Description of posterior fossa syndrome in children after posterior fossa brain tumor surgery.

Brain tumors are the second most common malignancy in children less than 15 years of age and the most common solid tumor of childhood. Approximately 60% to 70% of pediatric brain tumors originate in the posterior fossa. Since 1989, the two hospitals that comprise the setting for this study have treated 121 children with posterior fossa brain tumors. A postoperative syndrome, labeled posterior fossa syndrome, has been identified in certain children. This syndrome involves a variety of signs and symptoms including mutism or speech disturbances, dysphagia, decreased motor movement, cranial nerve palsies and, emotional lability. These signs and symptoms develop from an average range of 24 to 107 hours after surgery and may take weeks to months to resolve. The exact etiology of the syndrome is unknown. The purpose of this retrospective medical records review of 19 children diagnosed with posterior fossa syndrome is to describe the symptoms of the syndrome. Early recognition of this syndrome could facilitate preventive and restorative patient care, prevent subsequent complications, decrease length of hospital stays, and promote patient and family understanding of and coping with the syndrome.

The natural connection: the clinical nurse specialist and bedside nursing research.

The educational preparation and consistent clinical focus of CNSs position them ideally for conducting research at the bedside and helping staff nurses see the relevance of such research. Our research studies have identified a new category of clinical nursing research termed bedside nursing research. Like its parent category of clinical nursing research, the function of bedside nursing research is to generate new knowledge or validate and expand previously generated knowledge. Characteristics that distinguish bedside nursing research from other forms of clinical nursing research are: focus, idea stimulus and setting, originator of the research question, relationship with theory, sensitivity to changing technology in health care, and impact on nursing practice. To illustrate the nature and outcome of this type of research, we describe three bedside nursing research studies conducted by CNSs in a pediatric oncology setting. These studies assessed: (1) the effects of chest tube stripping on the incidence of pain, fever, and pulmonary complications; (2) the relative safety and efficacy of techniques for blood sampling from Hickman catheters; and (3) the effects of infusion method on quality and survival of transfused platelets. The impact of these studies of hospital practices is reviewed.

Effect of long-term administration of ketoconazole in cats.

Four cats given ketoconazole (30 mg/kg of body weight/day) for 30 days developed dry hair coats and weight loss. Plasma cortisol and serum cholesterol, testosterone, and progesterone did not change significantly (P greater than 0.01), and significant alterations in serum albumin, calcium, and alkaline phosphatase (P less than 0.01) did not preclude use of the drug. Serum testosterone concentrations tended to decrease after 7 days of treatment, but in 2 cats returned to near-pretreatment values by day 30 of treatment, despite continued drug administration. These results were in contrast to those reported in the dog at similar and lesser dosages of ketoconazole.