Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Delayed ischemic neurological deficit associated to cerebral vasospasm is the most common cause of sequelae and death that follows the rupture of an aneurysm. The objective of this study was to evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm. PATIENTS AND METHOD: Eight patients diagnosed with aneurysmal subarachnoid hemorrhage who developed symptomatic cerebral vasospasm refractory to conventional medical therapy were enrolled. They received an intra-arterial infusion of Milrinone at a rate of 0.25 mg/min, with a total dose of 10-15 mg. Qualitative evaluation of angiographic response, neurological and systemic complications as well as functional outcome at 3 months were documented. RESULTS: All patients had a significant angiographic response. This was evidenced by a pre-treatment vessel stenosis greater than 70%, that improved to less than 50% after the intra-arterial Milrinone infusion. Three patients developed recurrent vasospasm that improved after a second intra-arterial Milrinone infusion. None of the patients developed neurologic or systemic complications attributed to the intervention. At 3 months follow-up all patients were alive and had a mean modified Rankin scale of 2 +/- 1 and a Barthel index of 83 +/- 10. CONCLUSION: Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

[Progressive cranial neuropathy due to perineural spread of a facial squamous cell carcinoma]. / Polineuropatía craneal progresiva secundaria a diseminación perineural de un carcinoma espinocelular facial.

The paper aims to present the case of a progressive and unilateral cranial polyneuropathy due to perineural spread of cutaneous squamous cell carcinoma. This is a case of a 73 year old man with a history of squamous cell carcinoma in the right temporal region that was removed in 1992. In May 2000 he first presented pain and numbness in the distribution of the first branch of right trigeminal nerve and weakness of the ipsilateral frontal muscle. Later on he presented right ophthalmoplegia, and damage of lower cranial nerves, leading to dysphagia and respiratory distress. He was admitted in March 2001 for a gastrostomy for feeding, when ataxia and recurrence of the right temporal lesion ensued. After three examinations with MRI, the fourth study showed meningeal carcinomatous and a metastatic lesion in the brainstem. Histopathologic examination demonstrated dermal and perineural invasion by squamous cell carcinoma. The necropsy also showed meningeal, perineural and endoneural infiltration of atypical epidermal cells and a pons mass composed of the same cells. We conclude that the perineural spread of the cutaneous carcinoma is an exceptional cause of cranial neuropathy, however it must be ruled out in patients with progressive and unilateral cranial neuropathy. In these cases, when no radiological abnormalities are noted, a biopsy may be performed on the peripheral branches of the cranial nerve to confirm the diagnosis.

Effect of ultraviolet light irradiation and nitrosoguanidine on viability of 46 strains of Arthrinium and their antibiotic production.

The ability of strains of the Arthrinium genus to inhibit microbial development has been previously described. In the present work different periods of mutagenic treatment using ultraviolet light, and of nitrosoguanidine treatment, on strains of Arthrinium were investigated. With nitrosoguanidine treatment the survival rate ranged from 2.17 to 8.78%. Mutant strains were only obtained with a higher antibiotic production in comparison with the wild-strain, when the mutagenic agent was UV light.

Virus-like particles in conidia and hypha of Arthrinium aureum.

This paper is the first report in the literature of the presence of virus-like particles in the conidia and hypha of Arthrinium aureum. These particles, detected with an electron microscope, are spherical and 52 nm in diameter.

Pie plano en el niño y acortamiento de sóleo y gemelos / The flat foot inthe children and shortening of soleo and geminus

El pie plano se menciona como una situación temporal que corrige espontáneamente. Se presentan 16 pacientes con pie plano y acortamiento sóleo y gemelos estudiándose clínico y radiológicamente. Se aplica tratamiento con ejercicios de estiramiento muscular y ortesis de polipropileno. Se obtuvieron excelentes y buenos resultados con el tratamiento conservador en 26 pies y malos resultados en 6 pies ameritando tratamiento quirúrgico que consistió en alargamiento del tendón de aquiles y atrodesis sub-astragalina. Se obtuvo en 3 pacientes excelentes y buenos resultados y en 2 pies malos resultados

Influence of the culture medium on the inhibitory activity of Arthrinium strains.

