Spinal Compliance Curves: Preliminary Experience with a New Tool for Evaluating Suspected CSF Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension.

BACKGROUND AND PURPOSE: Craniospinal space compliance reflects the distensibility of the spinal and intracranial CSF spaces as a system. Craniospinal space compliance has been studied in intracranial pathologies, but data are limited in assessing it in spinal CSF leak. This study describes a method to estimate craniospinal space compliance using saline infusion during CT myelography and explores the use of craniospinal space compliance and pressure-volume curves in patients with suspected cerebrospinal-venous fistula. MATERIALS AND METHODS: Patients with suspected cerebrospinal-venous fistula underwent dynamic CT myelography. During the procedure, 1- to 5-mL boluses of saline were infused, and incremental changes in CSF pressure were recorded. These data were used to plot craniospinal space compliance curves. We calculated 3 quantitative craniospinal space compliance parameters: overall compliance, compliance at opening pressure, and the pressure volume index. These variables were compared between patients with confirmed cerebrospinal-venous fistula and those with no confirmed source of CSF leak. RESULTS: Thirty-four CT myelograms in 22 patients were analyzed. Eight of 22 (36.4%) patients had confirmed cerebrospinal-venous fistulas. Bolus infusion was well-tolerated with no complications and transient headache in 2/34 (5.8%). Patients with confirmed cerebrospinal-venous fistulas had higher compliance at opening pressure and overall compliance (2.6 versus 1.8 mL/cm H20, P < .01). There was no difference in the pressure volume index (77.5 versus 54.3 mL, P = .13) between groups. CONCLUSIONS: A method of deriving craniospinal space compliance curves using saline intrathecal infusion is described. Preliminary analysis of craniospinal space compliance curves provides qualitative and quantitative information about pressure-volume dynamics and may serve as a diagnostic tool in patients with known or suspected cerebrospinal-venous fistulas.

Update in Infectious Diseases 2019.

The IX Course of Antimicrobials and Infectious Diseases update included a review of the main issues in clinical microbiology, epidemiology and clinical aspects for a current approach of infectious pathology. The present introduction summarizes about the most important meetings related to infectious diseases during 2018 (ECCMID, IAS, ASM and ID Week). In addition, the course provides a practical information to focus on nosocomial infection models, with immunosuppressed patients or complex multidrug-resistant pathogens. The closing lecture of this year reviewed the infection during donation process.

Nalbufina SP más ropivacaína versus fentanilo más ropivacaína peridural mediante bomba de infusión elastomérica para manejo de dolor postoperatorio en pacientes sometidas a histerectomía total abdominal

RESUMEN Actualmente, a pesar de los avances científicos y tecnológicos en la medicina, ni el dolor agudo ni el crónico suelen recibir un tratamiento adecuado por muy diversas razones de cultura, actitud, educación, política y logística. Sin embargo, el tratamiento efectivo del dolor se considera un derecho fundamental del paciente, así como un indicador de buena práctica clínica y calidad asistencial. Las intervenciones quirúrgicas ginecológicas y especialmente las histerectomías se realizan muy frecuentemente tanto en hospitales públicos como privados; el dolor generado por este tipo de intervenciones es un desafío terapéutico para el equipo multidisciplinario. Se ha documentado que entre 40% y 70% de las pacientes refieren dolor intenso y esto es debido a que los esquemas analgésicos establecidos no logran alcanzar niveles plasmáticos adecuados o que estos solo se circunscriben a analgésicos antiinflamatorios no esteroides. Objetivo: en el presente trabajo decidimos comparar la calidad de analgesia mediante su uso en infusión continua peridural en las pacientes operadas de histerectomía abdominal bajo anestesia regional a fin de proponer una herramienta útil para el manejo del dolor posterior a esta frecuente cirugía en nuestro hospital. Conclusiones: el uso de nalbufina más ropivacaína versus fentanilo más ropivacaína ofrece condiciones de analgesia satisfactoria; la nalbufina presentó superioridad, la cual fue estadísticamente significativa. El infusor elastomérico garantiza la administración continua del medicamento evitando los ''picos y valles'' del uso de dosis intermitentes.

SUMMARY Despite the scientific and technological advances in medicine, neither acute nor the chronic pain often receive appropriate treatment for various reasons. Effective treatment of pain is considered a fundamental right of the patient, and an indicator of good clinical practice and quality of care. The gynecological surgeries, especially hysterectomies are performed very frequently, both in public and private hospitals, while the pain generated by this type of intervention is a therapeutic challenge for the multidisciplinary team. 40%-70% of patients report severe pain and this is because the established analgesic schemes fail to achieve adequate plasmatic levels or that these are only limited to NSAIDs. The present work compares the quality of analgesia using a continuous epidural infusion, after abdominal hysterectomy operated under regional anesthesia, in order to propose a useful tool for pain management after surgery in our hospital . Conclusions: the use of fentanyl versus ropivacaine versus nalbuphine with ropivacaine provides satisfactory analgesia conditions. In a closer look nalbuphine present superiority which was statistically significant. The elastomeric infuser ensures continuous administration of medication to avoid ''peaks and valleys'' in the regular use of of intermittent doses.

