Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient

STUDY DESIGN: Case report. OBJECTIVE: To report an uncommon case of cerebral hemorrhage due to autonomic dysreflexia (AD) in a spinal cord injury (SCI) patient. SETTING: Institut Guttmann, Neurorehabilitation Hospital in Barcelona, Spain. CASE REPORT: An SCI patient developed AD due to urinary tract infection after surgery for a pressure sore. The hypertension was difficult to control and the case progressed to hypertensive encephalopathy. MRI of the brain was performed showing a hemorrhagic lesion on the left occipital area. The hypertension was finally controlled and the neurological status improved although with some cognitive deficits. CONCLUSION: This is an uncommon case of cerebral hemorrhage due to AD, showing the importance of an adequate diagnosis and treatment of AD to avoid this life-threatening complication.     

Cerebral fat embolism: usefulness of magnetic resonance spectroscopy

We report a case of cerebral fat embolism which occurred in a 33-year-old man after a diaphyseal femoral fracture without cranial traumatism. The initial examination showed an incomplete picture of coma with tetrapyramidal syndrome and cutaneomucous purpura. There was no respiratory damage. We present a magnetic resonance spectroscopy analysis of the cerebral lesions observed in the initial phase of the embolism, as well as follow-up, which has strengthened the clinical and imaging features for the diagnosis.     

Drinking-water quality and issues associated with water vending machines in the city of Los Angeles

The study reported in this paper sampled 40 water vending machines distributed throughout the city of Los Angeles, California, in the water servicing area of the Los Angeles Department of Water and Power. The authors examined water samples for temperature, turbidity, chlorine content, fungal growth, coliform bacteria, fecal coliform bacteria, Pseudomonas spp., Pseudomonas aeruginosa, and heterotrophic plate counts using plate count agar and R2A agar. Roughly 48 percent of the original 40 samples were sampled in a second or third round, and these subsequent samples were examined for coliform bacteria, fecal coliform bacteria, Pseudomonas spp., Pseudomonas aeruginosa, and both heterotrophic plate counts. Observations were made of vending-machine external conditions, identifying information, and permits. Statistically significant associations were found between operator accessibility and poor machine conditions, operator accessibility and permits, and operator accessibility and the servicing interval. Statistically significant associations also were found between operator accessibility and presence of fungi, Pseudomonas spp., and Pseudomonas aeruginosa, and between presence of fungi and the servicing interval. In addition, statistically significant associations indicate that the quality of machine maintenance is a factor in microbial levels. The microbial content of the water suggested a need for further research into potential health effects in susceptible populations.     

CE-108, a new macrolide tetraene antibiotic

In the search for strains producing antifungal compounds, a new tetraene macrolide CE-108 (3) has been isolated from culture broth of Streptomyces diastaticus 108. In addition, the strain also produces the previously described tetraene rimocidin (1) and also the aromatic polyketide oxytetracycline. Both tetraene compounds, structurally related, are produced in a ratio between 25 to 35% (CE-108 compared to rimocidin), although it can be inverted toward CE-108 production by changing the composition of the fermentation medium. This paper deals with the characterization of the producer strain, fermentation, purification, structure determination and biological properties of the new macrolide tetraene CE-108.     

A 7-year study of severe hospital-acquired pneumonia requiring ICU admission

Objective To examine the characteristics, prognostic factors, and outcome of patients with severe hospital-acquired pneumonia admitted to the ICU.Design and setting Prospective observational clinical study in two medical-surgical ICUs with 16 and 20 bedsPatients and participants During a 7-year period all hospitalized patients requiring admission to either ICU for hospital-acquired pneumonia were followed up.Measurements and results We diagnosed 96 episodes of severe hospital-acquired pneumonia, and in 67 cases a causal diagnosis was made. Most episodes were late-onset pneumonia. Gram-negative micro-organisms were isolated in 51% of episodes diagnosed, and Pseudomonas aeruginosa was the most frequent pathogen isolated (24%). Clearly significant variations happened between hospitals, particularly affecting the incidence of Aspergillus spp. and Legionella pneumophila. Forty-nine patients developed septic shock (51%). Fifty-one patients died (53%). Aspergillosis and pneumonia due to P. aeruginosa were associated with the highest mortality. Septic shock (OR: 14.27) and chronic obstructive pulmonary disease (OR: 6.11) were independently associated with a poor prognosis.Conclusions Patients with severe hospital-acquired pneumonia admitted to the ICU present high mortality. The presence of septic shock and chronic obstructive pulmonary disease in conjunction with specific microorganisms are associated with a poor prognosis. Local epidemiological data combined with a patient-based approach may allow a more accurate therapy decision making.     

New strategies of cyclosporine monitoring in heart transplantation: initial results

The aim of this study was to evaluate cyclosporine (CyA) absorption profiles in heart transplantation to establish the most adequate monitoring strategy and determine the optimal therapeutic range for AUC(0-4) or C2 levels. A total of 22 full pharmacokinetic studies were performed at steady-state in 22 adult heart transplant recipients (18 men, 4 women). Twelve studies were performed during the first month posttransplant (group I), and 10 studies were done after 1 month (group II). In 9 outpatients we performed an abbreviated AUC(0-4). The mean age of the patients was 49+/-15 years (range, 15-72 years), and the mean weight was 70.4+/-10.8 kg (mean, 54-98 kg). The CyA dosage had been adjusted to maintain trough levels (C0) in the putative target ranges of 200 to 400 ng/mL in group I and between 100 to 300 ng/mL in group II. Blood samples were drawn prior to and at 0.5, 1, 2, 4, 6, 8, and 12 hours after the morning dose. The CyA blood levels were measured by the AxSYM cyclosporine assay. The AUC was calculated by the trapezoidal rule. Multiple linear regression was done to evaluate the predictive ability of various limited sampling strategies. The C0 correlated poorly, either with the full AUC (r2=0.64) or the AUC(0-4) (r2=0.43), while C2 seemed to be the most accurate single predictor of drug exposure (r2=0.92 for AUC(0-12); r2=0.74 for AUC(0-4)). For both AUC(0-4) and AUC(0-12), all 2- or 3-point strategies had r2 values approaching that of the C2 value. In conclusion, C2 is a simple, fast, and accurate value to predict AUC(0-4) in routine clinical practice. Its implementation must focus on ensuring the commitment of all unit staff, thus ensuring that patients are sampled on time and minimizing the impact on workload.