Clinical data in children with meningococcal meningitis in a Spanish hospital

Neisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19h, p = 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p = 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+= 25h, GS^-= 16h, p = 0.004; CSF+= 20h, CSF^-= 12h, p = 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC+= 14 h, BC = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) ( p = 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third-generation cephalosporine.     

Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients

The second part of this review addresses the treatment and prognosis of the vasculitides Wegener's granulomatosis, microscopic polyangiitis, Churg–Strauss syndrome and polyarteritis nodosa. Treatment regimens consist of an initial remission phase with aggressive immunosuppression, followed by a more prolonged maintenance phase using less toxic agents and doses. This review focuses on the initial treatment of fulminant vasculitis, the mainstay of which remains immunosuppression with steroids and cyclophosphamide. For Wegener's granulomatosis and microscopic polyangiitis plasma exchange can be considered for first-line therapy in patients with acute renal failure and/or pulmonary haemorrhage. Refractory disease is rare and is usually due to inadequate treatment. The vasculitides provide a particular challenge for the critical care team. Particular aspects of major organ support related to these conditions are discussed. Effective treatment has revolutionized the prognosis of these conditions. However, mortality is still approximately 50% for those requiring admission to intensive care unit. Furthermore, there is a high morbidity associated with both the diseases themselves and the treatment.     

An on-line immunoassay method for theophylline using a protein A immunoreactor

A heterogeneous fluorescence immunoassay for theophylline has been automated using a flow injection analysis system containing a protein A solid phase reactor to separate antibody-bound and unbound fluorescein-theophylline. For each sample the antibody-protein A reaction takes place at near neutral pH, and the complexes are eluted at acid pH. The antibody-binding capacity of the reaction greatly exceeds the antibody level in each sample incubation mixture, and a single reactor can be repeatedly cycled between neutral and acid pHs. Experimental variations such as reactor size, flow rate, pH values, and reactant concentrations have been studied. Theophylline could readily be determined at the micrograms ml-1 level with on-line incubation with antibodies.     

Micturition syncopes.

Micturition syncope accounts for 8.39% of the total number of syncopes and is prevalent among men in the 50 and 60 year age groups. The cardiovascular vegetative nervous system is unaffected in patients with micturition syncope. Sixty-one percent of patients with micturition syncope also exhibit other kinds of syncope. These patients experience vasovagal reaction during the vegetative activation tests more often than patients exclusively with micturition syncope.     

Vértebra plana. Revisión de concepto y aproximación diagnóstica

Vertebra plana is a concept introduced by Calvé in 1925 to name a process characterized by the collapse of a single vertebra with no involvement of the discs, widening of the intervertebral space of at least one third compared with normal width, and an increase in the density of the collapsed vertebra. Because of its benign and self-limiting nature, this entity was originally thought to be an osteochondritis. Later publications did not corroborate this view and connected this entity initially with eosinophilic granuloma and subsequently with additional malignant infiltrating tumoral processes, in particular with Ewing's sarcoma and lymphomas, thus posing difficulties for its management. The initial concept was extended in 1990 to crushed and wedged vertebrae, including developmental abnormalities such as bone dysplasias. The present article provides a general review of vertebra plana, including the concept, etiology and pathogenesis of related processes, clinical findings and diagnosis. We also discuss the debate on the benign or malignant nature of vertebra plana and on the need for an immediate biopsy versus observation, as well as the therapeutic orientations.     

The pathologic cycle of the infection of the microsporidian Microgemma ovoidea (Thèl., 1895) Amigó et al. 1996 in the liver of the Red Band Fish (Cepola macrophthalma L.)

Pathologic study of the lesions caused by Microgemma ovoidea has shown that after the formation of the xenoma (stage 1), the parasitized cell is infiltrated by host macrophages (stage 2) and quickly encysted by the activity of fibroblasts that form a xenoma wall composed of collagenous fibers (stage 3). The phagocytic activity of the macrophages leads to the formation of a granuloma (stage 4) in which the cyst contents comprise macrophages filled with phagocytosed spores. This phagocytic activity is limited by the fact that some parts of the microsporidian spores, such as the spore walls, cannot be lysed by macrophages, which leads to the formation of fused giant cells containing nondigestible spore remnants. The final step in the process is healing (stage 5), in which some cells may start proliferating to regenerate the damaged area. Nevertheless, the host occasionally fails to control M. ovoidea infections. This failure can take two forms: bursting of the granuloma, or the appearance of secondary infections in granulomas, probably through parasitism of macrophages. Received: 2 April 1997 / Accepted: 4 June 1997     

Ethnicity,social status,and families' experiences of caring for a mentally ill family member

There is growing attention to the role of families as caregivers of family members with serious mental illness. This paper presents data from a multicultural sample of 90 family caregivers from diverse ethnic backgrounds. The paper examines families' experiences with mental health services; their support networks and family burdens; and their conceptions of mental illness. The paper both provides one of the first comparative studies of family caregivers from different ethnic groups and suggests an agenda for future research in this area.Peter J. Guarnaccia, Ph.D., is affiliated with the Institute for Health, Health Care Policy and Aging Research, Rutgers University. Pilar Parra, Ph.D., is affiliated with the Dept. of Nutritional Sciences, Cornell University.The study reported on in this paper was carried out as part of the larger research program of the Center for Research on the Organization and Financing of Care to the Severely Mentally Ill at the Institute for Health, Health Care Policy and Aging Research, Rutgers University. The Center is funded by the National Institute of Mental Health (MH43450-04). The specific research project on minority family caretakers of mentally ill family members was supported by a grant from the Robert Wood Johnson Foundation (#13180) and by funding from the Center. Dr. Parra was supported by a Minority Investigator Supplement from the National Institute of Mental Health (5P50 MH43450).We would like to thank all of the families who shared their experiences and insights with us. Our hope is that this work will serve to improve their lives. We also wish to thank the staff of the various mental health programs who collaborated with us in the study through identifying families and through providing us feedback on our research results. We would like to thank Nuri Argiles, Dr. Aura Deschamps and Glen Milstein who interviewed families and participated in discussions and presentations of the results of the study. Dr. Hilton Miller has contributed to both presentations of the research and discussion of research findings. Henry Henderson was actively involved in the analysis of data.     

Selective Changes in the Microorganization of the Human Epileptogenic Neocortex Revealed by Parvalbumin Immunoreactivity

The microanatomy of the human lateral temporal cortex removedfrom patients with intractable temporal lobe epilepsy was studiedusing correlative light and electron microscopic immunocytochemicalmethods for the localization of the calcium-binding proteinparvalbumin (PV). PV immunostaining was mainly used to labela subpopulation of powerful cortical inhibitory interneuronsthat have been shown to be lost at epileptic foci in certainanimal models of epilepsy. In the human neocortex with normalappearance, we identified the same local neuronal circuitryas in the normal monkey cortex, but in some regions of the samecortex, a fine disorganization of neuronal circuits (loss ofinhibitory neurons and presumptive thalamocortical terminals)was found. This abnormal circuitry may interfere with normalcerebral activity in epileptic patients. These results alsoindicate that PV immunoreactivity can be a useful tool to studynormal and abnormal synaptic circuits in the human cerebralcortex.