Reagent strips in the evaluation of cerebrospinal fluid glucose levels

The value of Visidex IIR, Haemo-Glukotest 20-800RR, MultistixR and DextrostixR reagent strips--the latter alone or in combination with a glucometer--in the determination of cerebrospinal fluid (CSF) glucose levels has been evaluated and compared with the results of a standard glucose oxidase method (Beckman). Fifty-four CSF specimens were evaluated and the closest correlation (r = 0.8002) obtained by the use of DextrostixR in combination with a glucometer. All four methods detected two cases with very low CSF glucose values (less than 1.5 mmol/l) but confusing results were obtained in three cases having slightly reduced CSF glucose values (2.0-2.2 mmol/l).     

病毒性脑炎患儿脑脊液和血清神经元特异性烯醇酶测定的临床意义

目的　探讨血清及脑脊液 (CSF)神经元特异性烯醇酶 (NSE)水平与脑损伤的关系及其临床意义。方法　用酶联免疫分析法分别测定 32例病毒性脑炎及 12例对照组患儿血清和CSF中NSE含量。结果　病毒性脑炎组血清和CSF中NSE含量分别为 13.87± 6 .93μg/L ,2 7.5 2± 18.31μg/L ;对照组为 6 .6 0±2 .5 9μg/L,9.5 9± 3.5 6 μg/L ,两组比较有显著性差异 (P <0 .0 1)。血清NSE与CSF中NSE水平呈正相关 (r =0 .4 35　P <0 .0 5 )。CSF中NSE与血清NSE含量预测脑损害程度的敏感性分别为 90 .6 %及 78.1%。结论　血清和CSF中NSE含量增高尤其后者增高可作为评估急性脑损伤严重程度的指标之一     

手术前抗肿瘤药物VCA联合化疗对小鼠伤口拉力的影响

目的 探讨手术前抗肿瘤药物联合化疗对小鼠伤口愈合的影响,以寻找联合化疗后最佳手术时机。方法 实验小鼠设４组,每组４０只,Ａ组为对照经且,Ｂ、Ｃ、Ｄ组为化疗后不同时间的实验组,给予ＶＣＡ联合化疗,分别于化疗后０ｄ、７ｄ和１４ｄ在背部做相同切口并缝合,所有小鼠术后７处死,愈合伤口做拉力实验。结果 Ｂ组与其他３组比较差异有显著意义（Ｐ〈０．０５）,而Ａ、Ｃ、Ｄ组之间有显著意义（Ｐ〈０．０５）,Ｂ组与Ａ组     

Normal cerebrospinal fluid values in children: another look

Cerebrospinal fluid samples sterile for virus and bacteria from 371 patients who had no evidence of CNS pathology were examined. The patients were divided into five age categories. The white blood cell polymorphonuclear, and mononuclear cell counts were evaluated. The frequency distributions for these cell counts were markedly skewed, so values were calculated as percentiles for each age group. WBC values were highest for CSF obtained from patients in younger age categories, but 25% of patients from all age categories had two or three WBCs in their CSF. Patients from all but the 3- to 6-month category had three polymorphonuclear cells in their CSF 5% of the time. There was no significant difference in CSF WBC count between patients who had seizures and those who did not. Knowledge of normal values in different age groups is needed for the interpretation of CSF findings, but it should be used in conjunction with other clinical and laboratory findings.     

Effect of inhaled nitric oxide on cerebrospinal fluid and blood nitrite concentrations in newborn lambs

Inhaled nitric oxide (iNO) has many extrapulmonary effects. As the half-life of nitric oxide (NO) in blood is orders of magnitude less than the circulation time from lungs to the brain, the mediator of systemic effects of iNO is unknown. We hypothesized that concentrations of nitrite, a circulating byproduct of NO with demonstrated NO bioactivity, would increase in blood and cerebrospinal fluid (CSF) during iNO therapy. iNO (80 ppm) was given to six newborn lambs and results compared with six control lambs. Blood and CSF nitrite concentrations increased 2-fold in response to iNO. cGMP increased in blood but not CSF suggesting brain guanylate cyclase activity was not increased. When sodium nitrite was infused i.v. blood and CSF nitrite levels increased within 10 min and reached similar levels of 14.6 +/- 1.5 microM after 40 min. The reactivity of nitrite in Hb-free brain homogenates was investigated, with the findings that nitrite did not disappear nor did measurable amounts of s-nitroso, n-nitroso, or iron-nitrosyl-species appear. We conclude that although nitrite diffuses freely between blood and CSF, due to its lack of reactivity in the brain, nitrite's putative role as the mediator of the systemic effects of iNO is limited to intravascular reactions.     

