Risk factors for infections related to external ventricular drainage.

BACKGROUND: External ventricular drainage (EVD) is frequently used in neurosurgery for cerebrospinal fluid (CSF) drainage in patients with raised intracranial pressure. The major complication of this procedure is an EVD-related infection, i.e., meningitis or ventriculitis. The purpose of the present retrospective single centre study is to assess the possible causes of these infections. PATIENTS AND METHODS: Two hundred and twenty-eight patients were included in the period from January 1993 until April 2005. Patient and disease demographics, as well as EVD data, and the occurrence of infection were reviewed, compared, and included in a risk-analysis study. RESULTS: The population's mean age was 56 +/- 15 years and the sexes were equally distributed. Most frequently, the indication for EVD was hydrocephalus due to intraventricular haemorrhage (48.2%). An infection was documented in 23.2% of all patients. Duration of EVD drainage appeared to be a risk factor for infection (>11 days: OR 4.1; 95% CI 1.8-9.2, p = 0.001). CSF sampling frequency was also a significant risk-factor (no sampling: OR 0.2, 95% CI 0.2-0.5, p = 0.003). CONCLUSIONS: We found a relatively high percentage of EVD-related infections. After multivariate analysis there appears to be a relation with duration of drainage and frequent CSF sampling. As a result, a new EVD protocol is proposed in our institution that we believe will decrease the number of EVD-related infections to a minimum.

Enhanced visualization of soft tissues in the study of aborted fetuses through the use of xeroradiography.

As part of the diagnostic workup following an episode of fetal loss, it is generally recommended that fetal tissue be submitted for chromosome analysis and that the fetus be photographed and radiographed. Our recent clinical experience has suggested that, in those fetuses where size is compatible, xeroradiography may be superior to standard radiography. Xeroradiography utilizes principles similar to those in film radiology, with low-energy photon beams and relatively long exposure times. The physical characteristics of the beam and imaging system provide optimal soft tissue visualization. We have found this technique to be of use in studying a broad variety of abortuses with abnormalities. Examples of fetal abnormalities in which we have used this technique include acardia, neural tube defects, nuchal cystic hygroma, and arthrogryposis. In fetuses weighing 500-1,000 gm, the exposure settings are 25 MA, 1 second, 40 KVP. For larger fetuses the KVP should be increased by 1 or 2. This technique has not been useful for a complete body view of large fetuses due to the size limitations of the xeroradiographic cassette itself.

Jejunal atresia associated with Cafergot ingestion during pregnancy.

Fetal vascular accidents have been suggested as one cause for jejunal atresia due to in utero interruption of the superior mesenteric arterial supply to the intestines. Experimental studies support this hypothesis, and ergotamine has been shown to be a teratogen in experimental animals as a consequence of its vasoconstrictive action. We report the occurrence of intrauterine growth retardation and jejunal atresia in an offspring of a woman who also experienced four spontaneous abortions. During each of six pregnancies, the mother had taken as many as eight Cafergot tablets daily. We raise the hypothesis that Cafergot (1 mg ergotamine tartrate and 100 mg caffeine) might represent a vascular disruptive teratogenic agent during pregnancy. This hypothesis is supported by the clinical association of nonduodenal intestinal atresia with other defects that have a disruptive vascular etiology.

Partial lipodystrophy and familial C3 deficiency.

A familial deficiency of C3 in the family of a patient with partial lipodystrophy is reported for the first time. This genetic defect is termed hypomorphism of C3 fast (C3f). The defect is detected by analysis of C3 phenotype by densitometry and crossed gel-immunoelectrophoresis; all affected individuals have had reduced serum C3 (lower than 2 SD below mean) on at least one occasion. The possibility that partial lipodystrophy and the frequently associated glomerulonephritis occur in immunologically deficient individuals is supported by this observation.

Transient respiratory depression of the newborn. Its occurrence after succinylcholine administration to the mother.

A baby born after a cesarean section experienced transient respiratory depression. The mother had a postsuccinylcholine apnea caused by homozygosity for the atypical allele for serum pseudocholinesterase; the baby was heterozygous for this allele and the usual allele for serum pseudocholinesterase. The possible relationship between the genotype of the baby and the respiratory difficulty at birth is raised.

Camptomelic dwarfism associated with XY-gonadal dysgenesis and chromosome anomalies.

We have studied two female newborns with comptomelic dwarfism, XY-gonadal dysgenesis and chromosome anomalies. The preponderance of "females" among the hitherto reported cases of this allegedly autosomal recessive form of lethal drawfism may be due to an increased incidence of an associated XY-gonadal dysgenesis.

Banding identification of chromosomal abnormalities in four patients: ring (6), translocation (2q-;15q+), translocation (21q;21q) and deletion (22q-).

Four children with mental deficiency and different chromosomal errors, previously reported, have been restudied with the use of the G-banding technique. The errors include ring-6, t(2q-; 15+), t(21q;21q) and 22q-.