RESUMEN
This study evaluated the presence and extent of contamination with Legionella spp. in the hot water distribution systems of three hospitals in Catania (Italy). In total, 291 hot water samples were collected between September 2002 and August 2005 and these were examined in order to monitor the hospital distribution systems and evaluate the efficacy of decontamination measures. L. pneumophila was detected at variable concentrations up to over 10000 UFC/L at several collection sites in some hospital buildings and branches of the water distribution system while other buildings/branches were found to be free of contamination. The most frequently isolated serogroup was L. pneumophila serogroup 3, occasionally associated with serogroups 4, 5 and 6. Molecular typing of Legionella strains by pulsed-field gel electrophoresis of genomic DNA restriction fragments identified four different genotypes, each recovered from a different branch of the distribution system. Decontamination procedures, including shock hyperchloration and two different thermal shock methods, performed between October 2003 and August 2005, led to only temporary reductions in contamination. In fact, previous concentrations of the same L. pneumophila serogroup were found within 3 to 8 months of decontamination. In order to prevent and monitor Legionella infections, sterilizing filters were installed in water taps of all wards with high-risk patients and urinary antigen testing was performed on all patients diagnosed with nosocomial pneumonia. No cases of Legionella pneumonia were identified in 2005.
Asunto(s)
Hospitales , Calor , Legionella/aislamiento & purificación , Microbiología del Agua , Abastecimiento de Agua/normas , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Descontaminación/métodos , Humanos , Legionella/clasificación , Enfermedad de los Legionarios/prevención & control , Estudios Retrospectivos , SiciliaRESUMEN
Cystic malformations of the posterior cranial fossa are all but arachnoid cysts contained within the general context of the Dandy-Walker complex and may be further classified in two groups on the basis of their embryological origin: anomalies of the anterior membranous area (AMA) and anomalies of the posterior membranous area (PMA). Whether the latter group of malformations can be regarded as separate entities is still quite controversial. The present authors give a detailed account of the various embryological stages in the formation of the posterior cranial fossa and its contents and propose the identification of two anomalies derived from a defect of the PMA: the mega cisterna magna (MCM) and the persisting Blake's pouch, a new entity with different MRI features from MCM. Criteria for their recognition are discussed, stressing the capital importance of a differential diagnosis in view of the radically different therapeutic approach.
Asunto(s)
Fosa Craneal Posterior/anomalías , Quistes/clasificación , Quistes Aracnoideos/patología , Preescolar , Cisterna Magna/anomalías , Cisterna Magna/patología , Fosa Craneal Posterior/embriología , Fosa Craneal Posterior/patología , Síndrome de Dandy-Walker/diagnóstico , Diagnóstico Diferencial , Humanos , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVE AND DESIGN: The authors report the outcome of early treatment with long-term external ventricular drainage (EVD) of progressive post-hemorrhagic ventricular dilatation (PPHVD), following peri-intraventricular hemorrhage (PIVH) in a population of preterm newborns. SETTING: Neonatal Intensive Care Unit (NICU) of a Children's Hospital. PATIENTS: Twenty-one preterms of 29.6 +/- 2.4 weeks of gestational age, weighing at birth 1443 +/- 445 g, mechanically ventilated, submitted to early EVD because of PPHVD following PIVH of III (n 11) e IV (n 10) grade. METHODS: PPHVD was diagnosed on the basis of US and TC findings. An external liquoral drainage suitable, for its technical characteristics, to be maintained for a long period of time and peculiar anesthesiologic, intra and postoperative treatments were utilized. RESULTS: EVD was placed at 21 +/- 5.8 days of life and maintained for 40 +/- 16 days. In all cases reduction of ventricular size was observed. One case (5%) developed liquoral infection and recovered with antibiotic therapy. No obstruction or dislocation of the ventricular catheter occurred. During EVD 3 patients (14%) died because of respiratory complications. After the normalization of cerebrospinal fluid (CSF), a "permeability test" was performed to assess the canalization of the liquoral system. Seven patients (33.5%) underwent ventriculo-peritoneal shunt (VPS) and 11 (52.5%) became shunt-free. CONCLUSIONS: Our results indicate that long-term use of EVD has a low risk of complications, avoids the need for transcutaneous tips and allows monitoring of CSF characteristics. Furthermore EVD protects the brain from liquoral hypertension, while waiting for a possible recurrence of natural CSF circulation, and is associated with a low number of definitive VPS.
Asunto(s)
Hemorragia Cerebral/complicaciones , Hidrocefalia/cirugía , Enfermedades del Prematuro/cirugía , Ventriculostomía , Femenino , Humanos , Hidrocefalia/etiología , Recién Nacido , MasculinoRESUMEN
The authors describe a new instrumentation for repositioning of the Brown-Roberts-Wells (BRW) stereotaxic system, useful for precise fractionated radiotherapy. A lucite ring is fixed to the patient's skull with four screws. Another ring, partially open, is then firmly connected co-axially to the lower part of the first one with four spacer-bars. The fixture permits an exact repositioning of the B.R.W. stereotaxic system, placing the target point in the linear accelerator isocenter. The preliminary technical results obtained in five children are reported and the fixture performance, advantages, and perspectives are discussed.