Modifications in the antibiotic capacity of Arthrinium strains when they were developed in culture media of various compositions were studied. The culture media used were 2% malt extract agar, Czapek-Dox agar, Sabouraud dextrose agar, oatmeal agar, Yoshimura's medium, mixed medium of salts, modified phytone agar, malt extract-yeast extract agar, potato dextrose agar, and Wickerham's medium. The inhibition values were compared with those obtained when the strains were developed in Wickerham's medium. The media which enhanced the production of inhibitory substances were potato dextrose agar and 2% malt extract agar.

Chemical microanalysis of hyphae and conidia from Arthrinium aureum.

Analysis of the chemical composition of hyphae, conidia and chlamydospores of Arthrinium aureum enabled all sample constituents of > 23 kD molecular weight to be detected. Sulphur, chlorine, potassium and calcium were present in the hyphae and condia of A. aureum, and sulphur, potassium and calcium in the chlamydospores.

Antimicrobial activity of essences from labiates.

Bacteria, filamentous fungi and yeasts were subjected to the action of Lavandula officinalis, Melissa officinalis and Rosmarinus officinalis essences in a steam phase, using a microatmospheric technique. Due to the methodology employed, L. officinalis essence was more active in filamentous fungi than the other essential oils studied. All three essences possessed a similar degree of activity against the micro-organisms tested, though a relatively higher activity was seen in the case of M. officinalis.

Presence of sterile hyphae in moulds: relationship with inhibitory activity.

The relationship involving the presence of sterile hyphae in moulds and their inhibitory activity on 34 micro-organisms was investigated. From the results it was evident that antimicrobial activity varied when morphological changes were observed in the cultures.

Keratinophilic fungi from soil of Brittany, France.

The Present work reports the study of the distribution of keratinophilic fungi isolated from 39 samples of soil collected in Brittany, France. Keratinophilic fungi were isolated from 35 (92.3%) of the samples studied. The most frequently found species wereFusarium moniliforme, Penicillium viridicatum and an unidentified species ofAcremonium. The other fungi isolated were members of the generaChrysosporium, Gliocladium, Mucor, Trichoderma andTrichophyton.

Development of Arthrinium species on several nitrogen sources.

The aim of this study was to determine the growth aspects of Arthrinium strains in the presence of several nitrogen sources. The addition of tryptone, peptone or soybean peptone to the culture medium stimulated larger colony diameters in most of the isolates.

Ultrastructure of the concentric membrane system in Arthrinium aureum.

An ultrastructural study was performed on Arthrinium aureum. The fungi were treated with glutaraldehyde and osmium tetroxide fixation. The hypha and conidia has a concentric membrane system which consisted of multiple membranes of a myelinoid appearance, and continued to the conidia and hypha plasma membrane. The fungi were also treated with periodic acid-alkaline bismuth (PABi) staining after glutaraldehyde and osmium tetroxide fixation. PABi positive materials were found on the marginal glycogen granules, the concentric membrane system and the conidia plasma membrane.

Ultrastructure of the hyphae and conidia of Arthrinium aureum.

Electron microscopic observations of structures in Arthrinium aureum, which have not previously been described, are presented and discussed. Considerable attention is given to cytoplasmic inclusions, especially nuclei, mitochondria and Woronin bodies.

Influence of the addition of mineral salts on the inhibitory activity of strains of the Arthrinium genus.

The influence which the addition of certain mineral salts has on the inhibiting activity of strains belonging to the Arthrinium genus was studied. The salts employed were AgNO3, FeCl2, MnCl2 and CuSO4, in concentrations of 10, 50, 100, 150 and 200 mg/l, in the presence of Bacillus subtilis, Enterobacter cloacae, Staphylococcus aureus, Escherichia coli, Serratia marcescens, Klebsiella pneumoniae, Candida albicans and Aspergillus niger. For B. subtilis and S. aureus greater inhibition was observed after the addition of FeCl2 (200 mg/l) and MnCl2 (10 mg/l). E. coli showed a greater sensibility in the presence of AgNO3 (200 mg/l) and CuSO4 (150 mg/l). Inhibition before Enterobacter cloacae and Serratia marcescens was not increased by the addition of any of the salts. The addition of MnCl2 at 10 mg/l concentration to the basal medium showed a considerable increase of inhibitory activity over Klebsiella pneumoniae and Candida albicans. Activity for Aspergillus niger decreased when any of the salts were added to the medium.