Decompressive craniectomy and brain death prevalence and mortality: 8-year retrospective review.

Decompressive craniectomy (DC) is a surgical practice that has been used since the late 19th century. The cerebral blood flow increase after the performance of a DC can delay and even prevent the development of cerebral circulatory arrest and brain death (BD). We aimed to determine the prevalence of BD, the use of DC, and the evolution to BD with versus without DC. This retrospective, observational, cross-sectional study was performed in a single high-intensity center in Argentina from January 2003 to December 2010. Inclusion criteria were all patients with Glasgow Coma Score of at most 7 on admission or during their stay in the intensive care units. Exclusion criteria were patients with incomplete data. In cases of death, we assessed whether they fulfilled BD criteria or if the cause of death was a cardiac arrest (CA). The 698 patients considered for analysis showed a 60% (n = 418) global mortality rate. The causes were: CA (n = 270); BD (n = 108) and others considered to be "undefined," namely not assessed completely for the diagnosis of BD (n = 40). According to diagnosis category, traumatic brain injury (TBI) was largest (nearly 50%). The DC group (n = 206) showed significant differences regarding sex and diagnosis category versus no DC group. Mortality was significantly lower in this group (48% versus 65%, P < .001). No significant differences were observed comparing causes of death (CA, BD, or undefined). The use of DC did not influence the frequency of BD development (24% versus 26%, P = .72). The average DC rate was 30% and of BD 16%. The prevalence of DC and better survival were recorded compared with subjects without DC. The prevalence of BD was lower than expected in accordance with national registries; however, among our group, DC did not seem to modify the evolution to BD.

[Neutralizing antibodies to 5 HIV-1 strains in macaques immunized with the multi-epitope polypeptide TAB9]. / Anticuerpos neutralizantes frente a 5 cepas de VIH-1 en macacos inmunizados con el polipéptido multiepitópico TAB9.

Presence of neutralizing antibodies(Nab) to 5 laboratory strains of human immunodeficiency virus type-1 (HIV-1) was studied and compared in the sera of eight macaca (Macaca fascicularis) after the third and fourth immunizations with multi-epitope polypeptide TAB9, emulsified with adjuvant Montanide ISA 720. Four animals were inoculated 1 mg and the others 200 micrograms, 2 animals were used as controls and injected only with adjuvant. Although the presence of neutralizing antibodies to homologous strains of HIV-group group B was confirmed in most animals after immunization through antigen p24 capture ELISA (DAVIH-Agp24, Cuba), no statistically significant differences were found neither in titers caused by antigen concentrations nor in the responses after the third and fourth immunizing doses. Controls did not develop neutralizing antibodies.

Intravenous magnesium load test in elderly patients with protein-energy malnutrition.

Forty-two elderly patients were subjected to a nutritional assessment and an intravenous magnesium load (0.5 mmol/kg). After 48 h, patients with protein-calorie malnutrition (PCM) showed magnesium retentions (MgR) above 20 per cent, thus indicating magnesium deficit, and greater (P < 0.001) than those from well-nourished patients. The discriminating cross-point for undernourished patients was at 28 per cent with 95 per cent sensibility and specificity. There were significant correlations between MgR and most nutritional parameters. An increase of the RMg constitutes a PCM indicator which may be useful to quantify it.

[Evaluation of the efficacy of naltrexone in alcoholism by the determination of serum carbohydrate-deficient transferrin]. / Evaluación de la eficacia de Naltrexona en la dependencia alcohólica mediante determinación sérica de transferrina deficiente en carbohidratos.