RESUMO Atualmente, apesar dos avances científicos e tecnológicos na medicina, a dor aguda nem a dor crônica tem recebido um tratamento apropriado, por diversas razoes: culturais, de atitude, educacional, política e logística. Entretanto, o tratamento efetivo da dor considera-se um direito fundamental do paciente, do mesmo modo um indicador de boa pratica clinica e qualidade assistencial. As intervenções cirúrgicas ginecológicas em especial as histerectomias som realizadas muito frequentemente, tanto em hospitais públicos como particulares e a dor provocada e um desafio terapêutico para a equipe multidisciplinar, porém, apesar das diferentes modalidades existentes para atingir boa analgesia, esta não é controlada satisfatoriamente. que apesar das diferentes modalidades existentes para alcançar analgesia, não se controla satisfatoriamente. Relata-se que entre 40% a 70 % dos pacientes referem dor intensa e isto é devido ao fato de que os esquemas analgésicos estabelecidos não atingem níveis plasmáticos adequados o que simplesmente se prescreve são analgésicos antiinflamatórios não esteroides. O objetivo deste trabalho foi comparar a qualidade da analgesia da infusão continua peridural, em pacientes post-cirúrgicas de histerectomias abdominal com anestesia regional, tendo a finalidade de propôr uma ferramenta útil para o alivio da dor de uma das cirurgias que se realiza mais frequentemente em nosso hospital. Conclusões: o uso de nalbufina mas ropivacaina versus fentanyl mas ropivacaina oferece condições de analgesia satisfatória. A mistura com nalbufina apresenta superioridade estatisticamente significativa. O infusor elastomérico garante uma administração continua do fármaco, evitando as concentrações variáveis do uso de doses intermitentes.

Neoadjuvant in situ gene-mediated cytotoxic immunotherapy improves postoperative outcomes in novel syngeneic esophageal carcinoma models.

Esophageal carcinoma is the most rapidly increasing tumor in the United States and has a dismal 15% 5-year survival. Immunotherapy has been proposed to improve patient outcomes; however, no immunocompetent esophageal carcinoma model exists to date to test this approach. We developed two mouse models of esophageal cancer by inoculating immunocompetent mice with syngeneic esophageal cell lines transformed by cyclin-D1 or mutant HRAS(G12V) and loss of p53. Similar to humans, surgery and adjuvant chemotherapy (cisplatin and 5-fluorouracil) demonstrated limited efficacy. Gene-mediated cyototoxic immunotherapy (adenoviral vector carrying the herpes simplex virus thymidine kinase gene in combination with the prodrug ganciclovir; AdV-tk/GCV) demonstrated high levels of in vitro transduction and efficacy. Using in vivo syngeneic esophageal carcinoma models, combining surgery, chemotherapy and AdV-tk/GCV improved survival (P=0.007) and decreased disease recurrence (P<0.001). Mechanistic studies suggested that AdV-tk/GCV mediated a direct cytotoxic effect and an increased intra-tumoral trafficking of CD8 T cells (8.15% vs 14.89%, P=0.02). These data provide the first preclinical evidence that augmenting standard of care with immunotherapy may improve outcomes in the management of esophageal carcinoma.

Opsonophagocytosis versus complement bactericidal killing as effectors following Neisseria meningitidis group C vaccination.

BACKGROUND: Opsonophagocytosis and complement-mediated Neisseria meningitidis killing after vaccination were investigated. METHODS: Twelve seronegative healthy volunteers received one dose of polysaccharide A/C vaccine and were followed for 3 years. Ex vivo serum killing rates with polymorphonuclear cells (PMN) and/or complement were performed at 0, 1.5, 6, 12, 18, 24, 30 and 36 months. RESULTS: High mean total and median bactericidal antibodies were detected over time in all subjects. Considerable reduction of the initial inoculum was obtained only in the presence of complement, with or without PMN (with significant differences compared to curves without complement) a long time after vaccination. CONCLUSION: PMN did not increase post-vaccination bacterial killing, suggesting that antibody complement-mediated killing, and not opsonophagocytosis, is the main immune effector of the vaccine protection against N. meningitidis.

[Evaluation of the frequency of depression in patients with endometriosis and pelvic pain]. / Avaliação da freqüência de depressão em pacientes com endometriose e dor pélvica.

OBJECTIVE: Evaluate the frequency of depression in women with endometriosis and actual symptom of pelvic pain to determine the necessity of psychological support. METHODS: A total of 50 women aged 24 to 48 with endometriosis and referring pelvic pain. The prevalence of depression was evaluated by Beck's Depression Inventory adapted to the Brazilian population. RESULTS: It was found that 92% of the subjects presented depressive symptoms, being 56% from moderate to high levels. Although 66% of the women were using hormonal medication to treat endometriosis, there was no significant correlation between the presence of depression and the use of these medications. CONCLUSION: The results showed a high prevalence of depression symptoms in these patients confirming the necessity of psychological support.

