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Cerebrospinal fluid (CSF) leak through petrosal air cells is a known complication after drilling the posterior wall of the internal acoustic canal (IAC) for resection of vestibular schwannoma (VS). Whereas mild pneumocephalus is common after retrosigmoid craniotomy, tension pneumocephalus has been rarely documented. To testify a case of fatal tension pneumocephalus after VS resection in a patient with ventriculo-peritoneal (VP) shunt and to propose possible recommendations to limit the risk of this dramatic complication. A case of fatal tension pneumocephalus after VS resection in presence of hidden CSF fistula is illustrated with pre- and post-operative images. In the uneventful situation of concomitant post-operative CSF fistula in presence of VP shunt, tension pneumocephalus may occur. The negative pressure created by the shunt system and the presence of osteo-dural defect allow the air to enter and, at the same time, prevent the outflow. After VS resection, tension pneumocephalus can occur as a consequence of CSF fistula from petrosal air cells in the presence of functioning VP shunt. Precautions as pre-operative increase to 'virtual-off' the pressure of the valve, subsequences CT scans after surgery and sealing of the petrous air cells are recommended to avoid such as fatal complication. [ABSTRACT FROM AUTHOR]

Germany is well known around the world for the strength of its economy, its industry and for the ‘German model’ for higher engineering education based on developing technological skills at a very high level. In this article, we firstly describe the former and present model of engineering education in Germany in a context of the globalisation of the world economy and of higher education, in order to understand how it covers the current demand for engineering resources. Secondly, we analyse the impact of globalisation from a technological perspective. To this end, we describe initiatives for innovation driven by the German federal government and engineering societies, and summarise the first impacts on engineering education and on social competence for engineers. Thirdly, we explore to what extent engineering education in Germany trains engineers in social and intercultural competency to comply with the future demands of the challenge of globalisation. [ABSTRACT FROM AUTHOR]

The two Morvern Callars—Alan Warner's 1995 novel and Lynne Ramsay's 2002 film adaptation—are key contemporary Scottish texts yet represent two quite different moments in Scotland's recent cultural history. Warner's novel is decidedly devolutionary in its handling of Scotland and Scottishness. Although superficially faithful to its source text, Ramsay's film is actually far more faithful to its depoliticized—or differently politicized—early post-devolutionary moment. Examining the two Morvern Callars in light of Robert Stam's theory of adaptation helps us understand both their complex relationship and the ideological consequences of aesthetic choices. [ABSTRACT FROM PUBLISHER]

Objective. The aim of this study was to evaluate the outcomes of through-the-scope (TTS) large diameter self-expanding metal stent (SEMS) placement for palliation of malignant colorectal obstruction. Material and methods. Between January 2005 and December 2009, all patients who underwent endoscopic SEMS placement for palliation of malignant colorectal obstruction were prospectively enrolled. Results. Thirty-nine patients (17M and 22F; mean age 75.9 ±± 10.6 years, range 50--91) were enrolled. The most frequent location was the sigmoid colon (13 cases). The causes of obstruction were colorectal malignancy in 32 patients and extracolonic malignancy in 7. Technical success was achieved in 36/39 patients (92.3%) and clinical success in 35/39 patients (89.7%). Technical failure was related to female sex ( p == 0.04) and the extracolonic etiology of the stricture (p < 0.001). There were three early complications: two procedure-related perforations successfully managed conservatively and one hemorrhage treated with APC. Early complications were related to the location of strictures at the recto-sigmoid junction (p < 0.001). Late complications occurred in 10 patients: 8 of these patients experienced occlusive symptoms (attributable to tumor ingrowth in 5 cases and stool impaction in 3 cases); the remaining 2 were one case of tumor ingrowth with sub-occlusive symptoms and hemorrhage, and one case of distal migration. There was no procedure-related mortality and all complications were managed without surgical intervention. SEMS patency duration was 236 ±± 128 days (range 31--497) and mean survival of the patients was 259 ±± 121 days (range, 32--511). Conclusions. In our experience, TTS large-diameter SEMS placement is a safe and effective treatment for palliation of malignant colorectal obstruction. [ABSTRACT FROM AUTHOR]

