritual needs of pediatric patients and their families

Holistic perioperative nursing care of children and their families includes assessing their spiritual needs and identifying interventions that help them achieve spiritual comfort. This is achieved by therapeutic listening and by facilitating children's and family members' access to clergy members of their practice of religious rites and rituals. Perioperative nurses have a unique opportunity and responsibility to assess children's or family members' spiritual needs and to intervene on their behalf. This article describes the opportunities a surgical liaison nurse may have to intervene on the behalf of family members during children's perioperative experiences.     

Ulceration of the ileum in Crohn''s disease: correlation with vascular anatomy

Forty-five cases of gastroschisis and 85 of omphalocele were reviewed. The survival of gastroschisis has dramatically improved over the past 20 years, however, that of omphalocele still remained in the lower value, because the size of the defect and the presence of associated anomalies are prognostic factors. The primary fascial closure was first employed for the patients with gastroschisis and a silo chimney was used for limited cases. On the other hand, for the patients with omphalocele, primary closure was possible in 34 cases, silo chimney was used in 17, and 45 cases had nonoperative management with epithelialization. Among them, nonoperative management using painting was the most reliable therapeutic for omphalocele.     

Women's mental health: some directions for research

Some key issues regarding gender differences in the prevalence of mental disorders, the course of mental illness, and the use of services are reviewed, along with their diagnosis and psychopharmacologic treatment. Implications for clinical practice are examined, as are directions for future research that will ensure the presence of women's mental health as a major element in the national agenda on women's health.     

Polycrystalline silicon solar cells on low cost foreign substrates

The use of polycrystalline silicon layers on low-cost substrates is a promising approach for the fabrication of low-cost solar cells. Using low-carbon steel and graphite as substrates, solar cell structures have been deposited by the thermal decomposition of silane and appropriate dopants.Steel was selected as a substrate on the sole basis of its low cost. However, steel and silicon are not compatible in their properties, and an interlayer of a diffusion barrier, such as borosilicate, must be used to minimize the diffusion of iron from the substrate into the deposit. The deposited silicon on borosilicate/steel substrates is polycrystalline with a grain size of 1–5 μm, depending on deposition conditions. P-n junction solar cells were found to have low open-circuit voltages and poor current-voltage characteristics, and Schottky-barrier solar cells were found to show negligible photovoltages.Graphite is more compatible with silicon in properties than steel, and silicon deposited on graphite substrates shows considerably better microstructures. A number of solar cells, 2·5×2·5 cm in area, have been fabricated from n⁺-silicon/p-silicon/p⁺-silicon/graphite structures. The best cell to date had a V_oc of 0·35 V and an AMO efficiency of 1·5% (no antireflection coating). This type of solar cell is very promising because of the simplicity in fabrication.     

Translumbar placement of inferior vena caval catheters: a solution for challenging hemodialysis access

Access to the central venous circulation for hemodialysis has traditionally been achieved via the subclavian or jugular venous routes. With ongoing improvements in medical management, many hemodialysis recipients develop exhaustion of these routes and require alternative means of central venous access. Inferior vena caval (IVC) catheters have been placed with a percutaneous translumbar approach to allow central venous access for chemotherapy, harvesting of stem cells, and total parenteral nutrition. Translumbar placement of IVC catheters has become accepted by some as a useful and reliable alternative in patients who require long-term hemodialysis but have exhausted traditional access sites. IVC catheters have been placed in patients with IVC filters, and IVC filters have been placed in patients with IVC catheters. Complications include those associated with central venous catheters, for example, sepsis, fibrin sheaths, and thrombosis. A complication specific to placement of IVC hemodialysis catheters is migration of the catheter into the subcutaneous soft tissues, retroperitoneum, or iliac veins. Translumbar placement of IVC catheters is performed only in patients considered to have few or no other medical options and is not intended as a primary means of central venous access.