Avaliaçäo da freqüência de depressäo em pacientes com endometriose e dor pélvica / Evaluation of the frequency of depression in patients with endometriosis and pelvic pain

OBJETIVO: Avaliar a freqüência de depressäo em pacientes com endometriose e queixa atual de dor pélvica para determinar a necessidade ou näo de atendimento psicológico. MÉTODOS: Participaram deste estudo 50 mulheres com idade entre 24 e 48 anos, com diagnóstico de endometriose e queixa atual de dor pélvica. Para avaliar a prevalência da depressäo, utilizou-se o Inventário de Depressäo de Beck, validado em nosso meio. RESULTADOS: Identificou-se a presença de depressäo em 92 por cento das pacientes avaliadas, sendo 56 por cento de intensidade moderada a grave. Apesar de 66 por cento das pacientes relatarem o uso de medicaçäo, näo foi observada correlaçäo significativa entre a presença de depressäo com o uso de hormônios. CONCLUSÄO: Os resultados demostraram uma alta prevalência de depressäo, justificando-se, assim, a necessidade do atendimento psicológico a essas pacientes

Comorbilidad de los trastornos de la conducta alimentaria y el abuso de sustancias / Comorbidity between eating disorders and substance abuse

Objetivo: los distintos trastornos de la conducta alimentaria presentan diferentes tasas de comorbilidad con uso y abuso de sustancias. La bulimia nerviosa es la enfermedad en la que se han descrito mayor número de trastornos por abuso de sustancias. El objetivo de este estudio es conocer la asociación entre los trastornos de la conducta alimentaria y el uso y abuso de alcohol y otras sustancias psicoactivas y comparar el consumo entre los diferentes tipos de los trastornos de la conducta alimentaria. Material y métodos: en un estudio retrospectivo realizado en Álava (277.000 habitantes) en el único centro de tratamiento intensivo de los trastornos de la conducta alimentaria. Los pacientes fueron evaluados mediante la entrevista semiestructurada SCID-P para el DSM-IV. Se utilizó un detallado cuestionario para recoger historia de uso de drogas o alcohol según criterios DSM-IV. Resultados: se evaluaron un total de 47 pacientes, con una mediana de edad de 18 años. El 55,32 por ciento eran Anorexias Nerviosas Restricitivas (ANR), el 21,28 por ciento Anorexias Nerviosas Purgativas (ANP) y el 23,40 por ciento Bulimias (B). EL 100 por ciento de las pacientes bulímicas consume algún tipo de sustancia, el 60 por ciento de las ANP y el 34,61 por ciento de las ANR. Discusión: los pacientes con ANR tienen patrones de consumo significativamente diferentes a los otros dos grupos, presentando las ANP consumos intermedios. Es necesario hacer estudios para identificar los factores etiológicos de la comorbilidad de estos dos síndromes. Objetivo: los distintos trastornos de la conducta alimentaria presentan diferentes tasas de comorbilidad con uso y abuso de sustancias. La bulimia nerviosa es la enfermedad en la que se han descrito mayor número de trastornos por abuso de sustancias. El objetivo de este estudio es conocer la asociación entre los trastornos de la conducta alimentaria y el uso y abuso de alcohol y otras sustancias psicoactivas y comparar el consumo entre los diferentes tipos de los trastornos de la conducta alimentaria. Material y métodos: en un estudio retrospectivo realizado en Álava (277.000 habitantes) en el único centro de tratamiento intensivo de los trastornos de la conducta alimentaria. Los pacientes fueron evaluados mediante la entrevista semiestructurada SCID-P para el DSM-IV. Se utilizó un detallado cuestionario para recoger historia de uso de drogas o alcohol según criterios DSM-IV. Resultados: se evaluaron un total de 47 pacientes, con una mediana de edad de 18 años. El 55,32 por ciento eran Anorexias Nerviosas Restricitivas (ANR), el 21,28 por ciento Anorexias Nerviosas Purgativas (ANP) y el 23,40 por ciento Bulimias (B). EL 100 por ciento de las pacientes bulímicas consume algún tipo de sustancia, el 60 por ciento de las ANP y el 34,61 por ciento de las ANR. Discusión: los pacientes con ANR tienen patrones de consumo significativamente diferentes a los otros dos grupos, presentando las ANP consumos intermedios. Es necesario hacer estudios para identificar los factores etiológicos de la comorbilidad de estos dos síndromes. (AU)

[Malignant hyperthermia during cataract extraction in an elderly patient]. / Hipertermia maligna durante la extracción de catarata en un anciano.

The case of a 67-year-old patient who suffered an episode of malignant hyperthermia during the extraction of a cataract is described. The outcome was favourable in spite of the lack of sodium dantrolene. Twenty months later the patient was operated on the contralateral eye with local anesthesia presenting no complications. It is worthy of note that the rareness of the syndrome in this age group and in this type of surgery, as well as the probable safeness of local anesthetics in susceptible patients. We also comment on the lack of sodium dantrolene and the nonexistence of a center facilitating information and diagnosis of malignant hyperthermia in our country.