Cephalic tetanus presenting with bilateral facial palsy

We discuss the case and differential diagnoses of an elderly man who presented with bilateral facial palsy. He had injured his forehead in the garden during a fall on his face and the open wound was contaminated by soil. He then presented to the emergency department with facial weakness causing difficulty speaking. The penny dropped when he started developing muscle spasms affecting his lower jaw a day after admission. It also became clear that he could not open his mouth wide (lock jaw). The combination of muscle spasms and lock jaw (trismus) made tetanus the most likely possibility, and this was proven when he had samples taken from his wound and analysed under the microscope, which showed Clostridium tetani bacilli. C. tetani spores are widespread in the environment, including in the soil, and can survive hostile conditions for long periods of time. Transmission occurs when spores are introduced into the body, often through contaminated wounds. Tetanus in the United Kingdom is rare, but can prove fatal if there is a delay in recognition and treatment.

Effective AC needleless and collectorless electrospinning for yarn production

Nanofibrous materials are essential components for a wide range of applications, particularly in the fields of medicine and material engineering. These include protective materials, sensors, cosmetics, hygiene, filtration and energy storage. The most widely used and researched technology in these fields is electrospinning. This method for producing fibers yields highly promising results thanks to its versatility and simplicity. Electrospinning is employed in multiple forms, among which needle and needleless direct current (DC) variants are the most distinctive. The former is based on the generation of just one single jet from a nozzle; hence this fabrication process is not very productive. The latter uses the destabilization of free liquid surfaces by means of an electric field, which enhances the throughput since it produces numerous jets, emitted from the surfaces of rollers, spheres, strings and spirals. However, although some progress in total producibility has been achieved, the efficiency of the DC method still remains relatively low. A further drawback of DC electrospinning is that both variants need a collector, which makes it difficult to combine DC electrospinning easily with other technologies due to the presence of the high field strength within the entire spinning zone. This paper describes our experiments with AC electrospinning. We show that alternating current (AC) electrospinning based on a needleless spinning-electrode provides a highly productive smoke-like aerogel composed of nanofibers. This aerogel rises rapidly from the electrode like a thin plume of smoke, without any need for a collector. Our work shows that AC needleless electrospinning gains its efficiency and collector-less feature thanks to the creation of a perpetually charge-changing virtual counter-electrode composed of the nanofibers emitted. High-speed camera recordings demonstrate the formation mechanism of the nanofibrous plume, which is wafted by an electric wind. This wind's velocity field is experimentally investigated. One potential use of AC needleless electrospinning is demonstrated here by spinning it into a yarn.

Dosimetry at an interim storage for spent nuclear fuel

The Czech nuclear power plant Dukovany started its operation in 1985. All fuel spent from 1985 up to the end of 2005 is stored at a dry interim storage, which was designed for 60 CASTOR-440/84 casks. Each of these casks can accommodate 84 fuel assemblies from VVER 440 reactors. Neutron-photon mixed fields around the casks were characterized in terms of ambient dose equivalent measured by standard area dosemeters. Except this, neutron spectra were measured by means of a Bonner sphere spectrometer, and the measured spectra were used to derive the corresponding ambient dose equivalent due to neutrons.

Coronary artery bypass grafting in patients with left ventricular ejection fraction of 30% or less

BACKGROUND

The results of a merely pharmacological therapy in patients with advanced left ventricular dysfunction are unsatisfactory. Coronary artery bypass grafting is frequently the only therapeutic option, but ventricular dysfunction is generally considered to be a risk factor.

AIM

To find out the frequency of coronary artery bypass grafting and its outcome in patients with a ejection fraction of 30% or less who were operated on at a single institution.

METHODS

Between January 1st, 1996 and October 30th, 1999, 90 patients (4.6% of all patients operated on due to of coronary artery disease) with EF of 30% or less underwent coronary artery bypass grafting. This group consisted of 12 women and 78 men at an average age of 60.2 +/- 9.4 years (range, 33 to 78 years); 75.6% patients were in functional class III or IV and 80.0% had three-vessel disease. On the average, 2.5 grafts per patient were implanted, the left internal mammary artery was used in 24.4% patients, and 10.0% of patients had cardiac surgery without cardiopulmonary bypass.

RESULTS

Hospital mortality was 10%. The main cause of death was cardiac or multiorgan failure. Low cardiac output syndrome and supraventricular dysrrhythmias were the most common postoperative complications. Advanced age and low cardiac output syndrome were found to be risk factors of early mortality. Five other patients died during the follow-up (4 to 48 months). One- and three-year survival rate were 83.1% and 81.9%, respectively. Ejection fraction improved during the follow-up from 27.5% to 33.7%. The improvement was more pronounced in patients in whom preoperative end-diastolic diameter of the left ventricle was below 70 mm, and in patients with two and more hibernating segments on dobutamine stress echo.

CONCLUSIONS

Successful results of surgical revascularization in patients with severe impairment of left ventricular function can be achieved by careful selection of patients (the presence of viable myocardium is necessary) and management. Early mortality and morbidity was higher than in patients with normal ventricular function. Age and low cardiac output syndrome were revealed as risk factors of early mortality. Long-term prognosis for hospital survivals was satisfactory. (Tab. 5, Fig. 1, Ref. 13.)