Effect of age on cerebrospinal fluid levels of metabolites of biopterin and biogenic amines

We identified an age effect on biopterin and biogenic amine metabolites in the cerebrospinal fluid from 56 neurologically normal patients, aged 1 mo to 80 y. The levels of total and reduced forms of biopterin, homovanillic acid, and 5-hydroxyindoleacetic acid were found to peak during the first year of life. The levels of these metabolites then gradually decreased, plateauing at the age of 20 y. We found significant correlations between biopterin, homovanillic acid, and 5-hydroxyindoleacetic acid.     

Measurement of cerebrospinal fluid output through external ventricular drainage in one hundred infants and children: correlation with cerebrospinal fluid production

OBJECTIVE: Cerebrospinal fluid (CSF) production rates influence shunt design and the care of children with hydrocephalus. Measurement of hourly CSF output through external ventricular drainage (EVD) reflects the CSF production. In the present study, hourly CSF outputs in children with hydrocephalus were measured while they were treated with EVD and correlated with the age, sex and body weight of the patients as well as other clinical parameters. METHODS: One hundred children with hydrocephalus due to various causes had EVD treatment. Twenty-six had EVD on two or three separate occasions; thus, the CSF output measurements were observed and analyzed on the basis of 130 EVDs. The most common reason for EVD treatment was shunt infection (n = 75). The duration of EVDs ranged from 25 to 774 h (mean 269 h). The height of the drip chamber from the mid-head position ranged from 0 to 23 cm (mean 9.8 cm). The hourly CSF output was analyzed according to the patient's age, sex and body weight as well as the presence of CSF infection. RESULTS: The hourly CSF output rapidly increases during the first year of life. By the second year, it reaches 64% of the hourly CSF output of 15-year-old children. The mean hourly output ranged from 0.1 to 26.5 ml/h (mean 8.1 ml/h), with the standard deviation ranging from 0.4 to 10.8 ml/h (mean 5.2 ml/h). A regression analysis indicated that the age and body weight appeared to correlate with the hourly CSF output. Using the natural logarithm of age, body weight and sex, these predictors accounted for 50.9% of the variability in hourly CSF output. The regression equation is as follows: hourly CSF output = 2.78 - 2.23(male = 0, female = 1) + 0.97 log(age in years) + 2.26 log(body weight in kg). R sd = 3.36, R(2) = 0.509. The type of infecting organism and the height of EVD did not influence the overall CSF output. CONCLUSION: The hourly CSF output fluctuates, but the CSF output increases logarithmically with age and body weight. The gender also influences the CSF output, with males having a greater output than females. The data produced by the present study will help us to understand CSF production rates in developing children. They will also help us in the care of children receiving EVD treatment, as well as in selecting and designing shunt systems.     

地塞米松对脑膜炎家兔脑脊液中血管内皮生长因子质量浓度变化的影响

目的 探讨地塞米松(DEX)对脑膜炎家兔脑脊液(CSF)中血管内皮生长因子(VEGF)质量浓度变化的影响,为临床应用DEX辅助治疗脑膜炎提供理论依据.方法 家兔36只,随机分为模型组、DEX处理组和对照组.于注射大肠埃希菌悬液后6、12及24 h采用双抗夹心ELISA法定量检测兔CSF中VEGF的质量浓度.结果 模型组6、12及24h CSF中VEGF质量浓度[(1 219±176)ng/L、(1 343±160)ng/L、(981±134)ng/L]明显高于同时相对照组[(374±172)ng/L、(370±169)ng/L、(367±171)ng/L],差异有非常显著性(P<0.01);脑组织含水量高于对照组[(80.8±0.5)%vs(80.0±0.5)%],差异有非常显著性(P<0.01);脑组织含水量与24 h CSF中VEGF质量浓度呈正相关(r=0.919,P<0.01).DEX处理组6、12及24 h CSF中VEGF质量浓度[(941±147)ng/L、(1 083±123)ng/L、(825±66)ng/L]低于同时相模型组,差异有显著性(P<0.05),脑组织含水量(80.4±0.5)%低于模型组,差异有显著性(P<0.05).结论 细菌性脑膜炎病程中VEGF分泌增多,VEGF参与脑水肿形成;DEX通过抑制VEGF表达和(或)分泌,减轻血脑屏障损害,抑制脑水肿形成.     

