[Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak]. / Complicaciones postquirrgicas de la malformación de Chiari tipo I: duroplastia y fístula de líquido cefalorraquídeo.

UNLABELLED: The surgical treatment of Chiari I malformation is to carry out a suboccipital decompression. It is described that postoperative complications may occur, especially if the dura is open and closed using a graft (duraplasty). Among them, one of the most important events due to its difficult handling is cerebrospinal fluid leak through the suture line. OBJECTIVE: To conduct a postoperative review to analyze the outcome of the patients and the occurrence of complications depending on the dural plasty used. MATERIAL AND METHODS: A retrospective study was carried out between 1997 and 2008, both inclusive, where we assessed 36 patients. All of them were studied with preoperative and postoperative craniospinal magnetic resonance, and by a thorough clinical examination performed before and after the surgery. The surgical procedure consisted of suboccipital decompression and resection of the posterior arch of C1 or C1 and C2 (depending on the extent of the caudal displacement of the tonsils), followed by duraplasty using either an autologous graft (pericranium) or a synthetic graft (Gore-tex). RESULTS: After a mean follow-up of 2 years, the clinical results were: excellent (55%), if there was a great clinical improvement; good (29%), if there was slight improvement; and bad (16%), if there was no improvement or there was worsening. In the 30 patients given a duraplasty (18 with an artificial graft, 12 with an autologous pericranium graft), 6 cases of cerebrospinal fluid leak appeared, although no significant association between the type of dural plasty and the presence of leak was observed. CONCLUSIONS: The best results were obtained for headaches, cervical pain and dizziness. Despite the fact that there were more cases of cerebrospinal fluid leak in patients receiving an artificial graft compared to patients with pericranium graft, there was no significant difference.

The photocatalytic enhancement of acrylic and PET solar water disinfection (SODIS) bottles.

The solar water disinfection method (SODIS) was modified by the addition of a photocatalytic layer of titania on the interior surface of polyethylene terephthalate (PET) and acrylic bottles. Titania was solvent deposited on the interior of commercially available PET bottles, as well as bottles that were constructed from acrylic. Uncoated and titania-coated acrylic bottles removed 3,000,000-5,000,000 colony forming units per milliliter of K12 E. coli from 670 mL of contaminated water in 40 min of solar irradiance. After five hours of sunlight exposure, the concentration of 10 ppm methyl orange (a representative organic water contaminant), was reduced by 61% using the titania-coated acrylic bottles. The concentration of 87 ppb microcystin-LR (a representative algal toxin) was reduced by 70% after 7 hours of sunlight exposure in the titania-coated acrylic bottles. Acrylic is an effective alternative to PET for use in the SODIS method due to its greater UV transparency. The addition of titania to PET and acrylic bottles confers the ability to remove chemical contaminants in addition to inactivating microbiological contaminants.

Complicaciones postquirúrgicas de la malformación de Chiari tipo I: duroplastia yfístula de líquido cefalorraquídeo / Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak

El tratamiento quirúrgico de la malformación deChiari tipo I consiste en realizar una descompresiónósea suboccipital. Está descrito que pueden producirsecomplicaciones derivadas de la cirugía, sobre todo sise realiza apertura dural y posterior cierre con injerto(duroplastia). Una de las más importantes por su difícilmanejo, es la fístula de líquido cefalorraquídeo en lazona quirúrgica.Objetivo. Llevar a cabo una revisión postquirúrgica,donde analizaremos la evolución de los pacientes y lacorrelación de las complicaciones respecto al tipo deplastia dural usada.Material y métodos. Se ha realizado un estudio retrospectivode los pacientes intervenidos en nuestro centroentre el año 1997 y 2008, ambos inclusive, recogiendoun total de 36 pacientes. A todos ellos se les realizó unestudio pre y postoperatorio con resonancia magnéticacraneoespinal, así como un examen neurológico antes ydespués de la intervención. La intervención quirúrgicaconsistió en una descompresión ósea suboccipital, juntocon la extirpación del arco posterior de C1 o C2 (dependiendodel descenso amigdalar), y duroplastia coninjerto autólogo (pericráneo) o con injerto heterólogo(Gore-tex).Resultados. Tras un seguimiento medio de 2 añosobtuvimos los siguientes resultados clínicos: excelente(55%), si hubo gran mejoría clínica; bueno (29%), sihubo leve mejoría; y malo (16%), si no hubo mejoría ohubo empeoramiento. En los 30 pacientes a los que seles realizó duroplastia (18 plastia artificial, 12 plastiaautóloga de pericráneo occipital), (..) (AU)