Asunto(s)
Neoplasias Encefálicas/cirugía , Malformaciones Arteriovenosas Intracraneales/cirugía , Radiocirugia/instrumentación , Técnicas Estereotáxicas/instrumentación , Diseño de Equipo , HumanosAsunto(s)
Antibacterianos/administración & dosificación , Infecciones Bacterianas/terapia , Enfermedades del Sistema Nervioso Central/terapia , Defectos del Tubo Neural/complicaciones , Adolescente , Antibacterianos/farmacocinética , Infecciones Bacterianas/complicaciones , Enfermedades del Sistema Nervioso Central/complicaciones , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Niño , Preescolar , Terapia Combinada , Drenaje , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/complicaciones , Meningitis/terapiaAsunto(s)
Infecciones Bacterianas/cirugía , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Drenaje/métodos , Infecciones Bacterianas/etiología , Ventrículos Cerebrales , Preescolar , Drenaje/instrumentación , Estudios de Evaluación como Asunto , Humanos , Lactante , Resultado del TratamientoAsunto(s)
Enfermedades del Sistema Nervioso Central/microbiología , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/terapia , Candidiasis/terapia , Enfermedades del Sistema Nervioso Central/terapia , Niño , Humanos , Incidencia , Lactante , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/terapia , Estudios RetrospectivosAsunto(s)
Absceso Encefálico , Empiema Subdural , Adolescente , Absceso Encefálico/diagnóstico , Absceso Encefálico/microbiología , Absceso Encefálico/terapia , Niño , Preescolar , Empiema Subdural/diagnóstico , Empiema Subdural/microbiología , Empiema Subdural/terapia , Femenino , Humanos , Lactante , Masculino , Resultado del TratamientoRESUMEN
The authors describe a new method for reproducible, non-invasive fixation of a stereotaxic localizing frame. A localizing system similar to that of Brown-Roberts-Wells for MR can be fixed at the base of the facial skeleton to the upper dental arch by an orthodontic resin plate. Results of trials with CT scan, advantages and disadvantages are discussed. The new fixture could be employed in open surgery and in fractionated radiotherapy.
Asunto(s)
Aparatos Ortodóncicos Removibles , Resinas Sintéticas , Técnicas Estereotáxicas/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Mapeo Encefálico/instrumentación , Humanos , Modelos AnatómicosRESUMEN
Surgery of the dorsolumbar spine is currently benefiting from diverse approaches and the advent of computed tomography. This report describes a bilateral posterolateral approach with transversoarthropediculectomy and corporectomy. The advantages and disadvantages of this approach and its indications are discussed.
Asunto(s)
Enfermedades de la Columna Vertebral/cirugía , Femenino , Humanos , Masculino , Métodos , Persona de Mediana EdadRESUMEN
A large casistic of severe CNS infectious diseases in pediatric age was reviewed to underline mean clinic, EEG features and correlated them with CT images. We conclude that CT scanning is useful in CNS infectious diseases, above all in the first life years, because it can provide diagnostic and prognostic information and sometimes therapeutic indication.
Asunto(s)
Meningoencefalitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Infecciones Bacterianas/complicaciones , Varicela/complicaciones , Niño , Preescolar , Electroencefalografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Sarampión/complicaciones , Meningoencefalitis/etiología , Pronóstico , Toxoplasmosis Congénita/complicacionesRESUMEN
The transclival-transcervical approach to lesions of the craniocervical junction is described. It gives reasonable access to the lower part of the clivus and to C1 and C2 for removal to tumours and stabilization of fractures and otherwise caused dislocations of this region. Because an opening of the pharynx can be avoided, reconstruction work can be done using bone graft or reinforced methyl-methacrylate without risk of infectious contamination. The results obtained in 6 cases are presented.
Asunto(s)
Vértebras Cervicales/cirugía , Enfermedades de la Columna Vertebral/cirugía , Anciano , Artritis Reumatoide/cirugía , Vértebras Cervicales/lesiones , Cordoma/cirugía , Femenino , Estudios de Seguimiento , Humanos , Luxaciones Articulares/cirugía , Masculino , Apófisis Odontoides/lesiones , Apófisis Odontoides/cirugía , Plasmacitoma/cirugía , Prótesis e Implantes , Seudoartrosis/cirugía , Compresión de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/cirugíaRESUMEN
Lumbar surgery is currently benefiting from the development of anterior approaches to the spine and the possibilities of anterior arthrodesis. The transperitoneal approach is being replaced more often by an extraperitoneal approach that enables anterior access to the spine. The authors report an anterointernal approach to the lumbar spine.
Asunto(s)
Vértebras Lumbares/cirugía , Fijación de Fractura , Humanos , Ilion/trasplante , Vértebras Lumbares/lesiones , Peritoneo/cirugía , Enfermedades de la Columna Vertebral/cirugía , Fusión VertebralRESUMEN
The Authors report their experience using Harrington rods with segmental wiring for spinal pathology. They describe the advantages of this technical point in neoplastic and traumatological dorsal compression.