地塞米松对脑膜炎家兔脑脊液中血管内皮生长因子质量浓度变化的影响

Objective To investigate the effects of dexamethasone (DEX) on vascular endothelial growth factor( VEGF) in cerebrospinal fluid of rabbits with bacterial meningitis. Methods A total of 36 rabbits were assigned to study,which were randomly divided into meningitis model group (MOD) .dexametha-sone-treated group (DEXT) and control group( CON). CSF was sampled for determining at 6 h, 12 h and 24 h after injection of E. coli suspension. The concentration of VEGF in every CSF sample was determined quantitatively by ELISA. Results There were higher concentrations of CSF VEGF at6h,12h and 24hin M0D(( 1219 ±176) ng/L,( 1343 ±160) ng/L,(981 ±134) ng/L) than that in CON( (374 ±172) ng/L, (370 ± 169) ng/L,(367 ± 171) ng/L) (P<0.01). There was higher brain water content in M0D( (80.8 ± 0.5) % ) than that in CON( (80.0 ± 0.5) % ) (P < 0.01). There was positive correlation between the brain water content and the concentration of CSF VEGF at 24 h( r - 0.919,P < 0.01). Compared with MOD, the concentrations of CSF VEGF in DEXT at 6 h, 12 h,24 h ((941 ±147) ng/L, (1083 ± 123) ng/L, (825 ± 66) ng/L) were decreased significantly(P <0.05), the brain water content was less ((80.4 ±0.5) %) (P < 0.05). Conclusion The secretion of VEGF markedly increases in the pathological process of bacterial meningitis. VEGF contributes to the damage of blood brain barrier and the formation of brain edema. DEX can decrease the degree of brain edema by suppressing the generation of VEGF and lightening the damage of blood brain barrier.     

地塞米松对脑膜炎家兔脑脊液中血管内皮生长因子质量浓度变化的影响

Objective To investigate the effects of dexamethasone (DEX) on vascular endothelial growth factor( VEGF) in cerebrospinal fluid of rabbits with bacterial meningitis. Methods A total of 36 rabbits were assigned to study,which were randomly divided into meningitis model group (MOD) .dexametha-sone-treated group (DEXT) and control group( CON). CSF was sampled for determining at 6 h, 12 h and 24 h after injection of E. coli suspension. The concentration of VEGF in every CSF sample was determined quantitatively by ELISA. Results There were higher concentrations of CSF VEGF at6h,12h and 24hin M0D(( 1219 ±176) ng/L,( 1343 ±160) ng/L,(981 ±134) ng/L) than that in CON( (374 ±172) ng/L, (370 ± 169) ng/L,(367 ± 171) ng/L) (P<0.01). There was higher brain water content in M0D( (80.8 ± 0.5) % ) than that in CON( (80.0 ± 0.5) % ) (P < 0.01). There was positive correlation between the brain water content and the concentration of CSF VEGF at 24 h( r - 0.919,P < 0.01). Compared with MOD, the concentrations of CSF VEGF in DEXT at 6 h, 12 h,24 h ((941 ±147) ng/L, (1083 ± 123) ng/L, (825 ± 66) ng/L) were decreased significantly(P <0.05), the brain water content was less ((80.4 ±0.5) %) (P < 0.05). Conclusion The secretion of VEGF markedly increases in the pathological process of bacterial meningitis. VEGF contributes to the damage of blood brain barrier and the formation of brain edema. DEX can decrease the degree of brain edema by suppressing the generation of VEGF and lightening the damage of blood brain barrier.     

Sub-aponeurotic fluid collections: A delayed-onset self-limiting cerebrospinal fluid fistula in young infants.

BACKGROUND: Transient sub-aponeurotic fluid collections are rarely recognized lesions that may be frequently related to traumatic labor and occur within weeks after birth. Their etiology has remained uncertain. METHODS AND RESULTS: Here we report on five new cases with typical clinical findings and normal neuroimaging. A detailed analysis of the lesion aspirates was performed in three patients, always revealing beta(2)-transferrin and high concentrations of beta-trace protein. CONCLUSIONS: This indicates that cerebrospinal fluid leakage contributes to this rare condition. All lesions disappeared spontaneously within 2-5 months so that conservative treatment seems appropriate.