The surgical treatment of Chiari I malformation is tocarry out a suboccipital decompression. It is describedthat postoperative complications may occur, especiallyif the dura is open and closed using a graft (duraplasty).Among them, one of the most important events due toits difficult handling is cerebrospinal fluid leak throughthe suture line.Objective. To conduct a postoperative review toanalyze the outcome of the patients and the occurrenceof complications depending on the dural plasty used.Material and methods. A retrospective study wascarried out between 1997 and 2008, both inclusive,where we assessed 36 patients. All of them were studiedwith preoperative and postoperative craneoespinalmagnetic resonance, and by a thorough clinical examinationperformed before and after the surgery. Thesurgical procedure consisted of suboccipital decompressionand resection of the posterior arch of C1 or C1 andC2 (depending on the extent of the caudal displacementof the tonsils), followed by duraplasty using either anautologous graft (pericranium) or a synthetic graft(Gore-tex).Results. After a mean follow-up of 2 years, the clinicalresults were: excellent (55%), if there was a great (..) (AU)

Transfer factors as immunotherapy and supplement of chemotherapy in experimental pulmonary tuberculosis.

Problems of logistics, compliance and drug resistance point to an urgent need for immunotherapeutic strategies capable of shortening the current six month antibiotic regimens used to treat tuberculosis. One potential immunotherapeutic agent is transfer factors. Transfer factors (TF) are low molecular weight dialysable products from immune cells which transmit the ability to express delayed-type hypersensitivity (DTH) and cell mediated immunity from sensitized donors to nonimmune recipients. In this study we determined the efficiency of TF as immunotherapy to treat experimental tuberculosis. When BALB/c mice are infected via the trachea with Mycobacterium tuberculosis H37Rv there is an initial phase of partial resistance dominated by Th-1 type cytokines plus tumour necrosis factor-alpha (TNFalpha) and the inducible isoform of nitric oxide synthase (iNOS), followed by a phase of progressive disease characterized by increasing expression of IL-4, diminished expression of TNFalpha and iNOS, and low DTH. Animals in this late progressive phase of the disease (day 60) were treated with different doses of TF (one injection per week) obtained from spleen cells when the peak of immune protection in this animal model is reached (day 21), or with different doses of TF from peripheral leucocytes of PPD + healthy subjects. We show here that the treatment with murine or human TF restored the expression of Th-1 cytokines, TNFalpha and iNOS provoking inhibition of bacterial proliferation and significant increase of DTH and survival. This beneficial effect was dose dependent. Interestingly, murine TF in combination with conventional chemotherapy had a synergistic effect producing significant faster elimination of lung bacteria loads than chemotherapy alone.

Effect of continued treatment with timolol maleate on corneal endothelium: a fluorophotometric study.

PURPOSE: To verify whether the long-term use of timolol maleate is toxic for the corneal endothelium and whether the treatment time is a predisposing factor. METHODS: We used fluorophotometry to study 40 eyes that had been treated with timolol maleate uninterruptedly during a prolonged time (from 6 months to 14 years). The results obtained were compared with a sample of 40 hypertensive eyes that had not received any treatment. RESULTS: No statistically significant differences were found between the coefficient values of endothelial permeability between the treated and nontreated subjects. In addition, no differences were found in the coefficient of endothelial permeability between subjects treated with timolol in different treatment periods (between 6 and 12 months, between 1 and 5 years, and for > 5 years). CONCLUSION: These results suggest that long-term treatment with timolol has little effect on the integrity of the corneal endothelium.

Comparative study of three methods of evaluation of the corneal endothelium in pseudophakic patients: fluorophotometry, specular microscopy and pachymetry.

