Normal cerebrospinal fluid pressure in the newborn

Lumbar CSF pressure (CSFP) was measured on 61 occasions, in 49 babies undergoing lumbar puncture as part of a septic screen, by means of Gaeltec pressure transducers. In normal circumstances, intracranial pressure (ICP) has the same value. Measurements were made when the baby was horizontal and quiet, with the head deflexed. For acceptance of the measurement, it was essential for the CSF to be clear and to show pressure pulses with respiration, heartbeat and jugular occlusion. The mean CSFP and standard deviation were 2.8 +/- 1.4 mm Hg (3.8 +/- 1.9 cm water), with a normal range of 0 to 5.7 mm Hg (0 to 7.6 cm water). This value is similar to previous reports of CSFP measured invasively in infants, but is much lower than the "ICP" established noninvasively. No relationship was found between birthweight, gestational age, current weight, postmenstrual age, or postnatal age and CSFP.     

Puumala Virus Infection in Family,Switzerland

We report 3 cases of Puumala virus infection in a family in Switzerland in January 2019. Clinical manifestations of the infection ranged from mild influenza-like illness to fatal disease. This cluster illustrates the wide range of clinical manifestations of Old World hantavirus infections and the challenge of diagnosing travel-related hemorrhagic fevers.     

Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry

Annals of Surgical Oncology - The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to...     

Managing in uncertain times

Radical change, often referred to as a paradigm shift, will occur in the wake of the United States healthcare reform effort currently underway. It will be value-based, community-oriented and patient- and family-centered. These changes will pose great challenges for materiel management. The future will call for integrated healthcare delivery networks that will see hospitals lose their preeminence as providers and, subsequently, needed revenues. Strategies such as implementation of total quality management, and vendor and community partnering will become more pronounced. Materiel managers will see their role change to one of information gathering and disseminating. All healthcare managers will need new skills to help shape the future of healthcare delivery, including the ability to challenge assumptions, understand that there are alternative realities, anticipate business trends, and create and implement a vision of the future of their organization.     

Variable CSF findings in early and late Lyme neuroborreliosis: A follow-up study in 47 patients

The cerebrospinal fluid (CSF) of 37 patients with early Lyme neuroborreliosis (ELN) and of 10 patients with late Lyme neuroborreliosis (LLN, duration of symptoms 7 months) was investigated for typical features differentiating between acute and chronic courses of disease. Individual patients were studied after 2 and 4 weeks, and 3, 6, and 12 months. Patients with ELN presented predominantly with symptoms of the peripheral nervous system, while patients with LLN generally suffered from symtoms of the central nervous system. At the first lumbar puncture, patients with ELN revealed a more intense pleocytosis in the CSF (P < 0.02) and a higher intrathecal synthesis of total IgM (P < 0.0003) and ofBorrelia burgdorferi-specific IgM antibodies (P < 0.01). At the same time, in patients with LLN, the blood-CSF barrier was more severely impaired (P = 0.03), and local production of total IgG (P = 0.0001), ofB. burgdorferi-specific IgG antibodies (P = 0.03) and of total IgA (P = 0.001) was more markedly increased. The quantity of intrathecally producedB. burgdorferi-specific IgA antibodies did not differ between the two study groups. Clinical recovery was usually accompanied by a considerable improvement of the blood-CSF barrier function and pleocytosis. After 6 months, the intrathecal synthesis of total IgG had significantly decreased in patients with ELN but not in those with LLN. At the same time, the CSF of most patients in both study groups still contained intrathecally producedB. burgdorferi-specific IgG antibodies. In the absence of clinical illness or symptoms of inflammation 6 and 12 months after treatment,B. burgdorferi-specific IgG antibodies in the CSF might simply indicate an anamnestic reaction to a previous infection of the central nervous system. Six months after antibiotic treatment, patients with ELN still revealed evidence of intrathecal synthesis of total IgM, whereas those with LLN did not. These antibodies, however, were not related toB. burgdorferi.