Naltrexone (NTX) has been shown to be a useful drug for the treatment of alcohol dependence (AD). Carbohydrate-deficient transferrin (CDT) in serum is a new biologic marker of alcohol abuse. To evaluate the efficacy of NTX (50 mg/d) in AD, a group of 20 alcoholics with CDT > 20 U/l was studied using monthly laboratory tests (CDT, ESR, AST, ALT, GGT) and specific psychological testing (CAGE). After the second month statistically significant differences in CDT levels were found. By the end of the study, 13 patients (responders) had normalized their CDT levels. There was no correlation between CDT values and the other laboratory markers. The difference in routine laboratory markers between responders and non responders was not significant. NTX was well tolerated by all the patients and significant alcohol abstinence was achieved. CDT was demonstrated to be a effective marker for the evaluation of alcoholic abstinence during treatment with NTX. Superior results were obtained in comparison with the routine customary markers for AD.

Identification of blood meals of Phlebotomus perniciosus (Diptera: Psychodidae) in Spain by a competitive enzyme-linked immunosorbent assay biotin/avidin method.

Blood meals from Phlebotomus perniciosus Newstead, collected in four different places in Spain, were identified to determine host-selection patterns. Blood meals were tested using a competitive enzyme-linked immunosorbent assay (ELISA) biotin-avidin method. Results indicate that this species is an opportunist that feeds on those animals to which it has easiest access. However, some preferences were indicated, because the insect never fed on chickens and frequently fed on sheep at sites where both sheep and goats were present. At some sites, the number of sand flies feeding on dogs was higher than expected, based on the proportion of dogs to man. Nevertheless, differences in host behavior, dispersal of engorged sand flies, and their exo- or endophilic habits make it difficult to assign specific host preferences.

[Neck pyomyositis associated with polymicrobial sepsis of sinusal origin]. / Piomiositis cervical asociada a sepsis polimicrobiana de origen sinusal.

Spontaneous pyomyositis (primary pyomyositis) is an infrequent disease in non-tropical countries, caused by bacterial infection of skeletal muscle. Although pyomyositis is associated in many cases to septicemia, the occurrence of that disease as a secondary manifestation of bacteremia is very unusual, requiring a high-grade index of suspicion to diagnose it in the early stages. We present one case of cervical pyomyositis, caused by Fusobacterium necrophorum and group F streptococcus, during the course of a sepsis of sinusal origin, that was treated without surgical therapy. This so uncommon form of presentation of Fusobacterium septicemia, its diagnosis and treatment are discussed.

[Multiple paraganglioma]. / Paranganglioma múltiple.

Paragangliomas are tumors of the chromaffin system producing catecholamines and both the adrenal extra-adrenal type have a common origin at the neural crest, which has been supported by the similarities of the paraganglions both from a histological and functional perspective. Most of the extra-adrenal paragangliomas are bending and non-functional. In addition, they are usually confined to just one site. We present the case of a young patient with benign multiple paraglanglioma in two different locations, juxtahepatic and juxtacarotic (Chemodectoma) and, thus, far away from each other. The extra-abdominal location is very rare, with a frequency lower than 2%. In addition, one of paraganglions was functional and the other one was not. Initially, a surgical intervention was performed on the functional abdominal tumoration and latter, another intervention was performed at the cervical level, both with excellent results. We also highlight the good response to the postoperative therapy with Prazosin.

[Pseudometastatic hepatic lesions and Kikuchi necrotizing lymphadenitis]. / Lesiones hepáticas seudometastásicas y linfadenitis necrotizante de Kikuchi.

Kikuchi's necrotizing lymphadenitis (KNL) is a benign disease of unknown etiology affecting lymphatic nodes and some times extranodal organs. We present a case of KNL with hepatic lesions simulating metastatic liver disease.

[Thymidine kinase: a serum marker in clinical medicine]. / Timidina quinasa: un marcador sérico en medicina clínica.

The need for new seric markers of tumoral or viral activity to enable an early diagnosis or staging has brought about a proliferation of research in new markers. The deoxi-thymidine-kinase (DTK) is an enzyme of DNA synthesis during cellular proliferation. We review the literature, concluding that DTK is a good seric marker in some neoplasias and some viral diseases because of its specificity, low cost and rapid testing in multiple samples.