BACKGROUND: At present, three techniques, based on different methodological suppositions, are used indiscriminately for the study of the corneal endothelium. These are pachymetry, specular microscopy and fluorophotometry. The purpose of this work was to study the corneal endothelium of pseudophakic patients with the three techniques mentioned. On the basis of the results obtained, we discuss the relations between them and their practical clinical utility. METHODS: One hundred and fourteen eyes of pseudophakic patients were studied using the three corneal endothelial evaluation techniques, both in the immediate pre-operative period and 1 year after surgery. RESULTS: Statistically significant relations exist between the number of endothelial cells and the fluorophotometric endothelial permeability coefficient (Kc.ca) 12 months after surgery, between the increase in corneal thickness in the first week after the operation and the Kc.ca 12 months after surgery, and between fluctuations of the corneal thickness greater than 30 microns and both the endothelial cell count and the Kc.ca 12 months after surgery. There are no significant relationships among the pre-operative values obtained with the three methods. CONCLUSION: The results show how the parameters measured with the functional techniques (fluorophotometry, pachymetry) generally become normal after the surgical trauma, while the endothelial cell count remains irreversibly altered. The results obtained with different techniques are more closely related in more pathological endothelia, while no relation among them are shown in the study of normal endothelia. It is also shown how pachymetry is a good clinical predictor, in the immediate post-operative period, of the long-term status of the corneal endothelium.

Study of lens autofluorescence by fluorophotometry in pregnant patients with diabetes.

PURPOSE: Lens autofluorescence originates from an accumulation of fluorescent substances such as the tryptophan-derived residues and glycosylated protein aggregations, which are associated with the process of cataractogenesis and lens aging. The purpose of this investigation is to determine whether pregnancy alters the typical constituents of the lens autofluorescence in patients with diabetes and, if so, to what degree this may occur. METHODS: Lens autofluorescence was studied with fluorophotometry in 127 eyes of 72 individuals: 23 control subjects, 6 healthy pregnant women, 21 patients with diabetes, and 44 pregnant patients with diabetes. RESULTS: The autofluorescence values were 311 +/- 130 ng/ml, 253 +/- 40 ng/ml, 378 +/- 110 ng/ml, and 562 +/- 164 Eq ng/ml (Eq ng/ml = Ng/ml equivalent fluorescein) in the four groups, respectively. The difference between the nonpregnant and pregnant patients with diabetes was significant (P < 0.001). CONCLUSION: These results suggest that there is an important deterioration in the metabolic state of the lens during gestation in patients with diabetes, as is the case for diabetic retinopathy.

Determination of the pseudofacility by fluorophotometry in the human eye.

PURPOSE: Pseudofacility (decrease in aqueous humor flow in response to increase in the intraocular pressure (IOP)) has been evaluated in animals and in humans by a combination of different techniques that seriously alter the ocular physiology, such as the cannulation of the eyeballs, use of radioactive isotopes, perilimbic suction cups or tonography. Very different results have been obtained. Our objective is to relate the value of the aqueous humor flow in humans (as measured by fluorometry) with IOP. In order to obtain the widest range of IOP possible, we have performed this study in both normal as well as glaucoma patients. METHODS: 48 eyes were studied, corresponding to 31 subjects (mean age 58 +/- 14 years). Of these, 21 corresponded to normal subjects and 27 to glaucoma patients. The aqueous humor flow (F) was determined by fluorophotometry (Protocol of Yablonsky) and the IOP was measured thereafter. RESULTS: The mean value of F was 2.1 +/- 0.5 microliter/min for healthy eyes and 2.2 +/- 0.7 microliter/min for glaucoma-affected eyes. The values were not different (p > 0.1). The mean value of the IOP was 15.3 +/- 3.1 mmHg in the normal population and 22.1 +/- 4.3 mmHg in the glaucoma patients. A linear relationship between F and IOP was found (r = -0.41, p < 0.05, decrease in F = 0.081 microliter min-1 mmHg-1). CONCLUSIONS: The value of the pseudofacility in the humans can be estimated at 0.081 microliter min-1, mmHg-1, which constitutes 27% of the total outflow facility. This figure also makes it possible to estimate the role of the ultrafiltration in blood in the production of the aqueous humor since it is assumed that active secretion is pressure-independent. The results obtained are concordant with a secondary but no unimportant role of the plasmatic ultrafiltration with respect to the active secretion.

New feather mite species of Aralichus (Acarina, Pterolichidae) from the white-capped parrot, Pionus senilis (Spix).

Two new feather mite species of Aralichus Gaud (Pterolichoidea, Pterolichidae) are described from the white-capped parrot Pionus senilis (Spix): Aralichus elongatus and Aralichus menchacai. Immature instars and host-parasite associations are discussed.