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has dramatically changed over the past 10 y with the emergence of community-associated MRSA (CA-MRSA). Recent studies have reported a frequent association of these strains with hospital outbreaks, and an incidence varying over time and by region. In order to evaluate the MRSA lineages circulating in our area of Italy, we performed a molecular characterization of CA-MRSA isolates prospectively collected from April 2006 to July 2007 at the San Paolo Hospital of Milan. We investigated the protein A-encoding gene ( spa-typing), the staphylococcal chromosomal cassette SCC mec, the presence of Panton-Valentine leukocidin (PVL), and 3 adhesin genes. Twenty-five CA-MRSA isolates cultured from 25 patients were collected; an equal number of healthcare-associated (HA)-MRSA strains, from 25 patients hospitalized in various wards, were collected for comparison purposes. SCC mec type IV emerged as the most frequent genotype in both CA- and HA-MRSA. Seventeen different spa types were identified: t515 was the most common (36%), followed by t008 (20%). We detected 3 PVL-positive strains, only among the CA-MRSA. On the whole, our local MRSA epidemiology appears to be heterogeneous, with a predominant t515 spa type, only recently considered to belong to clonal EMRSA-15. [ABSTRACT FROM AUTHOR]

The article profiles the late U.S. novelist Kurt Vonnegut Jr. He escaped the firebombing as a German-American soldier at the Battle of the Bulge in Dresden, Germany during World War II, published his first novel "Player Piano" in 1952, and taught at the University of Iowa Writer's Workshop for two years. The article cites the plagiarism of Vonnegut's work by Scottish writer Alasdair Gray in his novel "Lanark." All of the main characters in the work of Vonnegut are alone. His son, Mark, became an author and a doctor who helps others suffering from schizophrenia.

A major problem in industrial applications of structural adhesives is the quality assurance of manufactured joints. At present, for lack of a suitable nondestructive technique, production standards for adhesively-bonded aluminum joints are established on the basis of destructive tests and statistical inference. An experimental study was carried out to assess if lock-in thermography (LT) could be used as a tool for nondestructive evaluation of adhesively-bonded aluminum joints. Several samples were fabricated by varying the governing parameters such as nature of aluminum alloy, substrate thickness, surface treatment, adhesive type and bondline thickness. The effects of surface treatments on the loading capability of lap joints were evaluated through both destructive tensile tests and nondestructive evaluation with infrared LT. Tensile tests showed that the joint performance was not affected by the nature of the aluminum alloy but by the substrate thickness, the adhesive type and the bondline thickness. LT was capable of detecting imperfections such as scratches on substrates and foreign inclusions in the adhesive layer. [ABSTRACT FROM AUTHOR]

Discusses the trend in American fiction intended for international market. American fiction in the eighties; Foreign writers who examined and extend fiction's range and formal capacities; Status of the American fiction in the nineties.

Discusses the novel 'Snow White,' by American author Donald Barthelme. Critique of the reductive linguistic democracy of the contemporary American mass culture; Complexity and technical proficiency of Barthelme's writing; Tendency to read the novel as a sign of an ethically bankrupt age; Form of jokes that constitute the author's critique of dwarf culture.

Comments on the book 'Da Vinci's Bicycle,' by Guy Davenport. Keen sense of narrative voice; Contrast between Richard Nixon and Mao Che Tung; Historical fact as the point of departure in the stories.

A young Down's syndrome patient developed tricuspid valve endocarditis several years after undergoing surgical closure of a congenital ventricular septal defect. Fungal etiology was established by PCR amplification of the Candida albicans ERG11 gene. Although antifungal therapy was administered, surgical replacement of the infected valve was required to eliminate the infection. [ABSTRACT FROM AUTHOR]